Inspection on 14/06/05 for Birchwood House Rest Home

This inspection was carried out on 14th June 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 House Rest Home 22/07/08

Birchwood House Rest Home 03/03/08

Birchwood House Rest Home 27/11/07

Birchwood House Rest Home 11/07/06

Birchwood House Rest Home 15/02/06

Birchwood House Rest Home 20/12/04

Birchwood House Rest Home 24/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Birchwood House Rest Home Stockland Green Road Speldhurst Tunbridge Wells Kent TN8 5DB Lead Inspector Ann Block Unannounced 14 June 2005 14.00 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 House Rest Home H56 H06 S23895 Birchwood House V225906 140605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Birchwood House Rest Home Address Stockland Green Road Speldhurst Tunbridge Wells Kent TN8 5DB 01892 863559 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) Malvirt Ltd Mrs Janice Eileen Collins CRH Care Home 38 Category(ies) of Old age (38) registration, with number of places Birchwood House Rest Home H56 H06 S23895 Birchwood House V225906 140605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 20 December 2004 Brief Description of the Service: Birchwood House provides accommodation for up to 38 older people. The house is a detached property with accommodation on four floors, standing in its own large landscaped grounds. The home is located in a rural area on the outskirts of a small village. The nearest public transport, pub, church and post office are approximately one mile away. There is car parking to the front of the premises. All bedrooms have en suite facilities with WC, call points and TV points. Many rooms have telephone points. There is a shaft lift to all floors in the main house and a stair lift to the three rooms in the annex. A few rooms require access up stairs. There is no designated guest room but if a room is free, arrangements could be made for guests to stay overnight. Communal facilities include two lounges, a conservatory and dining room on the ground floor with a smaller lounge on the first floor. A domiciliary care service is run from offices in the house. Birchwood House Rest Home H56 H06 S23895 Birchwood House V225906 140605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission was represented by Regulatory inspector Ann Block who was at Birchwood House between 2.00 and 8.00pm on Tuesday 14 June 2005. During that time two small groups of residents, two members of staff and the manager agreed to speak with the inspector. One of the residents had chosen to come to Birchwood House for her first test run of respite care and was hoping to book a further two weeks over Christmas. Barring a minor complaint which was being dealt with, she considered the home was ‘very nice’ with people there ‘very friendly’. A member of staff who had started employment that day said she had made a positive choice to work at Birchwood as the home ‘has a very good reputation, is in a lovely setting, a nice atmosphere when you walk in and looked well decorated and clean’. What the service does well: What has improved since the last inspection? Residents now have written confirmation that following assessment their needs can be met at Birchwood House. The involvement of residents in the setting up of care plans is now evidenced as far as possible by signatures. Medication administration records are now signed, detail the times of administration and record whether the medication is as required or at set times. Residents are better protected from the risks of burns now that all hot surfaces which present a risk are covered. Furniture that posed a risk of falling has been made Birchwood House Rest Home H56 H06 S23895 Birchwood House V225906 140605 Stage 4.doc Version 1.30 Page 6 safe. A number of residents’ rooms have been redecorated. Three older beds have been replaced. A deputy manager has been appointed. Residents now have meetings where they can voice opinion about the service. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Birchwood House Rest Home H56 H06 S23895 Birchwood House V225906 140605 Stage 4.doc Version 1.30 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 House Rest Home H56 H06 S23895 Birchwood House V225906 140605 Stage 4.doc Version 1.30 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) 1,3,4,5&6 Prospective residents can make an informed choice whether Birchwood House is suitable for them through good information and sound admission procedures. EVIDENCE: Prospective residents have access to a statement of purpose and service users guide which gives good information about the service. Copies were seen in service users rooms. Those spoken to said they had sufficient information to decide whether Birchwood House might be suitable for them. Residents spoke of meeting the manager or head of care before admission where questions were asked about their needs and health, and how they felt about coming into care. Supplementary information is also obtained from other professionals, such as care management and health professionals, as part of this assessment