Inspection on 25/05/07 for Birchwood

This inspection was carried out on 25th May 2007.

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

Similar services:

Henry Nihill House

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Spring Lane Care Home

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

CARE HOMES FOR OLDER PEOPLE Birchwood 406 Clayhall Avenue Clayhall Ilford Essex IG5 OTA Lead Inspector Stanley Phipps Key Unannounced Inspection 11:15 25 May to 5th June 2007 th 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 DS0000067413.V339267.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. DS0000067413.V339267.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Birchwood Address 406 Clayhall Avenue Clayhall Ilford Essex IG5 OTA 020 8551 2400 020 8551 7511 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) www.sanctuary-care.co.uk Sanctuary Care Ltd Ms Christine Mary Gammons Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (44) of places DS0000067413.V339267.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 44 elderly people who may have physical or sensory disabilities or mental frailty related to the ageing process, but who are not mentally ill, within the meaning of the Mental Health Act. 12/12/05 Date of last inspection Brief Description of the Service: Birchwood is a 44 bedded home for older people. It was previously managed by Ashley Homes and as of April 2006 has been formally taken over by Sanctuary Care Limited. The transition process to Sanctuary began in the last quarter of 2005. It is set on two floors and provides accommodation and personal care on a twenty-four hour basis, to both permanent and respite residents. The bed allocated for respite care is situated on the ground floor. Each floor has named sections e.g. on the first floor – Rosewood, Mayfair and Penthouse, while the ground floor has Hollywood and Woodlands. The home is situated in a residential area in Barkingside, close to local amenities, with satisfactory access to transport systems. All residents have the benefit of single bedrooms, ten of which have en-suite facilities and the home is accessible to wheelchair users. Birchwood is well maintained, and is made homely by the management and staff team. There is a well-kept garden designed for the residents’ enjoyment. The fees are charged at £498.95 per week with additional charges for: hairdressing between £ 7.00 and £20.00, private chiropody (£13.00), theatre (£5.00), newspapers between 40 and 70 pence, holidays (variable) and private dentists and opticians which are variable and means tested in line with NHS policy. The home’s statement of purpose is made available to all residents on request and, they are given a copy of the service users guide once they make a decision to live at Birchwood. DS0000067413.V339267.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and the first under the management of Sanctuary Care Ltd. It was a key inspection, which meant that all the key minimum standards for older people were tested. The inspection was carried out between the 25/5/07 and the 5/6/07. The key findings informed that people using the services continued to receive an excellent standard of care and support despite the transition to the new providers. Every resident was happy using the services, which could be summed up in one of their quotes “just an amazing place to live”. The registered manager continues to be a source of inspiration and inclusiveness for residents and staff, the impact of which has resulted in increasing standards and high levels of satisfaction for all concerned. A good example of this is the exceedingly high level of positive responses received from both groups. The inspection also considered a high level of responses written and verbal from relatives, and external professionals of which ninetyeight per cent were positive. An assessment of the premises including the external grounds, toilets and bathrooms was made along with an assessment of: staffing recruitment records, staffing supervision records, the policy and procedures file, health and safety in the home, the statement of purpose, the case records for four residents and other records required by regulation e.g. the complaints record. Formal interviews were held with four staff members, including the administrator, while informal discussions were held with other staff on duty. Twenty residents were spoken to during the course of the visit and detailed discussions were held with the registered manager. What the service does well: The manager and staff continue to consistently provide good quality care and stimulation in an environment that feels inclusive for the individuals who live and work in it. Relatives continued to comment that they too feel involved and well informed about life in the home e.g. their involvement in the ‘Relatives and Friends of Birchwood’ group, which has a presence in life in the home, particularly with regard to activities. The secret of the home’s success – and this is the view of all service users spoken to, is the drive, commitment and enthusiasm of the registered manager – Chris Gammons. Residents commented that: ‘Chris makes sure, we get what we want here and this includes making sure that we are well looked after’. Staff spoken to also expressed a similar sentiment in that they feel ably supported to carry out their duties effectively. DS0000067413.V339267.R01.S.doc Version 5.2 Page 6 Although the service operates at a high standard, there was evidence that the registered manager works tirelessly at aiming to improve standards further. In so doing she works closely with residents, the staff, friends and relatives, professional agencies, her management (Sanctuary Homes Ltd.) and other private and/or voluntary agencies in the community. One resident wrote; ‘Chris always looks for a new horizon, always asks residents what they want to improve in the home and does that’. A good support package is in place for staff and this involves training, formal supervision and appraisals. The resulting effect is: low –levels of staff turnover and sickness absence. There is a good evidence to support the fact that equality and diversity is promoted in the home, which extends to the residents, staff and, relatives coming into contact with the home. What has improved since the last inspection? What they could do better: Continue to closely monitor the new system of medication used in the home for at least a period of six months. Take steps to ensure that receipts are provided to relatives at all times, once a payment is made for services provided by the organisation. DS0000067413.V339267.