Inspection on 07/05/05 for Birchwood

This inspection was carried out on 7th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 13/09/08

Birchwood 18/09/07

Birchwood 14/11/06

Birchwood 22/02/06

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 7 May 2005 09:30 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 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 Version 1.10 Page 3 SERVICE INFORMATION Name of service Birchwood Address 35 Birchwood Road St Annes Brislington Bristol BS4 4QL 0117 9712266 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) Bristol City Council Miss Debra Jane Clifford PC Care home 30 Category(ies) of DE Dementia registration, with number DE(E) Dementia over 65 of places (30) Birchwood Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: May accommodate up to 30 persons aged 60 years and over. Date of last inspection 29 December 2004 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. 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 Briistol and is on a major bus route. Birchwood Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a Saturday between the hours of 10.45am and 6.30pm. Evidence was gathered from : • Talking to residents • Talking to two of the management team • Talking to staff • Talking to visitors • Observation • Participating in communal lunch • Looking at the premises • Records • Policies and procedures What the service does well: The care of each resident is looked at individually and is reviewed shortly after admission to ensure that Birchwood is the best place to receive personal care. Communication with Health professionals such as General Practitioners and District nurses is very good. Residents receive good health care and get the equipment they need. The food provided in the home is good and individual tastes and diets are catered for where possible. Despite the staff shortages staff morale is reasonable and communication with residents is very good. All residents looked relaxed with the staff providing their care. Relatives and friends are encouraged to visit and are made very welcome. They also know how to make a complaint and feel that their complaints will be listened to and taken seriously. Birchwood is very comfortable, homely and clean and has been made more suitable for older people with dementia. Staffing levels have improved at the weekends which has improved the quality of life for residents as more staff are available to meet residents’ needs. The manager is benefiting from the management course that she is attending. This has a direct effect on residents and staff who benefit from a open, positive management approach. Birchwood Version 1.10 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Birchwood Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Birchwood Version 1.10 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 standard(s) 1 , 3 and 5. Standard 6 is not applicable. The homes statement of purpose is not accuate and therefore may be confusing for prospective residents. Prospective residents needs are not sufficiently assessed prior to admission. The admission procedure needs to be improved to ensure that there is a full needs assessment completed prior to people moving into the home.Without this information there is no assurance that care needs will be met. Residents placements are reviewed following their admission to the home . This allows residents and their relatives to make sure that Birchwood can meet their individual needs. 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 59years of age. Birchwood Version 1.10 Page 9 The assessment document currently used by staff has gaps in information required to complete a full assessment. One member of the management team spoken to had completed an assessment where he had not been supplied with full details of the prospective residents medical and psychiatric needs from another care home. This residents needs were not fully met on admission. The statement of purpose gives clear details about the review process. One resident and her relatives were able to confirm that they had been invited to attend a review of the residents care within 4 weeks of admission. Comments received were “ … looks better than she has done for a long time”. and “ I am very happy here. “ The staff look after me very well”. “ Much better than the last place”. Birchwood Version 1.10 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 standard(s) 7, 8, and 9. Further attention needs to be given to the completition of care plans with residents and their represenatatives to ensure that residents’ emotional and mental health needs are identified and met. These shortfalls have a potential to place residents at risk. Residents’ health care needs are fully met but the medication administartion records were poor and potentially put residents at risk. There are insufficient measures in plcae to ensure that residents are protected from abuse 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 were not found on a sample of care plans. One residents review had been due in March 2005 and had still not been completed in May 2005. Daily entries into some case records had not been made. Birchwood Version 1.10 Page 11 Significant events in the home had not been fully recorded and entries available gave little indication of the actual care given. For example one resident has become emotionally attached to another resident who does not feel the same. This relationship has become abusive, but there was no record of this or any risk assessment and associated plan. Also no preventative measures had been recorded and The Commission for Social Care Inspection had not been notified of the situation. Discussion with staff and a member of the psychiatric team after the inspection suggested that some needs were being addressed even though there was a lack of clear plans and guidance. This approach is dependent on staff memory and good verbal communication systems. Records confirmed that health professionals such as General Practitioners, District nurse and chiropodists are contacted at the appropriate time. Equipment was observed to be in place to prevent pressure sores in residents who were at risk. There were numerous gaps in the medication administration records and signs of confused recording. For example it was unclear whether one resident had not been given medication because she was asleep or because the General Practitioner had advised the staff not to administer the medication due to a virus affecting a number of residents in the home. Birchwood Version 1.10 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 standard(s) 12, 13, 15 Birchwood does not consistently provide residents with the opportunity to experience a stimulating and varied life where various informal activities are regularly made available. However, visitors are made welcome and meals are well managed and provide daily variation, good nutrition and social contact for people. EVIDENCE: The statement of purpose states that “regular entertainment and outings are organised throughout the year. Activities include skittles, sing a longs, musical groups and outside entertainers visit the home activities”. A member of the management team told the inspector about a pianoist visiting the home the previous day. There were records in place to confirm that a clothes show had been booked. However, there was no other written information available to confirm that social activities had been taking place as the activity book was not available for inspection and there was no other record available. The staff time made available for getting residents involved with activities on the day of the inspection which was a Saturday had been reduced as one member of staff was on leave of absence and another was on holiday. There