CARE HOME ADULTS 18-65
Birchwood Bungalow The Bridle Path, Off How Wood Park Street St. Albans Hertfordshire AL2 2QZ Lead Inspector
Bijayraj Ramkhelawon Key Unannounced Inspection 16 May & 12th June 2006 10:00
th Birchwood Bungalow DS0000019294.V295038.R01.S.doc Version 5.2 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 Bungalow DS0000019294.V295038.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 Adults 18-65. 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 Bungalow DS0000019294.V295038.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Birchwood Bungalow Address The Bridle Path, Off How Wood Park Street St. Albans Hertfordshire AL2 2QZ 01727 874776 01727 874776 FP kthornber@hotmail.com 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) Milbury Care Services Limited Vacant Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Birchwood Bungalow DS0000019294.V295038.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 29th November 2005 Brief Description of the Service: Birchwood Bungalow is a small home, purpose built home providing personal and social care and accommodation for 7 people who have a learning disability. Milbury Care Services Limited owns the home. The property is a chalet style detached bungalow, which has been extended to provide its present accommodation and is set in two thirds of an acre of land; it is reached via a bridle path, one hundred yards long, which provides it with privacy whilst being close to local shops in a quiet residential area of St Albans. St Albans is an historic town, which boasts a lively town centre with various and wide ranging amenities. The town centre is a short car journey from the home. The home provides single bedrooms, each with a hand basin, for its occupants The home provides residential care in a family style environment for people who have a learning disability. The home has extensive and well-maintained, furnished and accessible gardens, and its own mini-bus to support service users to access their community. Birchwood Bungalow DS0000019294.V295038.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key inspection was carried out on the 16th May and there was a follow up visit on the 12th June 2006 to monitor the immediate requirement and to examine other key standards in relation to Staffing. Unfortunately, these files were not available again as the manager had gone off sick on the day. The outcomes of the National Minimum Key Standards inspected were satisfactory with the exception of fire safety practices when an immediate requirement was made. Care plans were well documented and other records checked were kept in good order. Staff were not provided with all the mandatory training as required to ensure safe practices were being carried out. The home was well maintained and reasonably kept clean. However, the entrance to the home is via the main kitchen and dining room which does not provide privacy at meal times. A separate main entrance to the home should be explored. Currently, the home does not have a registered manager. What the service does well: What has improved since the last inspection? What they could do better:
A copy of the statement of purpose and service user’s guide must be made available to service users. All assessments of needs carried out must be signed, dated and reviewed. Health care needs of service users must be monitored and evaluated. Policy and procedures in the administration of medicines must be reviewed to include that in an event of a death of a service user, medicines must be kept for seven days. A copy of the Royal Pharmaceutical Guidelines on the ‘administration and control of medicines in care homes’ must be provided. The complaints procedure must be devised in a format appropriate to service users. Staff must be provided with all statutory training including fire safety, infection control, protection of vulnerable adults, person centred planning and mental capacity. A copy of the General Social
Birchwood Bungalow DS0000019294.V295038.R01.S.doc Version 5.2 Page 6 Care Council (GSCC) should be provided to all care staff. Safe practices in relation to fire safety and infection control must be maintained. Formal supervision must be provided to all care staff on a regular basis and a quality assurance programme must be devised and implemented. 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 Bungalow DS0000019294.V295038.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Birchwood Bungalow DS0000019294.V295038.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1& 2 The quality outcome in this area is adequate. This judgement has been made using all available evidence including a visit to this service. The statement of purpose and service user’s guide were not available at the care home. Service users’ needs were assessed and formed part of individual care plan. EVIDENCE: A copy of the statement of purpose and the service user guide was not available at the care home. Service users needs were assessed but these were not signed, dated and reviewed. Whole life reviews were held annually and individual risk assessment were carried out. Birchwood Bungalow DS0000019294.V295038.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 The quality outcome in this area is good. This judgement has been made using all available evidence including a visit to this service. Care plans were detailed and included information on all assessed health care needs, social needs and risk assessments. Service users were treated with respect and assisted to make choices about their lives and to participate in community activities wherever possible. EVIDENCE:
