Inspection on 23/10/07 for Birchy Hill Nursing & Residential Home

This inspection was carried out on 23rd October 2007.

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 &... 21/09/06

Birchy Hill Nursing &... 12/01/06

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 Tim Inkson Unannounced Inspection 23rd October 2007 10:00 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.V347508.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 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.V347508.R01.S.doc Version 5.2 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 Shirley Dawn Gibbs 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.V347508.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. All service users must be over 60 years of age Date of last inspection 20th September 2006 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: Poplars Unit (13 beds): [4 double (1 with en-suite facility) & 5 single)], Pines Unit (16 beds):) [4 double (1 with en-suite facility) & 8 single] and 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. People wishing to live in the home or for whom arrangements are made to do so by relatives or other representatives are given written information about the home and the service that it provides and are invited to visit the home. A copy of a report of the most recent inspection of the home carried out by the Commission for Social Care Inspection (“the Commission”) is made readily available in the home. At the time of this key inspection of the establishment on 23rd October 2007 its fees ranged from £550 to £700 a week and this excluded the cost of personal toiletries, chiropody treatment and hairdressing. Birchy Hill Nursing & Residential Home DS0000011414.V347508.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit was part of the process of a key inspection of the home and it was unannounced and took place on 23rd October 2007, starting at 08:55 and finishing at 17:15 hours. During the visit accommodation was viewed including bedrooms, communal/shared areas and other facilities. Documents and records were examined and staff working practice was observed where this was possible without being intrusive. People living in the home, visitors and staff were spoken to in order to obtain their perceptions of the service that the home provided. At the time of the inspection the home was accommodating 49 people. Of these 21 were male and 28 were female and their ages ranged from 61 to 101 years. Two individuals were from minority ethnic groups. The home’s registered manager was present throughout the visit and was available to provide assistance and information when required. People both living and working in the home were canvassed for their views about the home using questionnaires before the site visit took place and their responses were taken into consideration when producing this report. Other matters that influenced this report included. An Annual Quality Assurance Assessment completed by the registered manager in which she set out how she believed the home met and planned to exceed the National Minimum Standards (NMS) for Care Homes for Older People and evidence to support this. A “Dataset” containing information about the home’s staff team, and some of its managements systems and procedures. Information that the Commission for Social Care inspection had received since the last fieldwork visit made to the home on 10th October 2005, such as, complaints and statutory notices about incidents/accidents that had occurred. Many people living in the home were unable to have a meaningful conversation because of dementia or other enduring mental health problems. There was however evidence of people’s general well being from observation of individuals and groups of people throughout the site visit. This was illustrated by levels of conversation that was heard and the degree and quality of the interaction between people living there and between them and staff as well as activities that some were pursuing. What the service does well: Best practice arising from research conducted into care for people with dementia influenced the service provided by the home. People living in the home were safe and believed that staff looked after them properly and treated them with respect. They were able to make most choices Birchy Hill Nursing & Residential Home DS0000011414.V347508.R01.S.doc Version 5.2 Page 6 for themselves and exercise personal autonomy as far as was reasonably possible. Views about the food the home provided and the activities that the home arranged in which people could participate and benefit from were generally positive. Careful consideration had been given to the decoration of the interior of the premises and the installation of signage, orientation aids and equipment in order to enable people with a range of disabilities and diverse needs to retain as much independence as possible. Staff, people living in the home and relatives had confidence in the effectiveness of the home’s manager. Management systems and procedures in the home worked well including, the administration of medication, dealing with complaints, quality monitoring, and health and safety. There was a strong commitment to staff support, training and development to ensure that they were able to fulfil their roles and responsibilities and meet the complex and diverse needs of people living in the home. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Birchy Hill Nursing & Residential Home DS0000011414.V347508.R01.S.doc Version 5.2 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.V347508.