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. DS0000067413.V339267.R01.S.doc Version 5.2 Page 8 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 DS0000067413.V339267.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): (1,2,3,6) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. A comprehensive range of information is available to prospective residents, in enabling them to make an informed choice about living at Birchwood. They have the benefit of receiving a statement of their terms and conditions for living in the home, which now also includes residents on respite care. Residents also benefit from having a comprehensive needs assessment carried out on them, to reduce the risk of choosing a home that is unsuitable for meeting their needs. EVIDENCE: An updated statement of purpose and service user guide was in place at the home. Newly admitted residents had a copy of the service user guide in their rooms and described the information provided as ‘useful’. In discussion with some of them, they confirmed that the information provided matched their expectations when they actually came to live at Birchwood. One hundred per cent of the feedback received from relatives indicated that they had comprehensive information about the service, which prompted them to come and have a look at the home. The service user guide is available in Braille and the manager confirmed that audiovisual copies were almost completed. DS0000067413.V339267.R01.S.doc Version 5.2 Page 10 A statement of terms and conditions was in place for each resident and this is standard for individuals living there. Where possible they sign this document along with a representative of the organisation e.g. the registered manager. This document is key to ensuring that residents’ rights and entitlements are not only stipulated, but also upheld. For residents who are unable to sign, their representatives sign on their behalf. It was noted that respite residents did not have copies of this document and arrangements were made to ensure that this was corrected. A contract was in place, but this was between the local authority and the individuals, which on its own, did not detail the obligations of the home. Respite residents are in a better position, having a statement of terms and conditions between the home and themselves. As part of case tracking, the files of the three most recently admitted residents were assessed, and it was conclusive that they all had a comprehensive assessment carried out prior to their admission. The registered manager or a senior member of staff usually carries out the assessments to ensure that a consistent approach is undertaken. There was evidence that summary assessments were obtained as part of the admission’s process to ensure that a detailed picture of needs is acquired, before a decision is taken. Residents and relatives spoken to described the admission’s process as being unrushed, which gave them reassurance that the home would be sensitive in meeting their needs. They also described the experience as a positive one. Intermediate care is not provided at Birchwood. It should be noted that should the home wish to so do in the future, then it would have to review its staffing, policies and procedures, statement of purpose and the environment to ensure that this type of service could be safely provided in the home. DS0000067413.V339267.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): (7,8,9,10,11) People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. A sound system of care planning and its implementation ensures that residents are assured that their personal, social and healthcare needs are well provided for. There is a strong commitment to promoting the rights and privacy of residents living at Birchwood, and this is extended to how they spend the rest of their life in the home. EVIDENCE: Four care plans were examined in detail and it was clear that the current system was thorough and took into the consideration the needs and wishes of the residents concerned. This meant that they were in control of their lives as one resident put it; “I can do what I choose to do and not what suits others”. The ethos of the home was one in which residents were at the centre and staff worked to this philosophy. To support this staff have been on person centred care planning training and each plan focussed on the health, personal and social care needs of the individual. They were all updated and accurately reflected the needs of residents. A key-worker system is in place and regular reviews were carried out involving the residents and their relatives. DS0000067413.V339267.R01.S.doc Version 5.2 Page 12 One of the strong points of the care planning system is that it took into consideration the diverse needs of individual residents. One good example was where the specific religious beliefs e.g. Jews and Christians were identified and provided for. It also detailed their medical conditions and the action/s required to ensure that the residents’ welfare and their best interests are protected. Risk