process. Often residents have periods of respite care before making the final decision to move into the home. Permanent residents said they enjoyed having someone new to talk to. Residents appreciate the opportunity to have a ‘trial run’ and to extend an initial trial period. Respite care is also used to give the primary carer a break or to offer a transition between a hospital stay and Birchwood House Rest Home H56 H06 S23895 Birchwood House V225906 140605 Stage 4.doc Version 1.30 Page 9 returning home. The home does not formally provide for rehabilitative intermediate care. Birchwood House Rest Home H56 H06 S23895 Birchwood House V225906 140605 Stage 4.doc Version 1.30 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) 7,8,9,10. & 11 Care and health needs are well met but would be better evidenced by sound, accurate and comprehensive care plan and medication systems. EVIDENCE: Each resident has an individual plan of care with separate records of daily life. Care plans contain a range of information and wherever possible are signed by the resident concerned. Staff referred to care records as a basis to provide care and were aware of residents changing needs. This was not routinely recorded in care plans. The continuity of care for residents would benefit from care plans being regularly reviewed and updated, and to contain core information from which judgments could be made whether needs were being met. Daily records should be a better reflection of life in the home for each resident and show how needs are being met. Health care is generally well managed with the assistance and support of local health professionals. Residents spoke of seeing the district nurse and of attendances at specialist services. Some records are made of such visits. Space in care plans is available to record weights but was not routinely being used. Medication is administered via the Nomad monitored dosage system. Records of administration were signed for but not routinely at the time of administration, as staff have been Birchwood House Rest Home H56 H06 S23895 Birchwood House V225906 140605 Stage 4.doc Version 1.30 Page 11 advised to do as part of their medication training. Storage of medication in the drug trolley could be improved. Residents considered that staff treated them with respect. Privacy is maintained by the use of lockable toilets and bathrooms. Locks can be provided for bedrooms on request. Residents have a payphone for exclusive use and a mobile phone which is shared with the office line. Many have their own phones installed. Wherever possible residents are cared for throughout the stages of older age, often with the support of the local General Practitioner and district nurse. Letters of thanks to staff for the care given in last stages of life had been sent to the home. Records of last wishes are not reliably incorporated in the care plan. Birchwood House Rest Home H56 H06 S23895 Birchwood House V225906 140605 Stage 4.doc Version 1.30 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) 12,13,14 & 15 Residents have the satisfactory quality of life they expect when they choose to move into Birchwood House. EVIDENCE: Residents often move into Birchwood House because they like the ethos and setting of the home. Those spoken to found that their expectations of such a service were met. Many mentioned the rural setting and the large gardens which a number were using. Residents said they felt occupied during the day often reading or watching TV. Some mentioned going out with friends and family. Visitors are welcomed with the visitors’ book recording many visitors to the home. A lounge with dining table on the first floor can be used for private visits. A number of residents maintain contact with local churches. Residents felt they were able to make choices about their lives but considered this was restricted as would be expected in any a group living situation. A number of residents have a daily paper delivered. Care staff provide activities such as gentle exercise. The head of care provides a trolley shop most weeks. One member of staff said how nice it was to be able to spend one to one time talking to residents. Residents said that the food was good with two choices for lunch and supper. Three seasonally based full meals plus interim snacks and drinks are provided. Individual dietary needs are met. Breakfast is brought to residents’ bedrooms, other meals can be taken in the lounge, dining room, conservatory or bedrooms. Birchwood House Rest Home H56 H06 S23895 Birchwood House V225906 140605 Stage 4.doc Version 1.30 Page 13 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) Not inspected EVIDENCE: Birchwood House Rest Home H56 H06 S23895 Birchwood House V225906 140605 Stage 4.doc Version 1.30 Page 14 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 Residents live in a pleasant and safe external and internal environment which would be enhanced by small improvements. EVIDENCE: Residents like the décor of Birchwood House. The owner considers that provision of a quality environment is essential and ensures money is available to maintain these