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home and their relatives/representatives were confident that the home could meet their needs. This was because the help that individuals required was identified before they moved in to ensure that the level of support and care they required could be provided. EVIDENCE: A sample of the records of 4 residents was examined including those concerned with the actions that the home took to identify the help and assistance that people needed. As on the last key inspection of the home on 20th September 2006 there was evidence on this occasion from the documents examined and discussion with people living in the home and or their relatives that the admissions to the home of the individuals concerned had all been planned with staff with the appropriate knowledge and skills. The home’s registered manager said that she usually carried out the assessments of the needs of people wishing to move into the home. • “If I am not here the senior clinical nurse will do it. I prefer to do it because before I came her there were some inappropriate admissions and also I know the dynamics of the different units and I try to match Birchy Hill Nursing & Residential Home DS0000011414.V347508.R01.S.doc Version 5.2 Page 9 residents, particularly if they are sharing a bedroom. You don’t want someone who is noisy sharing with someone who likes it to be quiet”. The assessment process also included visiting people wishing to live in the home where they were accommodated before they moved in order to identify the degree and type of help that they needed. The home’s pre-admission assessments were complemented by more thorough and comprehensive assessments of a resident’s needs when they actually moved into the home. Comments from individuals spoken to about the process referred to above included: • “Shirley (registered manager) came to visit him when he was receiving respite care in X to see if he was suitable to come here”. There was documentary evidence that assessments of residents needs were reviewed regularly and revised as necessary when an individual’s circumstances had changed. The home does not provide intermediate care Birchy Hill Nursing & Residential Home DS0000011414.V347508.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s health, personal and social care needs were met. The home had plans of care that individuals, or someone close to them, had been involved in making. People unable to manage their own medication were supported by the home to manage it in a safe way. Individuals’ right to privacy was respected and the support they got from staff was given in a way that maintained their dignity. EVIDENCE: The care plans were examined of the same sample of 4 residents as in the section above i.e. “Choice of Home”. Among the sample was an individual who was receiving treatment to a wound caused by an injury/trauma. The documents examined were comprehensive and the plans were based on the assessments that the home carried out in order to identify what help the individuals needed. Assessments included a range of potential risks to residents e.g. pressure sores; falls; moving and handling; malnutrition; etc. Where a pressure sore assessment indicated that an individual was at risk it was noted that the Birchy Hill Nursing & Residential Home DS0000011414.V347508.R01.S.doc Version 5.2 Page 11 corresponding plan of care identified how this would be addressed e.g. the use a pressure relieving aid e.g. pro-pad cushion, air-bed, and/or turning regime. The plans examined also set out the actions staff had to take and what specialist equipment was needed to provide the support and assistance each person required e.g. provision of high protein diet; pro-pad cushion; walking frame; hoist to transfer; etc. Where the care plans examined referred to the use of equipment or how a specific need was to be met this was observed to be available, provided or in place. There was evidence from documentation and discussion with individuals that wherever possible they and/or their representatives had been involved in developing the plans and reviews of them and had agreed with the contents. There were brief individual care summaries in the rooms of everyone living in the home. These enabled staff who were unfamiliar with the person concerned to quickly obtain information about the most important aspects of the help that the individual required. Records indicated that risk assessments and care plans were reviewed at least monthly and daily notes referred to the actions taken by staff to provide the needs set out in those plans. Staff spoken to knew the needs of the individuals whose records were sampled and they were able to describe the contents of the care plans. Comments from people living in the home and relatives/representatives about the abilities of staff the care and support that they provided included: • “It is absolutely marvellous, I am very happy …”. • • “They help me with showering and the toilet, they are very good”. “All the staff are warm, efficient, and they know what is going on … my sister seems a lot relaxed and happier for the first time in years and I feel so relieved …”. “I would say that they are doing a good job with my wife …”. • Responses in questionnaires returned by people living in the home indicated that 37 believed that they always received the care and support that they needed, 32 usually, 26 sometimes and 5 never. As all individuals that completed the questionnaires indicated that they did not wish to speak to an inspector the responses could not be followed up with the persons concerned during the site visit. Care plans examined were not simply task focussed. They were person centred and addressed the limited understanding of many individuals due to dementia. They included many references to the fundamental principles that underpin Birchy Hill Nursing & Residential Home DS0000011414.V347508.R01.S.doc Version 5.2 Page 12 social and health care such as independence, privacy, dignity and choice and entries in