Inspection on 07/04/05 for Birchy Hill Nursing & Residential Home

This inspection was carried out on 7th April 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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 &... 12/01/06

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

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

Similar services:

21 High Street

Vale House

Chestnut Walk

The Old Vicarage

Cherwood House Care Centre

Ashley House

Ascot Nursing Home

Fountain View

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

CARE HOMES FOR OLDER PEOPLE Birchy Hill Nursing Home Birchy Hill Sway Lymington SO41 6BJ Lead Inspector Anita Tengnah Unannounced 07.04.05 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Birchy Hill Nursing Home Version 1.10 Page 3 SERVICE INFORMATION Name of service Birchy Hill Nursing Home Address Birchy Hill, Sway, Lymington, Hampshire, SO41 6BJ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01590 682233 01590 682217 Angel Care Plc CRH 50 Category(ies) of DE, DE(E), MD, MD(E) registration, with number 10 10 of places Birchy Hill Nursing Home Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 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. Date of last inspection 13 October 2004 Brief Description of the Service: Birchy Hill Nursing Home is registered to provide nursing and personal care for 50 service users in the older person category. The home has 9 shared rooms and 32 single rooms. Accommodation is provided on two floors and there is a passenger lift that provide access to both levels. The home is situated in the village of Sway close to the New Forest with some local amenities. The home benefits from an extensive and well maintained garden with access for wheelchair users. The home is owned by Angel Care Plc. Birchy Hill Nursing Home Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 7.5 hours as part of the unannounced inspection and the continuous monitoring process to ensure that the home was meeting the National Minimum Standards. Two additional visits have been undertaken since the last inspection as part of Adult Protection investigations with Social services. A tour of the building took place and care and staff records were inspected. Seven staff on duty, 11 service users, 3 professional visitors and 3 relatives were spoken to on the day of the inspection. What the service does well: What has improved since the last inspection? Decoration and furnishings are gradually being improved and a number of locks have been fitted to service users bedrooms as agreed at the last Birchy Hill Nursing Home Version 1.10 Page 6 inspection. One member of staff has started to implement a new system of care plans and risk assessments to ensure that these meet the needs of service users. At the time of the inspection, a new system of care planning was being introduced. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Birchy Hill Nursing Home Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Birchy Hill Nursing Home Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3,6 Further development of the pre- assessment documents is necessary to assure that all care needs would be met. EVIDENCE: The home has in place a statement of purpose and a service users guide that gives details of the type of care provided by the home. Further development of this document is needed and should include the complaint procedure and information on what the service users must do in an emergency such as a fire. The manager or her deputy assesses the residents prior to admission. Some information was available. The home should develop this further and involve family members/ advocates in the assessments process, as service users due to their advanced stage of dementia cannot participate in the assessments process. This can result in vital information not being available for the formulation of care plans and meeting the immediate care needs of the service user. Care management assessments should also be secured prior to admission so that all in formation is available and service users are placed appropriately. Birchy Hill Nursing Home Version 1.10 Page 9 Staff reported that service users do not visit the home due to their frailty but relatives do visit. Service users should be given the opportunity to visit the home and spend some times at the home prior to admission as part of the assessment. The home does not provide intermediate care. Birchy Hill Nursing Home Version 1.10 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 Some progress has been made with regards to care planning. The lack of consistent approach to care does not meet service users needs. The lack of appropriate care plans for the management of wounds is detrimental to the welfare and well being of service users. The omission to store all medication safely is detrimental to service users safety. EVIDENCE: Individual care plans were available and some progress has been made by the introduction of new care planning system. However there was a number of service users care plans that had not been reviewed or updated since December in order to reflect the changing needs of service users. Significant events had not been recorded and care plans and daily records in care plans gave little indication of the care provided. Where problems have been identified this was not followed by care plans to demonstrate how these needs identified would be met. Birchy Hill Nursing Home Version 1.10 Page 11 Wound care plan was not available in the case of a recently admitted service that had been identified as having leg ulcers on admission. There was no guidance to the type of dressing required/ applied. No wound assessment / body map or wound grading available. Discussion with staff suggested that some needs were being met, however there was a lack of consistent approach in the formulation and review of care plans. A requirement was made at the last inspection for service users relatives/ carers’ involvement in the formulation of care plans. There was some evidence that this has started for one service user recently admitted. On a tour of the building some medication was not stored safely as these were found on the window sill in the office that is also used to access service users rooms and stairs. This was brought to the attention to the nurse in charge and staff must assure that all medication are kept locked