assessments were linked to the care plans in ensuring that the safety and independence of residents was promoted. In essence, the home encourages a positive approach to enabling residents to achieve whatever they set out to and this means that every individual is supported to live a life that is best suited to them. At Birchwood residents can choose their GP and each individual was registered with a practice. There was evidence that sound arrangements were in place for residents to access a full range of health care services. Some health care services e.g. physiotherapy, opticians, and chiropody were accessed privately, while others were done through the GP or a community referral. On the first day of the visit, the district nurse was visiting a resident to review the dressings. In an interview with her she indicated that staff were very good at making referrals and interventions where there is a problem with residents. Their interventions were regarded as timely which usually results in prompt attention being given to residents. During the course of the visit, a chiropodist and an optician were attending to residents and they were quite involved and looking forward to their appointments. What was remarkable was that all the residents receiving onsite health care were aware and involved in the process. They knew why they were having various interventions and most understood their medical conditions and why they were having treatment. This is positive. In an interview with the private chiropodist, he was of the view that residents were in receipt of a very high standard of care and support from the staff and manager. Every comment that was received from residents and their relatives echoed this. There was no incidence of pressure sores, high levels of nutritional screening and detailed records of every health appointment attended by residents. This is a strong area of the homes operations. A satisfactory medication policy is in place at the home, which covers the procedures for the self-administration of medication. This is complimented ensuring that only staff that are trained to administer medication do so. An updated British National Formulary is also available as a reference guide for staff. Following a detailed examination of the clinical room, medication was generally handled in a safe manner. There was evidence that residents, where possible, are given the support to maintain their independence in managing their medication. One individual spoke vividly of the training she received to monitor her blood sugar and to self-administer her insulin. Although the diabetic nurse provided the service there was good support from the staff in enabling her to maintain it. There was at least one other resident that proudly and safely manages her medication-which is positive. DS0000067413.V339267.R01.S.doc Version 5.2 Page 13 The home had recently (22/5/07) changed their medication system to the monitored dosage system provided by Boots and the manager had in place weekly auditing of the drugs, to ensure that the transfer is smoothly and safely implemented. However, during the assessment of the drug records and the drugs, there was evidence that a dosage had been omitted without a rationale for this. It was determined that the omission did not adversely impact on the resident’s welfare. However, this should not have happened. Action has been taken with the staff concerned and the manager has since requested Boots to carry out a drug audit. This reported that the current implementation was good. It is important, however, for the manager to continue to robustly monitor the medication during the initial stages of the new system. The management of controlled drugs was of a good standard and there was evidence that random checks were frequently carried out by the registered manager. The clinical room has storage facilities for dressing packs used by the district nurse and the registered manager also monitors this facility. Sound arrangements were in place for the disposal of drugs and appropriate safety measures were in place to ensure that the clinical room is safely maintained. There was a ‘one hundred’ percent positive feedback received in relation to how residents experience the way in which their health and personal care is provided. They all felt that staff respected them and were professional in ensuring that their privacy is maintained. This was widely observed during the course of the visits. Residents and their pet toys were addressed by their preferred names and a high value was placed on this. The organisation’s induction programme equips staff with the knowledge and understanding of promoting the dignity, respect and privacy of residents. There were good facilities for residents to privately make and receive phone calls, as well as for professional visits. This is a strong area of the homes operations. A satisfactory policy on death and dying remained in place at the home and each resident user is given an opportunity to discuss their wishes with regard to death and dying. Some residents were able to outline this early on following their admission, whilst others preferred to defer discussing this subject. There was also evidence that, with the consent of residents, relatives were involved in this process. There is an established relationship with a group of undertakers that are known to the resident group, which makes future planning easier. The manager is planning to introduce the Liverpool Care Pathway – a model that looks at the ‘end of life’ wishes of residents, into the home. Plans were in place for her to undergo training on the 6/6/07 and then cascade this into the home with a view to implementing the model. Once this is implemented, it would enhance further, the care and support provided to residents and their relatives around end of life care. Compliments cards were seen in relation to the support provided by the home during residents’ last moments and they were positive. DS0000067413.V339267.