plans illustrating this included the following: • “Aim to maintain privacy and dignity … encourage E to wash her hands and face … offer her a choice of clothes … always explain every intervention …”. “ Aim to reduce inappropriate behaviour … regularly orientate P … maintain privacy and dignity by closing toilet door …”. “Short term memory … use repetitive speech and memory aids … offer reassurance and remain patient …”. • • There was some discussion how some care plans could be improved by the inclusion of additional information. The records examined indicated that a range of healthcare professionals visited the home and that arrangements were made for treatment for service users when it was necessary. Individuals and relatives said that people received treatment from among others, doctors, podiatrists and opticians. • “I see a chiropodist every 2 months”. • “He saw the doctor recently because he had a chest infection”. It was suggested that care plans include specific details about how the eye, dental and foot care needs of the individual would be met. There was documentary evidence that when an individual had a wound/pressure sore that specific plans were implemented to manage the wound and monitor progress with healing. Specific plans were implemented when weight loss or eating difficulties had been identified as a problem for an individual and records were kept of their food and fluid intake and if the difficulty persisted advice and support was sought from the doctor of the person concerned. The home’s registered manager said that she was implementing a coloured tray system that would enable individuals with poor appetites to be identified readily and to ensure that staff monitored the people concerned carefully and gave them help and encouragement with feeding when required. She was also considering closing the home to visitors at mealtimes to ensure that all available staff could assist at mealtimes because of the large number of people that needed such help. It was suggested that arrangements be made for the home’s cooks to attend specialist training in nutrition and older people. Birchy Hill Nursing & Residential Home DS0000011414.V347508.R01.S.doc Version 5.2 Page 13 Individuals’ health was monitored routinely and regularly e.g. weight, blood pressure and temperature and medical equipment was regularly checked and serviced. The home’s registered manager said that she had a good working relationship with and received excellent support from a local specialist centre for psychiatry for older people. She also liaised with other specialists when necessary such as stoma nurses, stroke co-ordinator and the local district nursing service for support if necessary with managing wound care. The registered manager had delegated responsibility to registered nurses to take a lead in the home for all aspect for one of the following areas: • Infection control • Catheter care • Palliative care • Wound management The individuals concerned were expected to attend relevant training courses and to keep up to date with best practice and cascade that to nursing and care staff in the home. They would also advise and monitor situations when staff were dealing with matters within their specific area of expertise. The manager had implemented a weekly audit/review of any of wounds being cared for in the home. At the time of the site visit there was only one and it had been caused by an accident and there was documentary evidence that it was successfully healing. It was apparent from training records seen and discussion that nursing and care staff in the home had attended training in a range of clinical subjects/areas such as catheter care, male catheterisation and wound care. The home had written policies and procedures concerned with the management and administration of medication. Some reference material about medication was available but it was dated and it was suggested that more recent guidance be obtained. Medication was kept in locked and secured medicine trolleys, cupboards and where required in a medical refrigerator. Controlled drugs were stored securely and appropriately. A sample audit of controlled drugs indicated that the records were accurate and up to date. The home used a monitored dosage system with most prescribed medication in blister packs. The only staff in the home that gave out and were responsible for the management of medication on a day-to-day basis were registered nurses. Good practice noted during the fieldwork visit included: • Sample copies of the signatures of the Registered General Nurses that dispensed medication • Some sedative medication was treated as if it was a controlled drug Birchy Hill Nursing & Residential Home DS0000011414.V347508.R01.S.doc Version 5.2 Page 14 • • The dating of some medicine containers when they were opened. Protocols and related documentation/records about crushing and giving of medicines covertly It was stressed that where medication was prescribed as “when required” i.e. PRN, that the care plan of the person concerned and medication administration record (MAR sheet) must included clear instructions/criteria for its use and the outcome of its use should be recorded. The home’s registered manager was implementing a regular audit of the medication system and procedures as part of its quality monitoring system. At the time of the fieldwork visit no resident was managing all of his or her own medication. The importance of offering people the opportunity to do so based on an assessment of their ability/competence and recording the outcome of the assessment was part of a general discussion about the implications of Mental Capacity Act 2005 and individuals rights. People spoken to during the site visit confirmed that staff promoted their privacy and dignity and were polite and respectful. All shared bedrooms that were viewed were provided with screens to help with these important matters. One person spoken to confirmed that staff used the screen in his room when they helped him or the other occupant with their personal care needs. Birchy Hill Nursing & Residential Home DS0000011414.V347508.