and only administered to service users that these are prescribed for as this may adversely affect their health and well being. Birchy Hill Nursing Home Version 1.10 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15 Dietary needs of service users are well catered for with a balance and varied selection of food available. There are no restrictions on visitors, the lack of daily activity fail in meeting service users needs and family expectations. EVIDENCE: A number of service users and relatives were spoken to and everyone commented that the food was good and the choices offered. The inspector observed lunch being served. Staff was observed to offer support with meals in a sensitive manner. Meals were nicely presented and appeared well balanced and nourishing. The home has an open visiting policy and was evidenced by the record of visitors maintained by the service. The home does no longer have an activity coordinator; a member of staff was employed but has since resigned from this post, as she did not have enough hours. External entertainers visit the home; however there is no activity programme on a daily basis and staff reported that service users would benefit from this. Care staff undertake some activities on an ad hoc basis when able. Relative spoken to also highlighted that there is nothing for service users to do as there is no activity provided for them. This was discussed with the manager and action is required in providing suitable activities to meet the needs of service users. The manager reported Birchy Hill Nursing Home Version 1.10 Page 13 that students from the local college are planning to attend the home to undertake some activities with service users. The inspector observed that the conservatory area designated as the dining room was not used. The manager reported that staff would facilitate and encourage service users in using the dining area. This was highlighted at the last inspection and little has been done to improve this situation. Consideration should be given to ensure that meals are kept warm for service users that require help with feeds and meals are not left out in front of service users until staff are available to provide assistance. Birchy Hill Nursing Home Version 1.10 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 The complaints process of the home is poor as limited information is available to service users and staff are unsure about recording of complaints. Lack of training and awareness of the prevention of abuse does not protect vulnerable service users. EVIDENCE: The home has a complaint procedure in place. The complaints procedure was not included in the statement of purpose and service users guide. Two relatives spoken to said they would approach someone in the office. Staff reported that they would report to the manager but were unsure about recording process and investigation. This needs to be addressed as these staff are left in charge of the home in the absence of the manager. The commission has received two complaints since the last inspection that have been investigated as per Adult Protection by Social Services. Staff spoken to were unsure about adult protection procedure but said that they would talk to the manager if concerned. Two staff members reported that that they were not aware of training in the prevention of abuse. In order to protect vulnerable adults accommodated. The provider must ensure that the procedure for the protection of adults is clearly understood by staff and the training in adult protection is accessed and staff updated accordingly. Birchy Hill Nursing Home Version 1.10 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,24,26 Some improvement to the décor has been achieved and further development would ensure that the home provide a pleasing and safe environment for service users. There are sufficient communal toilets and bathrooms, however these are not accessible due to other equipment stored in these areas and is detrimental to service users safety. EVIDENCE: A tour of part of the building was undertaken as part of the inspection. Twelve service users rooms have been refurbished since the last inspection. Bed covers have been replaced as part of the refurbishment. Some service users rooms have been personalised with items of personal belongings. The shared rooms had screens provided. The overall appearance of the service was homely and some areas have improved since the last inspection. Assisted bathing facility has been provided for the ground floor bathroom as required at the last inspection. A number of areas require attention in particular: Birchy Hill Nursing Home Version 1.10 Page 16 Communal toiletries should be removed from all bathrooms and all service users should have their own toiletries as this practice does not promote autonomy and choice and may be detrimental to service users well being. Bedside lightings to 12 bedrooms tested and were out of order. The manager reported that bedside lightings had been introduced following the last inspection requirement, however they are battery operated and maintaining them has proved very costly. Action plan with regards to providing appropriate lightings in bedrooms is required. A programme of refurbishment of worn furnishing in some service users rooms is also required. A review of mattress covers that are torn must be undertaken and these replaced. The fitting of blinds in the conservatory designated as dining room for Pine unit must be completed as per May 2005 timescale agreed at the inspection. This remains an outstanding requirement from the last inspection. Alternative storage areas should be found so that bathrooms are free of hazards to service users. A review of furnishing in Room 29 that is a shared room is required to ensure that call bells and bedside lighting are accessible to meet the needs of both service users. Lock in en suite bathroom in Room 23 must be repaired as this is a shared facility and does protect the privacy and dignity of the service users that share this room. Since the last inspection a programme to fit appropriate locks to service users rooms have been undertaken. The manager reported that 21 bedrooms have locks fitted to date and the 29 remaining bedrooms would be completed by June 2005. Birchy Hill Nursing Home Version 1.10 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 The procedures for the recruitment and