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): (12,13,14,15) People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Residents enjoy a wide range of activities at Birchwood that is in line with their social, recreational and religious interests. They also enjoy maintaining strong links with family, friends and the local community. Their lifestyle is enhanced by the enabling choice in their lives and the provision of a variety of meals that are suited to their needs. EVIDENCE: It was overwhelmingly clear that all residents have a choice in relation to their preferred interests including religious observance, meals, personal and social relationships, activities and routines in the home. This follows on from an individual assessment, which is carried out with each individual. One testimony to the quality and lifestyle enjoyed at Birchwood is; ‘I love it here. I visit the library once a week and read between 2-4 books a week, this is living’. Another wrote; ‘I go out to the pie and mash shop with staff, McDonalds and on trips’. Over ninety percent of the responses from residents indicated that there is ‘always’ an activity that they can take part in. A similar level of responses from relatives indicated the same response. All other responses indicated that there is ‘usually’ an activity they can take part in. At Birchwood, residents regardless of their age, gender, belief or ability/disability have opportunities to DS0000067413.V339267.R01.S.doc Version 5.2 Page 15 live life to the fullest. There is something for everyone. Some of the internal activities include; bingo (four times per week), exercises, films, baking, painting club, tea dances, barbecues (last held 19/8/07), quiz nights, religious observance, knitting and darts. Externally, residents enjoy trips of their choice, e.g. Southend, London, Lakeside, Hainault Forest and High Beech, restaurants e.g. the Owl (Loughton), the pie and mash shop, the cheesecake shop and shopping. Recently, a ‘wish list’ activity has been introduced and one successful event had already been put on. Residents were buzzing with enthusiasm as the next event was a ‘fancy dress’ evening and most were counting down the days to this event. This is a very strong area of the home’s operations. Additionally, it must be stated that the equality and diversity practices with regard to religious observance is of a very high standard. There is regular input from the Rabbi, a Catholic minister, and a vicar from St. Margarets in Ilford. There was evidence that Elders from a Methodist Church visit a resident and that some individuals receive weekly communion. One resident informed that she attends church regularly and is picked up by volunteers from the church. Each individual in the home has the opportunity to pursue his or her belief and/or religious persuasion. There is strong input from relatives and friends in the life of the home. The ‘Friends of Birchwood’ is a well-established group, which meets quarterly to host events with residents, including fundraising events such as raffles and cake sales. This group was instrumental in enabling residents to realise the achievement of acquiring a large plasma screen television for their film evenings. There was a launch event to mark the occasion to which local councillors and at least one of the commissioners - attended. Residents found the experience special and memorable, as they had the pleasure of sharing in their home – the company of distinguished members of the community. There was also evidence of a relatives meeting being held on the 8/5/07 with guests that included the Principal Manager of Care (LBR) and a priest from the local church. Another good example of residents being supported to keep links with the community is where up to twelve individual wanted to witness a pre-season friendly between Leyton Orient FC and West Ham FC. The manager was in the process of writing a letter to the to one of the directors of the club to enable residents to have the experience. This is remarkable. Other interests that are being pursued included one individual wanting to see Steve Davis (snooker) live, while another wanted to see Arsenal FC play. There was no limit to the range of opportunities available for residents to have friends and relatives, and to engage with the wider community. This is a very strong area of the homes operations. Residents also have a wide range of opportunities to exercise choice and control in their lives. Some of the key areas included; handling their finances, DS0000067413.V339267.R01.S.doc Version 5.2 Page 16 medication, choosing a GP, and their engagement in social and spiritual events and this list is not exhaustive. The staff and management worked creatively to promote an enabling ethos to which nearly all the residents respond. Up to six residents handle their financial affairs with a much higher number, receiving support from their relatives. For those that are subject to a power of attorney and guardianship, sound arrangements were in place to promote and safeguard their interests. Information on advocacy services is widely available to all residents should this be required and access to personal information, which is facilitated in their best interests. Menus were examined over a four–week period and they were varied and from the combinations used – they were nutritional. Ninety-eight percent of the feedback received from residents indicated that they were always happy with the quality of food in the home. Two per cent indicated that they were usually happy with meals. In one case a resident reported that food was served cold on two occasions however, the individual took this up with the homes management with