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home were able to choose their own life style, social activities and maintain contact with families and fiends. Social, cultural and recreational activities generally met individuals’ expectations. The food provided was healthy, varied and nutritious and according to the choices and preferences of those living in the home. EVIDENCE: The home employed an activities organiser and people spoken to said that they enjoyed the opportunity to participate in a range of organised activities. • “They have quizzes in the lounge, and entertainment and a religious group come every month. The activities organiser comes to see him and brings him games” (visiting relative). The home’s programme of activities was on display in its reception/entrance hall. The activities organiser said that she had attended some specialist training and was hoping to attend further training about arranging activities for older people. The home had developed links with the Alzheimer’s Society and had obtained information and ideas about activities for people in later stages of the condition. There were materials in the home that were used to promote activities e.g. board games, art and craft material, books from a visiting library, CDS and DVDs and videos. Photographs and displays throughout the Birchy Hill Nursing & Residential Home DS0000011414.V347508.R01.S.doc Version 5.2 Page 16 illustrated the special events/occasions that had taken place e.g. visits to places of interest (Longleat Safari Park and Summer Fayre) and some of the results of activities such as arts and crafts. At the time of the site visit many of the people living in the home were being encouraged to become involved in preparations for Halloween e.g. designing and making decorations. It was apparent from observation during the visit that many individuals were engaged at some time during the day in stimulating activities of some sort. Individuals were also seen pursuing their own interests such as reading the newspaper. The activities organiser said that she spent one to one time with those people who were unable to participate in group events either through choice or because they were too frail. People spoken to confirmed that they were able to exercise choice in everyday matters such as getting up and going to bed. The home’s manager said that peoples’ spiritual/religious choices were supported and that a church service took place in the home once a month. The first language of one person living in the home was German and several staff working in the home were able to converse with the person if she lapsed into using it. There was some discussion and ideas mooted as to how the cultural needs of the person could possibly be enhanced. Responses from people living in the home canvassed for their views before the site visit about the activities that the home arranged indicated that 58 believed there were always activities that they could take part in, 21 usually and 21 sometimes. All those who responded to the questionnaire i.e. 100 , also indicated that they thought the staff always listened to and acted on what they said. People living in the home and visitors that were spoken to during the site visit confirmed that there were no restrictions concerned with visiting the home. Individuals visiting the home also said that that they were always made welcome. The home did not manage the financial affairs of anyone living there. Individuals were able to bring personal items into the home including furniture and it was apparent from discussion and observation during a tour of the building that many people had taken some trouble to personalise their bedroom accommodation. There was information readily available in the home about local advocacy services including the Independent Mental Capacity Advocate service (IMCA). Sensitive information that the home held about individuals was kept secure and the home had written policies and procedures about maintaining Birchy Hill Nursing & Residential Home DS0000011414.V347508.R01.S.doc Version 5.2 Page 17 confidentiality and the right of people living in the home to access their personal files and case notes. The menus and records of food provided indicated that the food was nutritious and there was a wide range of meals provided and an alternative could be provided to the main meal of the day. Individuals’ food preferences, dislikes, food related allergies and their nutritional and dietary requirements were recorded in their care plans and that information was also readily available in the home’s kitchen. Special diets and individual and special needs were catered for e.g. soft and pureed meals, diabetics and gluten free. Fresh ingredients were used in the preparation of meals and the ready availability of fluids was noted. The ingredients for pureed meals were prepared separately. The home’s registered manager was implementing a coloured tray system to ensure that people requiring help at mealtimes were easily identified and could be monitored more effectively. She had already implemented the use of coloured drinking mugs based on research and practice that indicated that people with dementia would associate them with drinking and eating. They also enabled people with poor/impaired vision locate them more easily. Preparations for and the main meal of the day were observed in 2 of the home’s living units. Staff were sensitive and respectful when helping individuals that required assistance with eating. There was