induction of staff are not robust and may be detrimental to the safety and welfare of service users, thus putting service users at risk. EVIDENCE: The inspector looked at four staff records as part of the assessment of staff competency, the home’s recruitment and safety of service users. It found that some progress regarding Criminal Record Bureau (CRB) checks for all staff were now in place. The manager is aware that CRB clearance must be in place for all new staff prior to employment. There are some concerns that were raised with the manager regarding some staff that have been in employment for the past 6 months with no records of any induction. One staff spoken to was unsure of the fire precaution and her record showed that she had not undertaken fire safety training. This is poor practice and must be address as this practice is detrimental to the welfare and safety of service users. The manager discussed plan of introducing an induction procedure as per TOPSS guidance for all care staff. Two relatives spoken to report that some staff have poor language skills and have difficulty in gaining information about their relatives. This issue have been highlighted on previous occasion and more recently at Adult Protection meetings. The manager reported that trained staff have been given topics of discussion such as communication to research and present to their peer groups. Birchy Hill Nursing Home Version 1.10 Page 18 Birchy Hill Nursing Home Version 1.10 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,37,38. The home has recruited a manager to provide guidance and direction to staff in ensuring that service users receive a consistent quality of care. Poor accident/ falls reporting and recording does not protect service users and is detrimental to their welfare. Lack of induction and training does not promote and safeguard the safety of service users. EVIDENCE: The home has in place a manager who has applied to be registered with the Commission. Service users and relatives made positive comments about the staff team such as “courteous and hard working”. Relatives gave example of poor communication as not being understood when seeking information about their relatives. One relative spoke about admission of her mother to hospital Birchy Hill Nursing Home Version 1.10 Page 20 following a fall and experienced difficulty in understanding the staff who telephoned to inform him of the incident. The manager reported that staff are working hard to make service users records easier to access. Some records have improved, however difficulty remains in gaining a clear picture due to inconsistency in recording. This is particularly apparent for accident/falls recording and reporting. Discussion was undertaken with the manager that all falls must be recorded and reported to the Commission as per Regulation 37. Records of these should also be available at the home. This should include all incidence of unexplained injury to service users and actions taken. Other concerns of poor communication had been received from healthcare professionals on two occasions following admission to accident and emergency departments. A robust procedure must be developed and staff inducted to ensure that written information is available for example when a service user is transferred to hospital or to another service. The manager must also ensure that service users records are maintained bound and in order as access to information held in service users records have been challenging, time consuming and some records could not be found at recent Adult Protection investigations. Fire doors were maintained safely and appropriate self-closures have been fitted to doors that allow these doors to be kept open as requested by service users. The lack of fire training for some staff as confirmed by records and staff spoken to is poor practice and places residents at risks. The manager must ensure that all staff have mandatory trainings and records of these maintained that can be readily accessible. Birchy Hill Nursing Home Version 1.10 Page 21 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 2 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 2 3 3 x x x x 3 STAFFING Standard No Score 27 3 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 2 2 3 x x x 2 2 Birchy Hill Nursing Home Version 1.10 Page 22 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 5(1) Requirement A review of the statement of purpose is required to include up to date information regading the management, complaint and emergency procedures. Care plans and risk assessments must be reviewed and updated on a monthly basis or sooner to reflect any changing needs of service users this is an outstanding requirement of November 2004. Medication must be maintained safely at all times.This is an outstanding requirement of November 2004. Blind to the conservatory in Pine unit must be provided to enable service users to use this area as this is the designated dining area. this is an outstanding requirement of November 2004. Call bell systems must be accessible in all bedrooms and appropriate to service users needs.This is an outstanding requirement of November 2004. Bedside lightings in service users rooms must be availableappropriate to their needs. Version 1.10 Timescale for action 30/05/05 2. 7 15(1) (9) 30/05/05 3. 9 13(2) 30/05/05 4. 19 23(1) 15/05/05 5. 22 16(1) (2) 30/05/05 6. 25 23(1) (a) (2) 30/05/05 Birchy Hill Nursing Home Page 23 7. 8. 30 38 13(4) 18(1) (c ) 13(4) 9. 24 12(4) 16 (1) An induction programme must be in place for all care staff and records of these maintained. All staff are required to undertake manadatory training including fire safety. Records of these must be maintained in such a way that it can be readily ascertained whether all staff have received, fire drills at the frequency and intervals required by the fire and rescue service. Action plan regarding the fitting of locks to the remaining bedrooms must be submitted to the Commission. 30/05/05 30/05/05 30/05/05 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 Good Practice Recommendations Birchy Hill Nursing Home Version 1.10 Page 24 Commission for Social Care Inspection 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. Extracts may not be used or reproduced without the express permission of CSCI Birchy Hill Nursing Home Version 1.10 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!