positive results. Sound arrangements were in place to enable residents to eat independently and for those receiving support this was done with sensitivity. One of the key reasons for such positive responses was that residents and their relatives are encouraged to participate in the menu planning as well as reporting on the quality of the food. There was evidence that equality and diversity is taken into account as one individual wrote; ‘always enjoy Kosher meals’. Another wrote ’Chris always discuss meals in residents/relatives meetings’. A group of residents spoke of having ‘jelly eel’ recently, which they described as a Londoner’s meal. This was described as bringing back some great memories to them, but also the assurance that almost anything they ask for they could have, so long as it is not contra-indicated in relation to their health. The inspector shared lunch and met with residents over tea and it was clear that meals were of a very high standard in the home. Nutritionally residents’ needs are taken seriously, even if they chose to have pie and mash or a McDonalds on some occasions. There was evidence of nutritional screening and, the chef and care staff alike were aware of the specialist dietary needs (e.g. vegetarians) of all residents. Apart from the three main courses, supper is prepared and is staggered to ensure that every individual has an opportunity to enjoy an evening bite. Fresh fruit and vegetables were available and drinks were served throughout both days of the inspection. The organisation planned to move the catering in-house by the middle of June 2007 with a view to improving the quality of catering across its services. However, residents at Birchwood currently receive a very high standard of catering services. DS0000067413.V339267.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): (16,18) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Residents and their relatives are assured by the management’s handling of complaints, that their concerns would be addressed as and when they arise. There are sound protocols and procedures in place for safeguarding adults at Birchwood. EVIDENCE: It was noted that one hundred percent of the feedback received from residents and ninety-eight percent from received from relatives indicated that they knew of the complaints procedure, their right to complain and who they could complain to. Some of the responses included; ‘ Chris always discuss complaints at residents – relatives meetings’, ‘From the provision we have had so far I would expect an excellent response’ and, ‘My problems are always dealt with as soon as physically possible’. Complaints are viewed by the management and staff as a way of testing the service capabilities, as well as providing opportunities to develop the service. It is widely advertised in various parts of the home, and in documents that are widely available to residents and their relatives. The registered persons also use residents meetings and one to one opportunities to enable residents to raise anything that concerns them. They also maintain a record of compliments, which were extremely positive about the service as a whole. There were seven complaints since the last inspection and they were handled in line with the home’s complaints procedure – including the detailing of outcomes in each case. Staff interviewed demonstrated a good understanding of their role in ensuring that complaints DS0000067413.V339267.R01.S.doc Version 5.2 Page 18 are duly recorded and acted upon. Residents interviewed made it clear that they felt safe and valued by the way in which complaints are managed in the home. This is a strong area of the homes operations. A satisfactory adult protection protocol remained in place at the home and all staff were provided with adequate safeguarding adults training. Training in areas such as diversity and person centred care also provided staff with a good understanding of promoting the safety and individuality of residents. From the staffing interviews held it was clear that all staff understood the protocols around dealing with allegations and/or suspicions of abuse. It was also clear that they were comfortable with and had a working knowledge of the whistle blowing policy. Residents and relatives interviewed showed an awareness of the notion of abuse and the overall feedback informed that individuals felt safe living at Birchwood. Policies and procedures were in place for managing verbal and physical aggression, and is such cases a risk assessment and plan is put in place for safely managing them. Staff were very clear about the action they would take if they suspected abuse and this also ensures that people using the services are safe doing so. There were no adult protection matters recorded in the home and it fair to say that all residents remained generally safe, living at Birchwood. DS0000067413.V339267.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): (19,21,23,26) People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Residents continue to live in an environment that is designed to meet their needs, one that is safe and well maintained. This includes the toilets and bathing facilities that are enhanced to meet their changing needs, while promoting their independence. Residents’ bedrooms are individually designed to meet their lifestyles and they all pride themselves in having a place at Birchwood. They describe their home as pleasant and always immaculately clean. EVIDENCE: Residents and their relatives were extremely pleased about the standard and quality of the accommodation with respect to both the private and communal spaces in the home. Importance is placed on ensuring that service users retain their independence and do so in a safe manner. One of the residents comments about the home included; ‘It is like a five-star hotel’. Another stated; ”I