Birchwood Bungalow DS0000019294.V295038.R01.S.doc Version 5.2 Page 10 Each service user has a care plan generated from the Care Management Assessment and the homes own assessment, which covers all aspects of personal and social support, and healthcare needs. The home carries out an annual whole life review of each service user’s care plan with the involvement of the service user, their relatives and other professionals involved in their care. Care plans were also reviewed at least every 6 months and updated to reflect any changing needs. The home provides service users with assistance and support as far as it is practical in helping them to make a decision or choose, but it was acknowledged that service users were generally unable to decide for themselves due to severe learning difficulties and difficulties in communication. Birchwood Bungalow DS0000019294.V295038.R01.S.doc Version 5.2 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 &17 The quality outcome in this area is good. This judgement has been made using all available evidence including a visit to this service. Personal development opportunities for each individual were evident. Service users took part in leisure and social activities and have a presence in their local community. The service users’ rights and responsibilities were recognised and respected. A healthy and varied diet of choice was provided at suitable and preferred times. Birchwood Bungalow DS0000019294.V295038.R01.S.doc Version 5.2 Page 12 EVIDENCE: Service users were supported to benefit from appropriate day care and social activities. Service users have access to local shops and other facilities with support from staff. All other social activities attended by services users were planned and organised by the staff and recorded in their care plans. These included visits to local places of interest, parks, cafés, shopping etc. Staff enabled service users to engage in other activities as much as possible, both indoors and outdoors. Rights and responsibilities were recognised and respected as evidenced in the guidance to staff in the care plans and also in the progress notes seen at this inspection. The menu seen at this inspection offered a varied and nutritious diet. Birchwood Bungalow DS0000019294.V295038.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 The quality outcome in this area is adequate. This judgement has been made using all available evidence including a visit to this service. Staff assisted service users to attend to their personal care and treated them with dignity and respect. Changed in health care needs must be recorded and monitored to ensure that service users needs were being met. A copy of the Royal Pharmaceutical Guidelines must be available for staff to follow the safe practices in the administration and management of medicines. The policy and procedures for the management of medicines must be reviewed to include that medicines must be retained for a period of 7 days in the event of the death of a service user. EVIDENCE:
Birchwood Bungalow DS0000019294.V295038.R01.S.doc Version 5.2 Page 14 Care plans scrutinised stated that personal care and support were provided to service users in the privacy of their bedroom. Staff stated that a flexible time for service users to retire to bed and to get up in the morning was practiced. Additional healthcare and specialist support were accessed via the GP. Changes in service users’ needs were not assessed and monitored. None of the service users self-administer their medication. Records in relation to the administration and management of medicines were kept in good order. However, staff were not provided with a copy of the ‘Royal Pharmaceutical Guidelines’ and the policy and procedure for the management of medicines did not include that medicines must be retained for at least 7 days in an event of the death of a service in case there is a coroner’s inquest. Birchwood Bungalow DS0000019294.V295038.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 The quality outcome in this area is adequate. This judgement has been made using all available evidence including a visit to this service. The complaints procedure must be kept up to date and in an appropriate format for service users. Training in the protection of vulnerable adults must be provided to all staff so that service users are not at risk. EVIDENCE: Behaviour management plans were in place to support service users to express themselves in positive ways whilst respecting others. Individual risk assessments provide guidance to staff to support service users from incidence of self-harm. The home has a ‘Whistle Blowing’ policy in place to ensure the safety and protection of service users in accordance with the Public Interest Disclosure Act 1998 and Department of Health Guidance No Secrets. The home also has a policy on physical intervention and restraint. The complaints procedure was not kept up to date and was not in a format appropriate to service users. Staff confirmed that they had not attended training in the protection of vulnerable adults. Birchwood Bungalow DS0000019294.V295038.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 The quality outcome in this area is good. This judgement has been made using all available evidence including a visit to this service. The home provided a comfortable and well-maintained environment for the service users. Staff maintained a good standard of cleanliness and hygiene. There was a large gap between the kitchen sink and the wall which needs to be repaired to prevent further damage due to water splash. Birchwood Bungalow DS0000019294.V295038.R01.S.doc Version 5.2 Page 17 EVIDENCE: Service users’ bedrooms personalised with individual’s belongings. Staff encourage service users to bring and/or choose their own furniture and can decorate and personalise their rooms, subject to fire and safety regulations. The premises were safe, accessible, comfortable, clean and free from offensive odours. Each room has sufficient light and ventilation. The home uses its own transport for service users to access local amenities and relevant support services. All rooms are for single accommodation. There was a large gap between the kitchen sink and the wall, which needs to be repaired. Birchwood Bungalow DS0000019294.V295038.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 & 36 (34 and 35- not inspected as staff files were not available for inspection. Again unable to access staff files on the second visit on 12th June 2006 as manager had just left work- feeling unwell). The quality outcome in this area is adequate. This judgement has been made using all available evidence including a visit to this service. There was adequate number of staff rostered on duty on days and at nights. Staff spoken to were aware of the needs of the service users and said that they well supported in their work. EVIDENCE:
