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Inspection on 26/01/06 for Birchwood Nursing Home

Also see our care home review for Birchwood Nursing Home for more information

This inspection was carried out on 26th January 2006.

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 found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Birchwood obtain detailed assessments of service users needs prior to their admission and trial stays are encouraged. At the time of this inspection oneservice user was on a trail visit and said, "I have really enjoyed my stay at Birchwood and received a lot of help from staff." Each service user is involved in completing their care plan and activity plan a copy is retained in their room. Service users in the independent living flats receive minimum support from staff. One service user said they attended day services in the local area and further education classes` examples were given of computer training and maths and English.

What has improved since the last inspection?

The home has improved their policies and procedures on the administration and storage of medication. All staff have received training in the administration of medication. Since the last inspection three bedrooms have been redecorated and new carpets have been supplied.

What the care home could do better:

It was evident through observations through the day, interviews with service users, staff and managers that the needs of service users were changing. Some service users require a great deal of care and one to one observations from staff with others being of a younger age group needing additional rehabilitation input. Some service users appeared unkempt due to limits on staff time. A review of staffing levels and work allocation needs to take place in order that the changing needs of service users are met. The main lounge dining room does not provide a homely environment. Meal times did not provide a pleasant dining experience, which would promote social skills and interaction with service users and staff. There was a lack of choice at meal times; although choices were available staff need to take a proactive approach in ensuring service users are aware of this. Service users on long term placements should be provided with a seven-day holiday, the home needs to consult with service users regarding this and how it will be implemented.