came here for respite care and did not want to go back home and is ever so pleased to be living here now”. Yet another comment included; “I love DS0000067413.V339267.R01.S.doc Version 5.2 Page 20 the warmth and ambience of the environment – it is where you want to be when you grow older”. A very good system of maintenance is in place at the home and this includes having an on-site handyman, as well as a weekly garden maintenance programme for the external grounds. A rolling programme of redecoration is in place that is carried out and realised; new lounge carpets for Woodlands, the redecoration and refurnishing of the visitors/quiet room and the re-painting of the kitchen and main foyer areas. Health and safety (29/6/06), environmental health (22/1/07) and fire inspections (25/1/07) were carried out and the home complied with the various regulations and was therefore deemed to be safe. There were more than adequate toilet and bathing facilities in the home to meet the needs of the resident group and this takes into consideration the fact that eleven of the bedrooms have en-suite facilities. In fact they exceeded the minimum requirements and were in very good condition on the day of the visit. In improving outcomes for residents a walk-in shower with a bidet has been installed in Woodlands, in response to requests made by them. It was reported that an increased number of residents have gained greater independence in maintaining their personal hygiene and are proud in doing so. More importantly an impact assessment carried out on the facility indicated there has been a reduction in the levels of urinary tract infections, since the introduction of the bidet, and that residents are enjoying the experience of maintaining their hygiene and dignity. It was clear that the registered persons were keen to creatively implement and provide facilities that would enhance not only the wellbeing, but also the lifestyle of residents. Costs were not prioritised over providing positive outcomes for residents, as plans were in place to install a similar facility on the ground floor. This is positive. A significant number of residents’ bedrooms were assessed with their agreement. Each of the bedrooms viewed was individually decorated and adorned with personal effects e.g. family pictures and personal interests like cuddly toys, televisions, radios and the like. It was clear that they reflected the culture of the individuals, which is diverse. All residents were able to identify and locate their bedrooms. The management and staff were creative in taking action in at least two cases to ensure that the individuals are able to retain independence in locating their bedrooms. They did this by placing pictures of their favourite pets on their bedroom doors. Interestingly both residents were very pleased about this. All residents were extremely pleased with the furnishings and fixtures in their private spaces. Residents and relatives comments included; ‘The home is spotless’, ‘You never get a urine scent in here’ and ‘The home is always immaculately clean every time you visit’. This was confirmed during the course of the inspection, as the home was clean, tidy and free from offensive odours. An infection control policy is in place and staff are taken through this as part of their induction training. Hand washing facilities are cited throughout the building and the DS0000067413.V339267.R01.S.doc Version 5.2 Page 21 arrangements for laundering soiled linen were more than adequate. The laundry floor is impermeable and staff working in this department were adequately trained to so do. The home complies with environmental standards and this ensures that everyone using the facility remain safe. It was noted during the course of the inspection that there were problems with the washing machines and the management ensured that the relevant contractors were out pretty quickly to work on the problem. Even so one could not tell, as the laundry remained clean, hygienic and without an unpleasant odour. Staff working in this area had a good understanding of infection control and policies and procedures were updated and available to all staff. This is strong area of the homes operations. DS0000067413.V339267.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): (27,28,29,30) People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. At Birchwood residents receive a very good standard of care and support from a team that is highly motivated, skilled, trained and in sufficient numbers to meet their needs. Residents’ safety is assured by the home’s robust recruitment practices and the high standards are maintained through an extremely well - supported and well - managed staff team. EVIDENCE: A careful examination of the rosters indicated that the staffing levels were generally based on the needs of residents, with additional staff in place at peak times. The home uses ‘floaters’ regularly, to ensure that residents are ably supported throughout a twenty-four hour period. It was also observed that despite having a clear structure and defined roles the registered manager would be out on the floor, whenever needed. All staff had a good package of training and so they were quite knowledgeable of the needs of the resident group. There was a one hundred per cent positive response from relatives and residents with regard to the adequacy of the staffing levels at Birchwood. Feedback received from staff indicated that approximately ninety-two percent of the staff felt that the staffing levels were always sufficient to meet the needs of the residents. A small percentage of staff felt that at times, mostly through sick leave, which is relatively low at this home – more staff are required. This was followed up with some of the staff sharing their experience and it determined that although they met residents’ needs – they were rushed off their feet. They also felt that on such occasions, there might be a slight DS0000067413.V339267.R01.S.doc Version 5.2 Page 23 increase in the risk to residents’ safety. The staff concerned did comment that they receive fantastic support from the manager on a daily basis. It was observed that this issue had not been raised in team meetings or otherwise. It was however shared with the manager who proposed to follow this up as part of quality assuring the service. Ancillary staff are employed in the home to ensure that staff are primarily engaged in caring and working directly with residents. From examining the training records and speaking with staff, it was observed that over ninety percent of the staff had achieved an NVQ level 2 in care, and in that ratio up to seven were aspiring for the level 3. This exceeds the minimum set required by this standard and the positive side of this was that nearly all the staff were motivated towards learning and developing. In essence most of the staff team had a sound understanding in the provision of good basic care, which was translated into practice during their engagement with residents. This is a strong area of the homes operations. The recruitment files of three of the most recently recruited staff were examined and it was clear that the home’s management was operating in line with their procedures. Detailed application forms were appropriately checked, there was close monitoring of references and, appropriate Criminal Records Bureau checks to ensure residents’ safety. All staff had the experience of being interviewed and were not employed unless the registered persons were satisfied that they are fit to work with the resident group. They also had a statement of their terms and conditions, as well as a copy of the GSCC code of conduct – which details the standards expected when working with residents. The management’s recruitment strategy ensures that the right staff i.e. committed, motivated and skilled is employed to work in the home. As a testament of this, there is a very low turnover of staff in the home with some individuals working for well over twenty years at Birchwood. Staff were quoted as saying: “It is the best place I have ever worked”, “Love working here” and “It is a pleasure to be working with the residents”. More importantly there was evidence that the equality and diversity runs through the recruitment practices adopted by the home. As a result residents have access to a diverse staff team that has the capacity to offer them for example – same gender care. All staff were in receipt of an induction and the most recently recruited had theirs in line with Skills for Care Induction standards. Staff also had the benefit of foundation training as well as training that enabled them to improve and achieve outcomes for people using the service. Up to eleven staff were known to have a first aid certificate and so the opportunities for receiving emergency support in the home is quite high. Some of the training that was provided over the last twelve months included; diversity, nutrition, first aid, dementia, bereavement, diabetic care, person-centred care, risk assessments, Legionella Awareness, medication, moving and handling, care planning, safeguarding adults, incontinence and fire. DS0000067413.V339267.R01.S.doc Version 5.2 Page 24 There is a ‘training and development’ needs analysis for staff, which identifies what is needed and the priority, which is based on delivering a safe service. A training plan is in place and sound arrangements are in place for refresher training. Feedback from external professionals supported the view that staff worked well in relation to meeting residents’ objectives and this sentiment was also supported by the feedback received from relatives and residents. Training is a high priority and treated as such by the management and staff. One staff member commented that although she had a long period of planned leave – she has had updated training since coming back and feels well equipped to do her job. It was positive to see the level of confidence among the staff team throughout their engagement with service users. This is a strong area of the homes operations. DS0000067413.V339267.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): (31,33,35,36,38) People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Residents benefit from a home that has sound management practices, which positively impacts on the quality of care they receive. Good quality assurance and financial systems and a staff team that is well supported provide positive outcomes for people who use the service. The health and safety and financial best interests of service users are well provided for at Birchwood. EVIDENCE: The registered manager has a wealth of management expertise, which is brought to the home. More importantly she continues to consistently and creatively seek to improve standards in the home thereby ensuring that the needs of residents and the staff are met. She is knowledgeable in caring for the elderly, as well as with the diseases associated with the resident group. A heavy emphasis is placed on ensuring that the diverse needs of each individual are met. Leading by example, the registered manager plans to pursue the NVQ DS0000067413.V339267.R01.S.doc Version 5.2 Page 26 Level 5 in Management as well as planning to do Mental Capacity Act and Sexuality Awareness training in July 2007. She has undertaken recent training in Empowerment for service users, Dementia Care, End–of –Life, Nutrition and ‘Train the trainers’ courses amongst others. There was strong evidence to confirm that plans were in place to cascade training to her staff and so share the learning and development. This is a strong area of the homes operations. There were sound systems in place for quality assurance and