however little conversation or noise in one unit. This was discussed with the home’s registered manager who said that it was her instruction and based on research that prior to a meal the level of stimulation should be limited to enable individuals to pick up clues about the event i.e. a meal and to enable them to concentrate on the food and eating rather than be distracted. The chef came into the dining room of one unit during lunch and noticed that one person was not eating and asked the individual if they wanted something else. People spoken to said that they received four meals a day and could have drinks and snacks at other times. Comments from people living in the home and visitors/relatives about the food included: • “The food is very good, I really enjoy my meals and there is more than enough”. • “We get plenty to eat”. • “The food is generally well cooked”. Responses from people living in the home canvassed for their views before the site visit about the food the home provided indicated, that 21 always liked the meals in the home, 37 usually and 42 sometimes. Birchy Hill Nursing & Residential Home DS0000011414.V347508.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. If people had concerns with their care, they or people close to them knew how to complain. Any concern was looked into and action taken to put things right. The care home safeguarded people from abuse and neglect and took action to follow up any allegations. EVIDENCE: The home had a written policy and procedures about how complaints could be made about the service that it provided. A copy was clearly displayed in the home’s entrance hall. There was also a copy of the home’s service users guide in all bedrooms and this included a copy of the complaints procedure. People living in the home and visitors spoken to during the site visit were confident about raising any concerns and one relative indicated that she had raised a problem with a member of staff and it quickly been resolved. • “I would speak to someone official”. A record of complaints made to the home was kept that detailed the issue, and set out any agreed action to remedy the matter and its outcome. There had been 1 complaint made to the home in the previous 12 months. It was apparent from the details kept by the home that it had been resolved satisfactorily. The Commission for Social Care Inspection (CSCI) had received 1 complaint about the home during the same period that was an adult protection matter arising from a person living in the home having developed a pressure sore. A letter to the home dated 20th September 2007 from the Adults Services Birchy Hill Nursing & Residential Home DS0000011414.V347508.R01.S.doc Version 5.2 Page 19 Department of the local authority responsible for co-ordinating investigations of such matters stated: • “We feel confident now that practice has been reviewed and can conclude this investigation”. The home had written procedures available concerned with safeguarding vulnerable adults. These were intended to provide guidance and ensure as far as reasonably possible that the risk of people living in the home suffering harm was prevented. Staff spoken to said that they received training about protecting vulnerable adults and an examination of staff training records confirmed this. They were also able to demonstrate an awareness of the different types of abuse and the action they would take if they suspected or knew that it had occurred. Where subsequent to a risk assessment it was considered necessary for some form of limitation to be imposed on the actions of an individual e.g. restrict movement to prevent falls (by installing bedrails); look after lighter and cigarettes to prevent fire. Written permission/consent was obtained from all interested parties including the individual concerned where they understood the need for such preventative measures to be taken. There was some discussion about including in a care plan, where relevant, any limitation on a person’s consumption of alcohol and recording the decision in the same way as the matters referred to above. Birchy Hill Nursing & Residential Home DS0000011414.V347508.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s environment was comfortable, safe and well maintained. The home’s procedures and staff practice ensured that as far was reasonably possible residents were protected from the risk of infection. EVIDENCE: At the time of the fieldwork visit the exterior and interior of the premises, its décor, furnishings, fittings and equipment were in good repair. There was also no unpleasant odour anywhere in the building. The home employed a maintenance operative who checked many of the home’s systems including fire safety and hot water and who was also responsible for delivering fire safety training. The home’s communal area comprised 3 separate lounge/dining rooms to provide for the 3 living units into which the home was divided. There were ramps that provided wheelchair access into the home’s back garden and patio Birchy Hill Nursing & Residential Home DS0000011414.V347508.R01.S.doc Version 5.2 Page 21 areas from the 2 living units that were located on the ground floor of the building. Railings were installed in the corridors of the home and there were assisted bathing facilities including a wet rooms/shower. Hoists, slide sheets and other suitable equipment was readily available for transferring and assisting people with poor mobility and weight bearing difficulties. The home’s registered manager had started decorating the premises based on research about colour schemes that benefited people with dementia. She had also had installed and arranged signage and orientation aids that promoted people independence as it could help them readily identify facilities e.g. WC or negotiate the premises without the assistance of staff. Responses from people living in the home who were canvassed for their views indicated that 68 thought that the home was always “fresh and clean” and 32 usually. The home had comprehensive procedures in place concerned with infection control and a registered nurse had lead responsibility in the home for ensuring procedures were followed and updated when necessary. It was noted that in accordance with best practice all communal WCs that were seen were provided with liquid soap dispensers (that were full and working) and paper towels. Protective clothing was readily available and staff were observed using gloves and aprons appropriately. The home’s laundry was appropriately sited and equipped and effective procedures were in place for the management of soiled laundry items. Birchy Hill Nursing & Residential Home DS0000011414.V347508.