Inspection on 05/01/07 for Birds Hill

This inspection was carried out on 5th January 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Birds Hill 23/01/06

Birds Hill 05/05/05

Birds Hill 30/09/04

Birds Hill 14/05/04

Birds Hill 13/02/04

Similar services:

The Vicarage

Fairfields Country Rest Home

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Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Birds Hill 25 Birds Hill Road Poole Dorset BH15 2QJ Lead Inspector Debra Jones Unannounced Inspection 5th January 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 Birds Hill DS0000020510.V326362.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. Birds Hill DS0000020510.V326362.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Birds Hill Address 25 Birds Hill Road Poole Dorset BH15 2QJ 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) 01202 671111 01202 660808 matron@birdshill.co.uk Mr B Seewooruthun Mrs S Seewooruthun, Mr R Seewooruthun, Miss S Seewooruthun Mrs Soussan Seewooruthun Care Home 72 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (26), Mental disorder, excluding learning of places disability or dementia (2), Mental Disorder, excluding learning disability or dementia - over 65 years of age (26), Old age, not falling within any other category (46), Physical disability (2) Birds Hill DS0000020510.V326362.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The Merlin and Starling units can accommodate a maximum of 46 persons who need general nursing care. The Nightingale unit can accommodate a maximum of 26 persons who need mental nursing care. A maximum of two service users, between the ages of 40 and 65, may be accommodated at the home at any one time. 23rd January 2006 Date of last inspection Brief Description of the Service: Birds Hill cares for 72 predominantly older people in a purpose built care home. It is set on a hill near the town centre and Poole General Hospital. The home is on four floors, with the three upper floors being used for the accommodation of the residents. There are two passenger lifts to all levels. Each floor houses a different unit. Nightingale is on the 1st floor, Merlin is on the 2nd and Starling is on the 3rd. Nightingale is the unit that is home to the residents with mental health problems and dementia. There are a variety of aids and adaptations around the building to allow residents to move about more independently. There are two double bedrooms on each floor. The rest of the bedrooms are single. Most of the rooms have ensuite facilities and there are communal bathrooms and toilets on each floor. The current weekly charges range between £525 and £850. Birds Hill DS0000020510.V326362.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 2 days and was the anticipated key inspection of the year. Due to the size of the home an inspector and regulation manager undertook the inspection. During the inspection some records were looked at. The inspectors walked around the building and met and chatted with some residents in lounges and in their rooms. The 7 requirements and 7 recommendations made at the last inspection were followed up to see if progress had been made. Shan and Seema Seewooruthun represented the management of the home and assisted inspectors in their work on the day. The staff of Birds Hill also helped the inspectors in their work. Prior to the inspection the home sent out comment cards on behalf of the Commission to people living in and interested in the service so that they could give feedback about their experience of the home. Twelve were returned from residents, 3 from relatives and 5 from GPs. All comment cards returned were generally positive about the staff and service provided at Birds Hill and all said that they were satisfied with the overall care provided there. These are some of the comments from people at the visit and that were on the comment cards sent to the Commission. ‘I’ve never had it so good.’ (a resident) ‘It is clean and tidy, I like the elevated position of the home.’ (another resident) ‘They go out of their way to keep it nice.’ (another resident) ‘It is very good on the whole, very good indeed.’ (another resident) ‘It is very good, very nice people who run it.’ (another resident) ‘It’s marvellous.’ (another resident) ‘It is very homely.’ (another resident) ‘I am very happy thank you.’ (another resident) ‘Birds Hill has a lot of very ill or demented patients. Usually care is good but occasionally staff do not have a good understanding of UK care. The managers however react very well to our concerns and correct problems quickly. They show that they are eager to learn and adapt.’ (a GP) ‘My mother has only been in Birds Hill since Jan 2006. The family are very pleased with her care, the nurses are very helpful and caring.’ (a relative) ‘Residents are well cared for and it seems like a family here.’ (a member of care staff) Birds Hill DS0000020510.V326362.R01.S.doc Version 5.2 Page 6 What the service does well: Birds Hill provides a residential care service for predominantly older people in a well decorated home that is furnished to a high standard. The home has a tranquil and relaxed atmosphere and staff polite and friendly. The home is well organised and the care and contentment of residents is at the heart of the way the home is run. A good admissions procedure is in place that ensures that only people whose needs can be met are offered places at the home. Comprehensive information about the home is available to help prospective residents to make the decision to move there. Assessments and care plans are in place for all residents. A range of community health professionals support the home’s staff in looking after the residents. Staff were observed throughout the inspection to be treating residents with courtesy, patience and kindness and residents confirm that their privacy and dignity are respected. Activities on offer at the home that residents can join in with if they choose to. The activities co-ordinator is able to spend time with residents individually if they prefer. Residents are free to spend their days doing as they wish. Visitors are always welcome at the home. Meals are varied and a choice is always available. The dining areas are pleasant and comfortable. The complaints and adult protection procedures reassure residents and their representatives that the well-being and comfort of residents is important to the home and that any concerns raised will be properly investigated and resolved. The home and grounds are well maintained, comfortable and safe for the residents living there and anyone visiting. The home is kept clean and smells pleasant. The numbers and skill mix of staff are sufficient to meet the needs of residents. Staff receive training in aspects of care work and other essential topics. There is a recruitment procedure in place that is followed to ensure that only suitable people are employed at the home. The home wants to know what people who live at the home and other people with an interest in the home; think about how Birds Hill is run and if they can Birds Hill DS0000020510.V326362.R01.S.doc Version 5.2 Page 7 make any improvements. An annual quality audit is carried out to help achieve this and a report, saying what the home did last year and is hoping to do in the next year. The home continues to withdraw from any involvement in residents’ finances. Systems are in place and records kept, that demonstrate the homes commitment to keeping residents safe. What has improved since the last inspection? The home have increased their staffing levels. They have employed an additional nurse to work with the units to improve their care documentation and to regularly audit this. They home has also employed an activities coordinator to work with residents on a 1-1 basis and do group work. The home has also increased their number of cleaners and maintenance staff. The statement of purpose has been revised and now includes more information about the services provided in the home especially the specialist mental health service that is delivered on Nightingale unit. By improving this information potential residents, relatives and placing authorities have a better understanding of what the home can offer and if it will suit their needs. The home informs people of how they can obtain the home’s statement of purpose and service user guide and that they can also have a copy of the last CSCI inspection report if they want to. The home is now routinely providing fruit juices to residents and fresh fruit is available on request. The home management has consulted with residents about what they would like to see on menus. The home is now keeping their staff records in accordance with the law. For example all staff have now completed Criminal Record Bureau checks, and been checked against the Department of Health Protection of Vulnerable adults list. The home has proof of identity of all their staff. All this is essential to show that residents are not at risk of having unsuitable staff working with them at the home. The written recruitment policy / procedure has been expanded to include all the things the home actually does, and needs to do, before employing people at the home. One unit in the home is just for people with mental health needs / dementia. Since the last inspection more staff at the home have had training to work with this resident group to ensure that they have a real understanding of the needs of residents and how to meet them. The home has surveyed residents and their relatives about views on the home. Following this a report has been compiled and an action plan developed to address the results of the surveys. Birds Hill DS0000020510.V326362.R01.S.doc Version 5.2 Page 8 The home has reviewed their policies and procedures. Policies and procedures are important in that they underpin the practice of the home and give staff direction in how they are to do things for the good of the residents. All records required to be kept by law are now being kept. This includes a recent photograph of every resident. What they could do better: The care planning system in place is designed to make sure that staff have the information they need to meet the needs of the residents but some areas of documentation need to be strengthened to ensure that all aspects of residents’ needs are being met appropriately. These include:• Making care plans specific for the individual where they have conditions that need close monitoring and care such as diabetes. • Having very robust and individual assessments in place where equipment is in place that restrains residents e.g. bed rails. • Making plans clearer about how each individual’s social care needs are to be met e.g. how the home are going to incorporate previous and current interests and hobbies into the residents daily life / the home’s activities programme. In addition where plans are in place that have moving and handling implications for the safety of the resident and staff, how staff are to approach tasks needs to be very clear in the plan and be closely monitored and reviewed. Some improvements are needed with the recording and administration of medication to protect residents. • Where changes are made to the Medication Administration Records they need to be countersigned by