Birchwood Bungalow DS0000019294.V295038.R01.S.doc Version 5.2 Page 19 Staff files were not inspected on this occasion, as these were locked and the manager was not present. Staff duty rota showed that there was adequate number of staff rostered on days and nights. Staff were aware of and promoted the main aims and values of the home including the key worker system. Staff confirmed that they have received a job description on starting employment and they undergo a period of induction, which included working along side a senior care staff. They also confirmed that they did not receive formal supervision on a regular basis. However, they said that they did not receive regular formal supervision and have not been provided with a copy of GSCC booklet on Code of Conduct. Staff training- see Standard 42. Birchwood Bungalow DS0000019294.V295038.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 & 43 The quality outcome in this area is poor. This judgement has been made using all available evidence including a visit to this service. The management within the home must be proactive in ensuring that safe working practices are in place including the provision of mandatory training to all staff in relation to fire safety and infection control. A quality assurance system based on seeking the views of service users and other relative parties must be developed. Birchwood Bungalow DS0000019294.V295038.R01.S.doc Version 5.2 Page 21 EVIDENCE: The home’s policies and procedures were kept in the office and were available to staff. Staff spoken to said that they adhered to the policies and procedures of the home. They also confirmed that they have not had training in person centred plan (PCP). However, staff confirmed that fire safety training was not provided. Fire doors were wedged open and there was no weekly fire alarm test carried out. (Fire door which was wedged open has now been fitted with magnetic held device). Used incontinence pad was left in the wash- hand basin and not appropriately disposed of. Accidents, injuries, incidents of illness were recorded and reported. A valid insurance cover for legal liabilities to employees, service users and third party persons to a limit commensurate with the level and extent of activities undertaken or to a minimum of £5 million was displayed. The home has yet to develop a quality assurance programme. Birchwood Bungalow DS0000019294.V295038.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 3 X 3 X X 1 1 Birchwood Bungalow DS0000019294.V295038.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2 Standard YA1 YA1 Regulation 4 (2) 5 (2) Requirement A copy of the ‘Statement of Purpose’ must be made available in the care home. A copy of ‘the service user’s guide’ must be supplied to each service user and the Commission. Assessment of needs carried out for service users must be signed and dated by the assessor. Assessment of needs must be kept under review. Identified health care needs of service users must be recorded and monitored. A copy of the ‘Royal Pharmaceutical Guidelines’ must be provided for care staff. Policy and procedures in relation to medication did not include that in an event of a service user dying, medicines must be kept for 7 days. Complaints procedure must be devised in an appropriate format for service users and updated with the correct address and contact number of the CSCI. Training in the ‘Protection of Vulnerable Adults’ (POVA) must
DS0000019294.V295038.R01.S.doc Timescale for action 21/07/06 21/07/06 3. 4. 5. 6. 7. YA2 YA2 YA19 YA20 YA20 14 (1) (a) 14 (2) (a) 12 (1) (b) 13 (2) 13 (2) 14/07/06 14/07/06 14/07/06 21/07/06 21/07/06 8. YA22 22 (2) & (7) 21/07/06 9. YA23 13 (6) 21/07/06 Birchwood Bungalow Version 5.2 Page 24 be provided for all staff. 10. 11. 12. 13. 14. 15. YA24 YA36 YA42 YA42 YA42 YA42 23 (2) (b) 18 (2) 18 (1) (c) (i) 23 (4) (d) 23 (4) (e) 23 (4) (c) The large gap between the kitchen sink and the wall must be repaired. Regular formal supervision must be provided for all staff. Staff must be provided with training in infection control. Fire safety training must be provided for all staff as part of their induction. Fire alarm test must be carried out on a weekly basis. Fire doors must not be wedged opened. (This requirement was met when a monitoring visit was carried out on the 12th June 2006). Used incontinent pads must be appropriately disposed of and not left in the wash-hand basin. Quality assurance programme must be devised and implemented. 21/07/06 28/07/06 28/07/06 21/07/06 14/07/06 16/05/06 16. 17. YA42 YA43 16 (2) (k) 24 (1) (a) and (b) 16/05/06 01/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA34 YA35 Good Practice Recommendations All care staff should be provided with the GSCC code of practice. Training in Person Centred Plan (PCP) and Mental Capacity should be provided to all care staff. Birchwood Bungalow DS0000019294.V295038.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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