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People had safe and appropriate support as there were enough competent staff on duty at all times. They had confidence in the staff at the home because checks had been done to make sure that they are suitable to care for them. Peoples’ needs were met and they were cared for by staff who had relevant training and support from their managers. EVIDENCE: The care team working in the home comprised, 8 registered nurses and 24 health care assistants. Out of the latter 10 (i.e. 42 ) had a qualification equivalent to at least National Vocational Qualification (NVQ) at level 2 and a further 5 were working towards the qualification. Some 10 overseas nurses had been working in the home in the previous 12 months to enable them to obtain a qualification in order to register and practice as nurses in the United Kingdom. These individuals had been deemed as having a qualification equivalent to NVQ level 3. All had completed their adaptation training and had left their employment at the home in order to take up posts elsewhere as qualified registered nurses. Consequently the ratio of care staff with a qualification equivalent to NVQ level 2 had been affected and their departure from the home for sound reasons resulted in a high staff turnover. At the time of the fieldwork visit the care staff rota setting out the minimum number and skill mix deployed in the home was as follows: Birchy Hill Nursing & Residential Home DS0000011414.V347508.R01.S.doc Version 5.2 Page 23 Registered nurses Health Care Assistants Total 08:00 to 14:00 3 10 13 14:00 to 20:00 2 7 9 20:00 to 08:00 1 4 5 The home’s registered manager was supernumerary and she was not included on the care staff rota. Apart from registered nurses and health care assistants the home employed other staff and these comprised. Activities organiser Chefs Administrator Kitchen assistants Housekeepers/cleaners Laundry assistant Maintenance operative The departure of a member of staff some weeks prior to the site visit had enabled the registered manager to slightly change the staff structure and provide extra staff on in the mornings. There was no indication from staff, visitors or people living in the home that staffing levels were other than sufficient and that the staff working there had the necessary skills and competence to carry out their roles. Comments about this included the following: • “I think there are adequate levels of staff, sometimes they seem short because there is so much for them to do … “. • • “It is the biggest unit and Shirley is increasing the staff here next week with another one in the mornings from 8:00 until 20:00 …”. “Every time I have been here there have been loads of staff at least 2 or 3 in here (unit) … and there is always some one at the front door …”. Records were examined of 4 staff that had been employed to work in the home since the last fieldwork visit to the establishment on 20th September 2006. It was apparent that in the case of 1 person that all the necessary preBirchy Hill Nursing & Residential Home DS0000011414.V347508.R01.S.doc Version 5.2 Page 24 employment checks to ensure among other things that they were suitable to work with vulnerable adults had not been completed before they had started work in the home. They had been obtained subsequently. A member of staff, who had started work after the individual referred to above, had not been employed until all her pre-employment checks had been completed. The registered manager was made aware of the importance of such checks and reminded of the legal requirements under Regulation 19 of the Care Homes Regulations 2001 i.e. to ensure that pre-employment checks are completed before anyone starts work in the home. All new staff received comprehensive induction training and health care assistants completed a common induction standards programme that satisfied the requirements of the training body for the social care workforce i.e. Skills for Care (previously the Training Organisation for Personal Social Services [TOPSS]). Staff training needs were identified through appraisals and individual supervision sessions and documentary evidence of regular supervision was seen. Staff spoken to confirmed that they participated in regular individual supervision sessions. The home’s registered manager kept a central record of all training that staff had completed and could identify readily the training needs or requirements of any individual in the home’s staff team. It was apparent from discussion with staff and examining relevant records kept in the home that they had opportunities to develop new skills and the training courses that they attended were relevant for their work roles e.g. clinical training, and in subject areas such as Dementia Care. Comments from staff about these aspects of their employment included: • “I have been here 5 years … in the last 12 months I have done fire safety, infection control, catheter care, wound