monitoring of the service. Residents’ surveys are carried out monthly, as were monitoring visits by the registered providers. Price Water House carried out an audit of the care services recently and it was noted that the management was complimented on the high standard of care provided at Birchwood. In addition two internal audits of the service were carried out and the registered persons have linked the outcomes to their annual development plan. There was evidence of a business plan for the service. Forums such as the residents’ committee and the friends of Birchwood group are useful in ensuring that outcomes for residents are kept high on the home’s agenda. It must be stated that every response received about the quality of the service at Birchwood has been positive and this took into consideration – responses from a very wide range of sources. Policies and procedures were updated and there was evidence of staff being brought up to speed with new developments regarding caring for the elderly. The manager in the course of her duty complies with the GSCC code of conduct, which ensures quality outcomes for residents. This is a strong area of the home’s operations. The financial and accounting interests of residents were safeguarded at Birchwood. An administrator deals with the internal finances and her work is, monitored by the registered manager and an external senior manager. Records were assessed where monies are handled on behalf of residents, and they were found in order. A random check on balances held for residents was also satisfactory. Financial guidelines were in place to guide how all finances are to be handled. It was noted that four residents had a power of attorney with another subjected to Guardianship. An accurate audit trail was available in relation to how the residents’ financial interests are promoted. All relatives commenting spoke with assurance of the home’s ability in safeguarding residents’ finances. However, one individual expressed concern that he did not always get a receipt when he pays the fees. This has been raised with the manager who proposed to look into the matter. A secure facility is available for storing the service users’ valuable possessions and up to six residents are supported to handle their financial affairs. This is positive. One hundred percent of the feedback received from staff was positive about the support and direction they received at the home. Formal supervisions were carried in excess of the required minimum as some staff had up to ten DS0000067413.V339267.R01.S.doc Version 5.2 Page 27 supervisions per year. They were generally regularly supervised and their work appraised. This allowed them opportunities to get feedback on their work, make contributions towards developing the service and their professional development. Staff also had the benefit of: regular team meetings and were able to informally approach the manager, described by all as transparent and approachable, with personal or work-related issues. Staff viewed supervisions and appraisals as mechanisms for allowing them time to learn, develop and contribute to the service. Some of their comments included; “I am well supported in my job”, “she treats every one with equity and respect”, “ she values our contributions” and “she is the best manager and is person centred”. There were very good systems in place to ensure that staff are monitored and given support in providing quality outcomes for people using the services. This is a strong area of the homes operations. An updated health and safety policy is in place for staff to follow in promoting the safety of people using the services. They also receive training to ensure that theory is put into practice and good arrangements such as random monitoring are in place to enable this. The health and safety files were assessed and found to be in order e.g. central heating checks, gas, PAT testing, fire drills, call point testing, the safe disposal of controlled waste (April 2007) and Legionella monitoring. Health and safety signs were appropriately posted throughout the home and arrangements for infection control were in place. Sound arrangements were also in place to ensure that visitors and contractors were appraised with the health and safety requirements of the home. Risk assessments for all safeworking practices have been carried out and there was evidence that the lift has been professionally serviced. Other inspections were carried out on the laundry and kitchen equipment, as well for pest control from which the outcomes were satisfactory. This is a strong area of the homes operations. DS0000067413.V339267.R01.S.doc Version 5.2 Page 28 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 4 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 4 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 3 4 X 4 X X 4 X 4 STAFFING Standard No Score 27 3 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 4 X 4 DS0000067413.V339267.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO 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. 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. Refer to Standard OP9 Good Practice Recommendations The registered manager should continue to robustly monitor the handling of medication over the next six months to ensure that the new system (Boots MDS) is safely established. The registered providers should take steps to ensure that receipts for payments made to the organisation are provided to relatives at all times. 2. OP35 DS0000067413.V339267.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: 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 © 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 DS0000067413.V339267.R01.S.doc Version 5.2 Page 31 - 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. 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