CARE HOME ADULTS 18-65 Birchwood Nursing Home Lees New Road Oldham Lancashire OL4 5PL Lead Inspector Sandra Bennett Unannounced Inspection 26th January 2006 11:55 Birchwood Nursing Home DS0000025456.V271078.R01.S.doc Version 5.0 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 Nursing Home DS0000025456.V271078.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 Nursing Home DS0000025456.V271078.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Birchwood Nursing Home Address Lees New Road Oldham Lancashire OL4 5PL 0161 621 2750 0161 621 2779 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) Turning Point Mrs Sheila Margaret Matthews Care Home 16 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (16) of places Birchwood Nursing Home DS0000025456.V271078.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users to include up to 16 (MD) No service user under the age of 18 years to be admitted to the establishment. 26th October 2005 Date of last inspection Brief Description of the Service: Birchwood is a large, detached building situated approximately four miles from Oldham town centre. The home is registered to provide nursing care for up to 16 service users with past and present mental health problems, aged 18 years and over. The property is owned and managed by the charity Turning Point, in conjunction with the local NHS Trust. Their aim is to provide care and accommodation to service users who no longer require care within a hospital setting but still require support and observation. The service offers a step down approach and enables service users to learn or re-learn life skills, enabling them to achieve independence within the community. Accommodation is in 16 single rooms, all of which have en-suite and shower facility. Two of the rooms have been adapted to form bed-sits, with a cooker and a fridge to promote independent living. Each room has a telephone, which receives incoming calls. There is a large lounge/dining room and a small library/sitting room. A kitchenette is provided for service users to make refreshments situated in the occupational therapy/computer room. The home provides a designated smoking area for service users. In addition to the en-suite facilities, there is one bathroom suitable for service users who may have a disability, and a domestic type bathroom; three communal toilets are situated in other areas of the building. The home has appropriate aids and adaptations to promote the independence of their service users. Birchwood Nursing Home DS0000025456.V271078.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unscheduled inspection took place on 26/1/06. During the inspection two residents were interviewed in private, as were three members of staff. Discussions also took place with a group of residents, the manager and deputy manager. The inspector undertook a tour of the building selecting rooms at random for inspection and scrutinised a selection of service users files, as well as other documentation, including duty rotas, medication records. Ten service user and three relatives questionnaires were left for completion on the previous inspection, only one relative questionnaire was returned which stated that staff are welcoming, knowledgeable and always complete what is asked. What the service does well: What has improved since the last inspection? The home has improved their policies and procedures on the administration and storage of medication. All staff have received training in the administration of medication. Since the last inspection three bedrooms have been redecorated and new carpets have been supplied. Birchwood Nursing Home DS0000025456.V271078.R01.S.doc Version 5.0 Page 6 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 Nursing Home DS0000025456.V271078.R01.S.doc Version 5.0 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 Nursing Home DS0000025456.V271078.R01.S.doc Version 5.0 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): 2, 4. Information is available to residents to enable an informed choice to be made. A detailed assessment ensures the home meets the needs of residents. Residents are encouraged to visit the home prior to admission and are offered a trail period in order to decide if the home can meet their needs. EVIDENCE: Detailed assessments of the residents needs are obtained prior to admission with an additional assessment being undertaken by the home. Residents are given information on the home’s facilities and services. Service users have a file within their rooms, which, contains the service user guide, their care plan, and activity programme. One service user discussed the gradual introduction into the home. An informal visit was made at which time an overnight stay is offered if the service user wishes, then a trial stay followed by a review. The service user said, “my key worker helps me and I can go out when I want, it is all right here.” Birchwood Nursing Home DS0000025456.V271078.R01.S.doc Version 5.0 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, 8, 9. Service users are involved in care planning and are given choices in their care delivery and rehabilitation programme, leaving them feeling in control of their lives. Risk assessments on daily living skills promote service users independence. EVIDENCE: All service users have a copy of their care plan and activity programme in their rooms for reference. The named nurse and key worker complete this with the service user. Service users spoke about their involvement in the care planning process. Two service user files were looked at in depth and included an individual support plan alongside risk assessments on daily living skills e.g. budgeting and managing finances. Any limitations placed on residents are within a risk assessment framework. Some residents spoke about going out alone into town for shopping, whilst others commented they needed staff support. Birchwood Nursing Home DS0000025456.V271078.R01.S.doc Version 5.0 Page 10 One service user spoke about attending further education classes and said, “I attend a computer class and maths and English.” Daily recording of service users progress was well documented. Community meetings are held every two weeks. There was also evidence of service user questionnaires having been completed. Service users in the rehabilitation flats receive minimum support from staff and are encouraged to budget, shop and cook for themselves. Birchwood Nursing Home DS0000025456.V271078.R01.S.doc Version 5.0 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): 11, 14, 17. Service users are provided with opportunities for personal