assessment and care … I did a 5 day course in dementia care …”. (Registered Nurse). “I have done moving and handling, food hygiene, health and safety. Dementia care … I have done bed sore prevention and catheter care … I am doing NVQ and I have nearly finished it ... we have both done abuse and protection of vulnerable adults … we have supervision every 2/3 months … ” (2 care health care assistants). “In the last 12 months I have done wound care management and I do moving and handling and fire safety every year … some of the other nurses have done male catheterisation, venapuncture and peg feeding … I supervise health care assistants and talk with them about hygiene, keyworking, pressure sores and other clinical things …” (Registered Nurse). • • Birchy Hill Nursing & Residential Home DS0000011414.V347508.R01.S.doc Version 5.2 Page 25 Staff canvassed for their views before the site visit took place indicated in their responses in questionnaires that they had the right support and experience to meet the different needs of people living in the home. Birchy Hill Nursing & Residential Home DS0000011414.V347508.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s registered manager provided effective leadership There were systems and procedures in place for monitoring and maintaining the quality of the service provided, supporting staff and promoting the safety and welfare of everyone living and working in the home EVIDENCE: The home’ registered manager had been in her post and responsible for the day-to-day operation of it for almost 2 years and prior to taking it up she had been the deputy manager at the home for 12 months. She was a registered mental nurse and had 25 years experience working with older people with dementia/enduring mental health problems in care homes and hospital settings. She had obtained a relevant management qualification in 2006 that indicated that she had the skills and knowledge considered necessary to enable her fulfil her role. She ensured that she kept up to date with developments by Birchy Hill Nursing & Residential Home DS0000011414.V347508.R01.S.doc Version 5.2 Page 27 attending study days and seminars and she had developed relationships with the local branch of the Alzheimer’s Society. From discussion with the registered manager, and from observation and discussion with staff, people living in the home and visitors it was evident that the registered manager was; knowledgeable; organised; highly motivated; enthusiastic; responsive; concerned; held in high regard; and she kept up to date with developments in the specialist field of dementia care. Comments from staff about the registered manager included the following: “Shirley is very supportive if you don’t understand something, or you need her she will come immediately she listens to us and encourages us … she listens to people …”. “She is very good, she talks with staff, she offers a lot of help and is willing to listen to suggestions and she will make changes … she promotes team work …”. “She is very good, we can talk freely with her about any matter … she will sort out any problem … she is approachable and she is knowledgeable in clinical things and management …”. The home had systems in place for monitoring the quality of the service that it provided that included the regular use of questionnaires to obtain the views of people living in the home and other interested parties. Relatives meetings were also arranged and as a result of such consultation menus had been changed, meal times had been altered and new items of furniture purchased. The manager had also implemented new and carried out existing audits of certain aspects of the home’s systems and activities e.g. medication, accident analysis, care plan audits and weekly review of wounds. There were a range of written of policies and procedures available that helped inform staff working practice. The home’s registered manager was reviewing them and updating them as necessary and during the site visit some were identified as in need of further amendment e.g. staff recruitment. The home did not look after any money on behalf of any people living there. Relatives and/or representatives of individuals were invoiced when a person received a service such as chiropody or hairdressing. Records examined indicated that the home’s equipment, plant and systems were checked and serviced or implemented at appropriate intervals i.e. passenger lift and hoists; fire safety equipment portable electrical equipment; hot water system; etc. There were contracts in place for the disposal of clinical and household waste. Birchy Hill Nursing & Residential Home DS0000011414.V347508.R01.S.doc Version 5.2 Page 28 Records were kept of accidents Staff spoken to said and records examined confirmed that they attended regular and compulsory fire and other health and safety training. There was a fire risk assessment for the premises and regular risk assessments of the premises and working practices were undertaken. Guards covered all radiators in the home. Matters requiring remedial action that had been identified by a local environmental health officer’s report of 29th January 2007 had all been properly addressed. There were hoists, and other equipment available in the home that promoted safe working practices. Birchy Hill Nursing & Residential Home DS0000011414.V347508.R01.S.doc Version 5.2 Page 29 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X N/A X X 3 Birchy Hill Nursing & Residential Home DS0000011414.V347508.R01.S.doc Version 5.2 Page 30 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.V347508.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Birchy Hill Nursing & Residential Home DS0000011414.V347508.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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