standards. Rooms are redecorated as needed, usually when there is a change of occupant. A maintenance/gardener works two days a week. Some deficits in maintenance and garden tidiness spoil the otherwise good standards. A better system for observation, reporting and actioning maintenance tasks would improve overall standards. Some residents spoke of liking sitting in the conservatory, with its bougainvillea and dessert grape vine, others prefer one of the two good sized ground floor lounges. Many residents choose to spend time in their rooms which they are able to personalize. Many bedrooms have beautiful views over the surrounding countryside. One room can be used for shared occupancy on request. Since the last inspection some beds have been replaced, other beds would benefit from similar replacement. Birchwood House Rest Home H56 H06 S23895 Birchwood House V225906 140605 Stage 4.doc Version 1.30 Page 15 There are large grounds with a patio leading from the conservatory and main lounge. Access to the grounds is by steps. Access to the patio for those with mobility problems would be improved by alternative storage of aids. Aids and equipment are provided as assessed. An assistance call system is fitted. There are three bathrooms in the main house, two with a Parker bath and one standard bathroom which is little used. The sit in bath in the annex is not used. Each room has its own en-suite toilet and washbasin. A toilet is sited near to the communal areas with a separate toilet for visitors and staff. Radiators and hot water pipes which have been risk assessed as presenting a risk have been covered. The majority of radiators can be controlled by the room’s occupant. Care needs to be taken in cooler aspect rooms that it is heated to the occupants needs. Domestic staff are employed for weekdays and are expected to maintain a good standard of cleanliness. To prevent the risk of cross infection and to maintain residents dignity, care staff should regularly monitor the condition of service users en-suite facilities. A laundry is provided with good storage for clean linen and personal clothing. Staff should be aware of individual needs regarding attire and clothes storage. Birchwood House Rest Home H56 H06 S23895 Birchwood House V225906 140605 Stage 4.doc Version 1.30 Page 16 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) 27,29 Residents’ care and support needs are met by sufficient staff with whom residents have good relationships. That staff are suitable must be evidenced by the availability of recruitment records. EVIDENCE: Residents spoke well of staff. Good interaction between staff and residents is promoted which residents feel is a strength of the service. There have been some recent staff changes with new staff recruited. One person has responsibility for running each shift. Four care staff are on duty each morning, three each afternoon/evening with two waking night staff. There is currently limited need for personal care with bathing normally carried out in the morning. A cook and cleaning staff are employed. Care staff are responsible for some cleaning and catering duties within their rostered hours. Agency staff are used to cover vacant hours. Wherever possible the same staff are requested. A number of staff work 12 hour shifts, one person felt this had a detrimental effect on her work performance and reduced hours to 6 hour shifts. A new member of staff referred to a good recruitment procedure, including Criminal Records Bureau and POVA checks being applied for. This process could not be confirmed, as the personnel file could not be located by the manager. Birchwood House Rest Home H56 H06 S23895 Birchwood House V225906 140605 Stage 4.doc Version 1.30 Page 17 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 & 37 Residents have access to experienced management who promote a good standard of living. Accurate records must evidence that this is being provided. EVIDENCE: The manager has worked at the home for some 6 years, holds qualifications relevant to care and management and has many years experience in the care field. A deputy manager is shortly to start work who it is hoped will offer support to improve administration and records maintenance, and give the opportunity for younger people to become involved in the management of the home. The manager is regularly available in the home and works some shifts in a hands on capacity. One of the directors of the owning company is in frequent contact with the home and available for residents and staff to talk to. At the request of a resident, a residents meeting was held the previous week. As noted at the previous inspection, files and records would benefit from greater structure and for there to be more efficient office administration. To evidence that residents best interests are being met, all records as required by Birchwood House Rest Home H56 H06 S23895 Birchwood House V225906 140605 Stage 4.doc Version 1.30 Page 18 regulation must be complete and available for inspection in the home at all times. Birchwood House Rest Home H56 H06 S23895 Birchwood House V225906 140605 Stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 2 3 3 3 2 3 2 STAFFING Standard No Score 27 3 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 3 x x x x 1 x Birchwood House Rest Home H56 H06 S23895 Birchwood House V225906 140605 Stage 4.doc Version 1.30 Page 20 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 OP9.4 OP9.7 Regulation 13 Timescale for action (2) The registered person shall make Action to arrangements for the recording, be taken handling, safekeeping, safe by 30 June 2005 and administration and disposal of medicines received into the care from home. thereafter This will include that medication is stored and handled in line with the guidelines from the Royal Pharmaceutical College. (2) (k) Procedures must be put in place Action to to ensure that all clinical and be taken by 30 June general waste is stored and 2005 and disposed of promptly in a manner which reduces the risk of from cross infection and odour. This thereafter will include prompt cleaning of contaminated surfaces. This part of the requirement is repeated from the inspection of 20 December 2004 (1 & 2) All records detailed in Schedules Action to 2,3 & 4 must be complete, be taken accurate, in date and available by 31 July for inspection in the home at all and from times thereafter Requirement 2. OP26 16 3. OP37 17 19 Birchwood House Rest Home H56 H06 S23895 Birchwood House V225906 140605 Stage 4.doc Version 1.30 Page 21 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 OP7.2 Good Practice Recommendations As a developmental issue greater detail should be recorded in the care plan, for example, the actual process of bathing and subsequent personal care needs. This recommendation is repeated from previous inspection reports dated 8 July 2003, 4 December 2003, 24 May 2004 and 20 December 2004 Where daily records are used to document how activities of daily living are met for an individual, the record should be a useful indicator of life in the home for that person including tracking and evaluating care and recording social activities. This recommendation is repeated from a previous inspection reports dated 24 May 2004 and 20 December 2004 Where a service user has had an accident, such as a fall, health records within the care planning system should evidence monitoring of the service users wellbeing and action that was taken. Not inspected Detail of the provider of ancillary health services and dates of last and due appointments should be recorded in the care plan. This recommendation is repeated from previous inspection reports dated 24 May 2004 and 20 December 2004 The planned upgrading of the annex should be carried out as a priority. This recommendation is repeated from a previous inspection report dated 20 December 2004 To ensure maintenance directives are not overlooked, the record of work should be formalised to detail the date and nature of the work required, followed by the date the work was carried out and by whom. From evidence obtained at this inspection this includes that all staff should be aware of maintenance deficits with prompt action taken to rectify such deficits. Access to the patio for those with mobility difficulties should not be restricted by storage of aids and equipment. Those beds needing replacement should be replaced as a priority – three beds have been replaced, a review of the H56 H06 S23895 Birchwood House V225906 140605 Stage 4.doc Version 1.30 Page 22 2. OP7.1 3. OP8.1 4. OP8.11&12 5. OP19.2 6. OP19.2 7. 8. OP20.3 OP24.2 Birchwood House Rest Home 9. OP24.5 10. OP26.1 11. OP29.1 12. OP30.2 13. OP35.5 suitability of all beds in use should be carried out Whilst the inspector is aware that service users are asked whether they wish to lock the door from the outside, it is recommended that consideration be given to routinely fitting locks which facilitate locking from the outside and inside and which meet fire safety recommendations. This recommendation is repeated from previous inspection reports dated 24 May 2004 and 20 December 2004 To minimize the risks of cross infection a cleaning schedule should be set up with areas of risk prioritised. That suitable action had been taken was not evidenced at this inspection. Satisfactory recruitment procedure should be carried out, this will include written evidence of the reason why a person left any position which involved working with vulnerable people. It is also recommended that a record of the interview be maintained. That such records are available for inspection at all times has been made a requirement All induction should have evidence that it has covered all areas necessary to ensure the member of staff has the skills and training necessary to carry out the work they are to perform. Not inspected, records were not available for inspection. All items held for safekeeping should be receipted to the service user concerned Not inspected Birchwood House Rest Home H56 H06 S23895 Birchwood House V225906 140605 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection The Oast, Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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