development, education and leisure, which are community based in order to promote their independence. The dining area, choices of meals and the service provided by staff needs to be reviewed in order to provide a more congenial atmosphere and promote social interaction for service users. EVIDENCE: One service user spoke about their stay in the rehabilitation flat and imminent discharge. They said that with the help of their key worker they had registered on various housing associations and had access to the Internet to see how their application was processing. They said, “I have really enjoyed my stay at Birchwood and received a lot of help from staff”. “ I have also learned a lot from further education classes and computer work”. Birchwood Nursing Home DS0000025456.V271078.R01.S.doc Version 5.0 Page 12 Another service user had been admitted with an exit strategy and date for discharge. Unfortunately the rehabilitation flat was not available. However staff had completed a support plan for independent living with the service user being encouraged to budget and shop for their own food with the occupational therapy kitchen being made available to them. The service user was happy with this situation and said “I have only been in the home for a short while but I like it here staff are very helpful”. Many service users go out unaccompanied to various activities and weekend leave. Service users have the opportunity to attend a local day centre for social and therapeutic intervention if this is assessed has a need. There is a wide age range in the home varying from young low dependency to older people with high dependency needs. Birchwood have a mini bus for activity purposes enabling high dependency older people to access community services. At the time of this inspection the home was without an activity co-ordinator therefore this aspect was reliant on staff availability. Standard 14 of the National Minimum Standards states long stay service users must be offered a as part of their basic contract price the option of a minimum seven day annual holiday outside the home which they have helped to choose and plan. Turning Point makes available to Birchwood a caravan in order to provide for this. However this does limit the service users choices and for those who are physically disabled is not accessible. At the time of this inspection no holidays had been planned. The home should give consideration to this in order to met service users needs. The dining experience in the home did not provide a homely atmosphere or promote social interaction for service users. Tables were not provided with cloths, napkins or set with knives and forks. Service users were served meals at different times with those that were able queuing at the service hatch for meals. Although a menu board was displayed no choices were reflected. Left over food was also scrapped into a container in close proximity to where people were queuing for food. Service users said they enjoyed the meals in the home and if they did not like it they could order a sandwich before 11am. Which for those service users who are motivated does not pose a problem. The concern is for those service users who have not got the skills to ask for their choice. Birchwood Nursing Home DS0000025456.V271078.R01.S.doc Version 5.0 Page 13 Two service users had gone to the local shop to buy a sandwich, they said this was because they did not always like the sandwiches on offer. Staff said service users could have what they wanted examples were given of egg on toast however this is not promoted and staff need to take a proactive approach. There were no set break times for tea or coffee. A kitchenette is provided off the main lounge for those service users who are able to make drinks throughout the day. Service users were asked if they received snacks through the day, two said they could have one they only have to ask. This is another issue were staff need to be proactive. Birchwood Nursing Home DS0000025456.V271078.R01.S.doc Version 5.0 Page 14 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 Service users personal care needs required additional support from staff in order to promote and maintain their dignity. Residents were satisfied that their emotional needs were being met. Medication procedures were sufficient to protect the interests of service users and promote good health. EVIDENCE: Two service users files were examined and contained detail care plans. The education, welfare and medical needs of service users had been recorded. Service users confirmed they are involved in the care planning process and their preferences taken into consideration. Evidence was on file of access to health professionals e.g. psychiatrist and psychologist. Service users are supported to clinical appointments by staff when required. Service users said “we have regular meetings with our key worker and named nurse together to look at what we have achieved and what we want to do.” Birchwood Nursing Home DS0000025456.V271078.R01.S.doc Version 5.0 Page 15 A number of service users appeared unkempt; the personal appearance of service users requires more vigilance form staff. Risk assessments had been completed for those who self medicate. Items bought over the counter by the service users had been identified on their risk assessment. Qualified nurses with the aid of care assistants dispense medication. had received training in the administration of medication. All staff One service user was self-administrating medication at the time of this inspection has part of their rehabilitation process. Birchwood Nursing Home DS0000025456.V271078.R01.S.doc Version 5.0 Page 16 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. Service users were confident they could raise concerns with staff and they would be listened to. Training arrangements in place ensure that service users are protected from abuse and exploitation. EVIDENCE: Training in the protection of vulnerable adults is mandatory within Turning Point and Birchwood. The home had received two complaints since the last inspection. These had been recorded together with action taken. Service users had been informed of the outcome of their complaint. Complaints are sent to Turning Point head office on a monthly basis for analysis. Service users said they could discuss any concerns with their key worker and nurses and they would always listen to them. Birchwood Nursing Home DS0000025456.V271078.R01.S.doc Version 5.0 Page 17 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, 25, 26. Service users are provided with a good standard of personal accommodation, which suited