was no organised activity on the day of the inspection, but residents were observed 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 Birchwood Version 1.10 Page 13 A member of the management team reported that entertainment had been cancelled as a result of the recent virus that had been present in the home which affected both residents and staff. There have been no trips organised by the home since November 2004, but staff are currently raising money to make plans for summer outings Menus were inspected and were found to be balanced and interesting. Meal times are also flexible enough to accommodate individual preferences. The inspector joined in with the relaxed communal lunch. Residents were seen eating later; for example, one resident had been out for the morning with his family and another younger resident prefers eating towards the end of the communal lunch. One visitor asked about food provided for her friend who is Italian and was told that she regularly had pasta dishes and that she had also indicated that she enjoyed a particular salad dressing which the cook has now purchased for the home. Residents were seen being assisted by staff members to eat soft diets and one resident talked about her diabetic diet which she feels helps to control her condition. Birchwood Version 1.10 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 standard(s) 16and 18 Residents and their relatives are confident that their concerns will be listened too and have been made aware of the complaints procedure Arrangements for protecting residents from harm are not satisfactory placing residents at 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. No Secrets in Bristol (Local authority Adult Protection procedure) is in place in the home. Seven staff members have already received the training to assist using the procedure and two are due to receive it within the next month. However, risk assessments and strategies to protect residents are not always in place as discussed earlier in the report and The Commission for Social care Inspection are not informed of all incidents that affect the welfare of a resident. Birchwood Version 1.10 Page 15 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 standard(s) 19, 20 21, 22, 23 , 24,25, 26 A comfortable, clean, safe standard of accommodation is provided for the residents of Birchwood EVIDENCE: In general, the environment is well maintained and suited to residents needs. Disabled access is due to be made available at the main entrance during the next few weeks. Alternative temporary arrangement to enter the home are to be made with minimum disruption to residents, staff and visitors. Birchwood is decorated and furnished to a standard that creates a comfortable homely atmosphere despite it being a purpose built building. There is a programme of redecoration and refurbishment to further improve the environment There are a number of small lounges through the home in the care home which residents and relatives were seen using and appeared comfortable and relaxed. Birchwood Version 1.10 Page 16 Residents bedrooms looked homely and were personalised with residents personal possessions and furniture. The toilet and bathroom facilities are sufficient to meet the needs of the residents and the toilet doors have all been painted in red and sign posted following consultation with Dementia Voice. There were no unpleasant smells in the home and the rooms were cleaned to a high standard Birchwood Version 1.10 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 30 Staff are not employed in sufficient numbers to meet the residents needs. Staff are trained and competent to do their job EVIDENCE: Staffing levels have improved since the last inspection when a requirement was made for staffing levels to be increased during the weekends. This inspection took place on a Saturday and it was observed that there is now one extra staff member at peak times ie when residents are getting up and going to bed. However as discussed earlier there were no care staff available to organise social activities with individual residents or groups of resident s There are four care staff vacancies at this home and gaps in the staff rota continue to be filled with agency staff. On the day of the inspection there were two agency staff on the morning shift who both demonstrated that they had experience of working with residents with dementia. There is a programme of statutory training which includes basic food hygiene, first aid, manual handling and Protection of vulnerable Adults . 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. Birchwood Version 1.10 Page 18 Training in this care home also include dementia care training, mental health training and loss and bereavement .Two members of staff who have worked in the home for 6months and eight months confirmed that they are due to attend this dementia care training in the next few weeks Resident s made comments such as “I like it here “. “The staff are very nice and helpful” Birchwood Version 1.10 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32, 33 35 38 The home is managed efficiently by an experienced manager and the majority of records were up to date and accurate EVIDENCE: The manager is in the process of completing an NVQ 4 in care management and is due to up date First aid training. All care staff are currently receiving training on effective recording . Records of residents valuables were well maintained The records of tests to the fire safety equipment,, fire drills and fire safety training were in good order and health and safety issues were well managed. Confirmation of good record keeping was seen in the monthly reports from the Social services and Health manager Birchwood Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 2 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 3 3 x 3 x x 3 Birchwood Version 1.10 Page 21 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 op1 Regulation 4 Requirement The statement of purpose must be clear that there is one resident 55 years and over and what training and facilities are in place to meet this youger persons needs The documentation used to complete a needs assessment must include all of the information care plans must be completed where possible with e involvement of the resident / and represenattaive where possble. Daily records must be up to date and acurate and detailed enough to show any changes in need Risk assessments and strategies must be in place to protect residents at risk of harm Medication administration records must be accurate Residents must be given regular opportunitisies for stimulation through leisure and recreational activities both inside and outside the home which meet their individual needs .Particular consideration must be given to people with dementia Version 1.10 Timescale for action 30th June 2005 2. op3 14 30th June 2005 3th June 2005 3. op7 15 4. 5. 6. op7 op9 op12 13(6) 13(3) 16(2)(m)( n) 7th June 2005 immediate 30th June 2005 Birchwood Page 22 7. 18 37 8. 27 18(1)(b) The Commission for Social Care Inspection must be informed about any incident that puts a resident at risk Permanent care staff must be recruited to the four vacancies to ensure that residents receive continuity of care immediate 31st October 2005 9. 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 op12 Good Practice Recommendations Up to date information about activities should be provided to all residents in a format that they understand t Birchwood Version 1.10 Page 23 Commission for Social Care Inspection 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. Extracts may not be used or reproduced without the express permission of CSCI Birchwood Version 1.10 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. 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