Inspection on 12/01/06 for Birchy Hill Nursing & Residential Home

This inspection was carried out on 12th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Birchy Hill Nursing &... 08/01/10

Birchy Hill Nursing &... 16/11/09

Birchy Hill Nursing &... 18/09/09

Birchy Hill Nursing &... 23/10/07

Birchy Hill Nursing &... 21/09/06

Birchy Hill Nursing &... 07/04/05

Birchy Hill Nursing &... 13/10/04

Birchy Hill Nursing &... 08/06/04

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

CARE HOMES FOR OLDER PEOPLE Birchy Hill Nursing & Residential Home Birchy Hill Sway Lymington Hampshire SO41 6BJ Lead Inspector Eamonn Kelly Unannounced Inspection 12th January 2006 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Birchy Hill Nursing & Residential Home DS0000011414.V277561.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Birchy Hill Nursing & Residential Home DS0000011414.V277561.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Birchy Hill Nursing & Residential Home Address Birchy Hill Sway Lymington Hampshire SO41 6BJ 01590 682233 01590 682217 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) Angel Care Plc Care Home 50 Category(ies) of Dementia (10), Dementia - over 65 years of age registration, with number (50), Mental disorder, excluding learning of places disability or dementia (10), Mental Disorder, excluding learning disability or dementia - over 65 years of age (50) Birchy Hill Nursing & Residential Home DS0000011414.V277561.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. No more than 10 service users can be accommodated at any one time in the categories of DE and MD between the ages of 60 and 64. 7th April 2005 Date of last inspection Brief Description of the Service: The home provides nursing and residential care for up to 50 older people. They are people who have dementia or who have mental health issues. The registration enables the home to admit older people over 65 (but some service users admitted may also be aged between the ages of 60 and 64). The premises have 11 shared and 28 single bedrooms (with bedroom accommodation on the ground and 1st floors, served by a passenger lift)). There are 3 residential sections: 1. Poplars Unit (13 beds): [4 double (1 with en-suite facility) & 5 single)], 2. Pines Unit (16 beds):) [4 double (1 with en-suite facility) & 8 single] and 3. Cedars Unit (21 beds): [3 double (all with en-suite facility) & 15 single (3 with en-suite facility). The premises have good car parking facilities. There is a garden at the rear. The village of Sway (in the New Forest) has a train station (but no bus service) and has shops, chemist, post office, GP surgery, church, hotels and pubs. Birchy Hill Nursing & Residential Home DS0000011414.V277561.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection consisted of meeting with the manager, owner, members of staff, visitors and some service users. Some of the homes records, preadmission documents and policy statements were seen. All bedrooms and communal areas were visited in Poplars Unit: most facilities were visited in the other 2 Units. Discussions were held with the care supervisor, administrator, maintenance engineer, chef, visiting infection control officer and housekeeper. A visit was also made to the premises on the home’s grounds, one of several where members of staff from abroad are provided with accommodation. The focus of the inspection was on meeting and observing service users and meeting those concerned with their care and well being. What the service does well: What has improved since the last inspection? What they could do better: The manager and owner are improving pre-admission written information. They are achieving better mobilisation of service users at lunch and evening meal times. In addition they are improving aspects of furniture and equipment for the safety and comfort of service users. Birchy Hill Nursing & Residential Home DS0000011414.V277561.R01.S.doc Version 5.1 Page 6 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. Birchy Hill Nursing & Residential Home DS0000011414.V277561.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Birchy Hill Nursing & Residential Home DS0000011414.V277561.R01.S.doc Version 5.1 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 the following standard(s): 3. Prospective service users are assessed in detail to enable them (and the home) to come to a decision as to whether they can receive support proportionate to their assessed needs. EVIDENCE: Prospective residents and their supporters receive advice and guidance before taking up residence. The previous inspection report required more detailed pre-admission assessments to be made. The newly appointed manager undertook to fully involve family members, care managers and PCT nurses in all assessments. All service users have been jointly assessed (by health and social services) as needing nursing care for dementia and/or mental disorder. The full information obtained at this stage forms the basis of individual care plans. The instances discussed pointed to good initial assessments. Birchy Hill Nursing & Residential Home DS0000011414.V277561.R01.S.doc Version 5.1 Page 9 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 the following standard(s): 7, 8. Service users receive good healthcare support and good personal and social care. EVIDENCE: Members of staff had a good knowledge of resident’s healthcare needs. The manager is reviewing the level of information contained in individual care plans. All reviews include how problems identified are to be resolved. The manager showed how some improvements have already been put into effect. Care plan records seen had good information about service user’s assessed needs and goals of care for each need. Service users have access to GP’s, optician, dentist and private chiropodist. At night a nurse is on duty: each morning 3 nurses are on duty with 2 available in the afternoon and evening. Medication is stored securely and MAR (medication administration record) sheets seen were up to date (and had photographs of residents attached). There is occasional contact with psychiatric nurses from the Becton Centre. Birchy Hill Nursing & Residential Home DS0000011414.V277561.R01.S.doc Version 5.1 Page 10 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 the following standard(s): 12 Service users have the benefit of being able to have a life style that matches their expectations and current needs. EVIDENCE: A tutor from a local college was met on this occasion. She is trained to provide appropriate art and craft sessions for service users, working as part of the college’s adult lifelong learning programme. She is employed by the home, is assisted by a member of home staff and visits weekly during term time. The previous inspection report indicated that the activities co-ordinator had left and had not been replaced on a permanent basis with agreed hours per week. There is now an activities co-ordinator who spends 3 days a week at the home. A variety of activities are offered within the home and there are regular external visits by car or minibus. Members of the care team also provide activities