their needs. The heating systems in the home needs to be repaired in order to ensure service users remain warm and comfortable. EVIDENCE: Service users are provided with single ensuite accommodation, which includes a shower. There are also communal bathrooms and toilets situated close to bedrooms and communal areas. An in coming telephone system is provided in each room. Community facilities include a large lounge/dining room on the lower ground floor, a smoking room and a small kitchen, which is in addition to the homes main kitchen. On the first floor there is a small quite lounge library area available to service users. Birchwood Nursing Home DS0000025456.V271078.R01.S.doc Version 5.0 Page 18 At the time of this inspection the home was experiencing a problem with the heating system which led to the lounge/dining room on the lower ground floor being very cold, however the top floor and service users bedrooms remained warm. The manger said the problem had been ongoing and was being addressed. The building layout does not promote a homely atmosphere, however many service users had personalised their rooms to a comfortable standard and often choose to spend time within their rooms. Since the last inspection the home has redecorated and provide new carpets in three bedrooms. Birchwood Nursing Home DS0000025456.V271078.R01.S.doc Version 5.0 Page 19 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): 31, 32, 33. Staffs training opportunities are appropriate to meet the service users needs. Staffing levels and the deployment of staff needs to be kept under review to ensure the changing needs of service users can be met. EVIDENCE: Each service users is allocated a key worker and a qualified nurse. Any issues the service users or key worker have are brought to regular key worker meetings. Professional guidance is sought in emergencies or any deterioration of the service users health. Staff demonstrated an awareness of their roles and responsibilities. The staff team reflects the gender composition of the service user group. Turning Point produces a calendar of training opportunities with staff. Alongside the mandatory training of protection of vulnerable adults, health and safety, moving and handling, food hygiene and first aid are topics directly related to the service user group. These include psychosocial intervention, none violent crisis intervention, therapeutic activities in care homes and equality and diversity. However the number of staff who holds NVQ2 needs to be increased to 50 . Birchwood Nursing Home DS0000025456.V271078.R01.S.doc Version 5.0 Page 20 It was identified through interviews with staff and discussions with the manager that referrals received recently lean towards a younger age group who require more intense rehabilitation work. A number of service users have high dependency needs which impacts on the rehabilitation work that is required by other service users. It is acknowledged that one service user receives funding from the primary care trust “ continuing care funding” and funding for another service user has been applied for. This provides the service user with a one to one worker. In order to be more effective in the delivery of personal care, activities, rehabilitation and the promotion of choice for service users, staffing levels and the deployment of staff need to be reviewed. Service users were complimentary regarding the support they received from staff. Birchwood Nursing Home DS0000025456.V271078.R01.S.doc Version 5.0 Page 21 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, 38, 39. The management structure in the home provides a good support system for service users and staff through effective communication. The management team need to review staffing levels, deployment of staff and the promotion of choice for service users in order to improve their quality of life. EVIDENCE: The manager is a Registered Mental Nurse and holds NVQ in management and has many years experience in care of people with mental health problems. A clinical nurse manager provides staff supervision and support in the absence of the manager. Regular staff and service user meetings are held and there was evidence of service users questionnaires being completed. Birchwood Nursing Home DS0000025456.V271078.R01.S.doc Version 5.0 Page 22 Some comments taken from service users questionnaires were that “Birchwood is homely” and “ I would like a wider choice of meals”. One relative questionnaire said, “Staff are welcoming, knowledgeable and always complete what ever I ask”. As mentioned previously in this report a review of staffing levels or deployment of staff is required to ensure choice for service users is promoted in the home. Health and safety training is mandatory for all staff. Birchwood Nursing Home DS0000025456.V271078.R01.S.doc Version 5.0 Page 23 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X 3 X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X 3 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 X X X X LIFESTYLES Standard No Score 11 3 12 X 13 X 14 3 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score 3 2 2 X X X CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Birchwood Nursing Home Score 2 3 3 X Standard No 37 38 39 40 41 42 43 Score 2 2 2 X X X X DS0000025456.V271078.R01.S.doc Version 5.0 Page 24 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. 1. Standard YA17 Regulation 12(3) 16(i) Requirement The registered person must consult with service users on their preference of meals and be proactive ensuring choices are offered. The registered person must ensure that the heating system in the home provides sufficient heat in all parts of the home for the comfort of service users. The registered person must ensure that staff deployment and task allocation is reviewed to ensure the rehabilitation and dignity needs of service users are met. The registered person must ensure that the number of staff who hold NVQ is increased to 50 . Timescale for action 28/03/06 2. YA24 23(P) 28/02/06 3. YA18YA37YA38YA39 18(1) 28/02/06 4. YA33 18(1) 30/06/06 Birchwood Nursing Home DS0000025456.V271078.R01.S.doc Version 5.0 Page 25 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 YA17 Good Practice Recommendations The registered person should review the dining arrangements in order to provide a more congenial atmosphere and promote social interaction between service users and staff. Birchwood Nursing Home DS0000025456.V271078.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD 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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