for service users. Although there is a significant number of staff from abroad, communication difficulties are addressed by staff attending English language classes. Some service users said that they appreciated the support provided by students. The manager is improving the mobility of service users at lunch and evening meal times. This entails the moving of most residents from their chairs to tables with the use of hoists in some cases. The manager recognised that Birchy Hill Nursing & Residential Home DS0000011414.V277561.R01.S.doc Version 5.1 Page 11 this is having a staffing implications (one being that the shortfall in staffing numbers in the afternoons and evenings needs to be addressed). The chef outlined how the preferences of service users are taken into account, regarding meals how allergies are identified and brought to her attention, how food is ordered and cooked and how meals are transported by heated trolley. The process observed was an effective way of providing food for service users. A member of staff was observed helping a service user with feeding. Birchy Hill Nursing & Residential Home DS0000011414.V277561.R01.S.doc Version 5.1 Page 12 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 the following standard(s): EVIDENCE: Birchy Hill Nursing & Residential Home DS0000011414.V277561.R01.S.doc Version 5.1 Page 13 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 the following standard(s): 19, 26. The premises are suitable for the care of service users. The manager is undertaking improvements to enhance their comfort and privacy. EVIDENCE: There are 3 units over two floors comprising a mix of shared and single bedrooms. An extension is planned that is likely to add a significant number of new bedrooms with associated facilities. The manager is assessing the levels of comfort, safety and privacy throughout the home. The priority is to carry out improvements particularly in Poplars Unit. The manager was asked to address the following issues: • • Use of ceiling-glide curtains in shared bedrooms to replace existing screens (the manager has already received approval to install these for ease of use by staff and better privacy of residents). Storage of continence pads in bedrooms where appropriate and not in bathrooms. DS0000011414.V277561.R01.S.doc Version 5.1 Page 14 Birchy Hill Nursing & Residential Home • • • • Provision of vanity units in some bedrooms (including two in shared rooms). All bedroom floors to be carpeted except where a care plan states that this would not be appropriate. All bathrooms to be cleared of obstacles such as wheelchairs and items of furniture. Review of the layout of all bedrooms to improve comfort of service users (the home is implementing measures recommended in the previous inspection report). This includes the provision or repair of suitable doorlocks and the review of the provision and positioning of call bells so that they are accessible to service users. The home was clean and free from odours during the inspection visit. Birchy Hill Nursing & Residential Home DS0000011414.V277561.R01.S.doc Version 5.1 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 Nurses (RGN’s & RMN’s), care supervisors and care assistants care for service users: a chef and kitchen staff, housekeeper and domestic staff, manager and administrative staff and a maintenance engineer support them. EVIDENCE: There are 9 registered nurses and 24 care staff. About one third of care staff have achieved NVQ Level 1 or 2 in Care. The manager is considering making employment dependent (other than in exceptional instances) on members of staff undertaking NVQ Level 2/3. Emphasis is currently being placed on improving the induction process and fire safety training has been provided for all staff. Twenty–four hour care is provided with a nurse and 4 care assistants on duty (over the 3 units) at night (08.00 pm – 08.00 am). The following members of staff are on duty (over the 3 units) during the day: 1. AM: Three nurses 9 care assistants (08.00 am – 02.00 pm). 2. PM: Two nurses 6 care assistants (02.00 pm – 08.00 pm). The manager and care supervisor outlined how they are re-assessing some aspects of day-time staffing to ensure that an appropriate level of care is provided across the 3 units at all times (including likely increased staffing during the evening shifts). Birchy Hill Nursing & Residential Home DS0000011414.V277561.R01.S.doc Version 5.1 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33. Service users have the benefit of living in a well managed home with increasing emphasis on the home being run in the best interests of service users. EVIDENCE: Following a period of instability during which difficulties were experienced in managing the home effectively, a new manager has been recruited. During the inspection, there was evidence that the manager has taken stock of what needs to be achieved to enable service users to be better cared for. Examples of such observations are referred to earlier in this report. The manager is a registered nurse and has taken an advanced diploma in clinical nursing (mental health). She is close to completing the Registered Manager’s Award. Birchy Hill Nursing & Residential Home DS0000011414.V277561.R01.S.doc Version 5.1 Page 17 Profiles of a number of service users looked at together with meeting them (and some of their visitors) indicated that staff had a good knowledge of their health and social care needs. The manager (previously assistant manager at the home) provided accurate outlines of service user’s needs and how these were being addressed. Improvements to care plan records suggested accurate recording of changes to service user’s health and how staff follow up these changes in practice. In particular, the plans that the manager is putting into place (including addressing issues contained in the previous inspection report) proved that the necessary records are being reviewed, staffing issues are being addressed and improvements to the premises are being made. The home provides the Commission with monthly reports following visits by a representative of the owner. The manager explained how better procedures have been adopted for making written information available when service users are admitted to hospital. The reporting of incidents under Regulation 37 is made to the Commission. The manager and senior members of staff are addressing communication difficulties (which were the subject of previous discussion between the Commission and the home) between staff and service users and with some agencies. Determined efforts are being made to have procedures and records that support the needs of service users and ensure their safety and comfort. Birchy Hill Nursing & Residential Home DS0000011414.V277561.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x x x x x Birchy Hill Nursing & Residential Home DS0000011414.V277561.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Birchy Hill Nursing & Residential Home DS0000011414.V277561.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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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