another competent person to show the changes are correct and that residents get the correct doses. • Pharmacist labels on bottles should never be altered. • Staff must ensure that they properly dispense medicines and complete records so that the amount of medication available to residents always matches the MAR records. • The home should replace the metal boxes they keep medicines in the fridges with plastic lockable boxes. Some good practice suggestions are made throughout the report they include:• Carrying out thematic care planning audits across the home to address areas of weakness on each unit e.g. diabetic care, bed rails assessments. • Providing training for the activities co-ordinator in how to deliver general activities and activities for people with dementia. • Regularly checking with residents that their choices and preferences are being respected to ensure that staff do not slip into routines. • Training all staff in adult protection e.g. including maintenance staff. Birds Hill DS0000020510.V326362.R01.S.doc Version 5.2 Page 9 • • • • • • • Giving consideration to the environment on the dementia unit to incorporate good practice ideas to minimise confusion. Providing training on nutrition in the elderly and nutrition and dementia for staff involved in food planning / preparation. Providing more in depth training on dementia care to the qualified staff on the specialist unit, and the nurse who is reviewing their care documentation, to keep their knowledge and practice up to date. Including how the home has responded to requirements and recommendations made by the Commission in their quality assurance report for 2007. Adding references to the Protection of Vulnerable Adults list in appropriate policies when they are next reviewed. Replacing old style accident books with ones that comply with data protection legislation. Adding regular maintenance checks of bed rails in the home to other regular health and safety checks. 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. Birds Hill DS0000020510.V326362.R01.S.doc Version 5.2 Page 10 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 Birds Hill DS0000020510.V326362.R01.S.doc Version 5.2 Page 11 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): 1, 2 & 3. Standard 6 does not apply to this home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admissions procedure enables prospective residents to make informed decisions about moving to the home and ensures that only residents whose needs can be met by the home are offered places there. EVIDENCE: The home has a brochure for the home that is given out to any people making enquiries about Birds Hill. A welcome letter is given to new residents. This includes information about where the statement of purpose and service user guide can be obtained. The statement of purpose and service user guide contain all the information required by law and recommended by the Department of Health in the minimum standards. Since the last inspection the statement of purpose has been amended and now gives specific information about the specialist mental health service delivered on Nightingale unit. Birds Hill DS0000020510.V326362.R01.S.doc Version 5.2 Page 12 Pre admission assessments are carried out for all prospective residents. A range of essential information is found out about the person. Once the home has confirmed that their needs can be met and a suitable place identified for the person in the home discussion takes place with the head of the unit where the person will be moving to. The assessment forms the basis of the care plan. Five of the 12 residents who returned comment cards to the Commission prior to the inspection said that they had enough information before they moved in to the home to decide if it was the right place for them, 7 said they did not, one of whom said ‘I can’t remember.’ The contract for residents has been amended as a response to the introduction of a new regulation to the Care Home Regulations relating to information about fees in nursing homes. Three of the 12 residents who returned comment cards to the Commission remembered getting a contract; 7 said they didn’t and the other two said ‘my family have,’ ‘my son has the paperwork.’ Birds Hill DS0000020510.V326362.R01.S.doc Version 5.2 Page 13 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 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care planning system in place is designed to make sure that staff have the information they need to meet the needs of the residents but some areas of documentation need to be strengthened to ensure that all aspects of residents’ needs are met. The health needs of the residents are met with evidence of good support from community health professionals. The home has a good medicines policy but nurses do not always follow the homes procedures for storing and administering medicines to protect residents. Some record keeping needs improving to confirm that all medicines are given correctly. Most residents confirmed that they were treated with dignity and that their privacy was respected. Birds Hill DS0000020510.V326362.R01.S.doc Version 5.2 Page 14 EVIDENCE: Since the last inspection an additional nurse has been employed 3 days a week specifically to audit, keep up to date and generally improve care-planning documentation. This is a welcome initiative and demonstrates the home’s commitment to improve the quality of care to residents. All residents at the home have care plans. Some were sampled as part of the inspection for a number of people on the different units. A range of assessments were on file that informed the plans. Such assessments included self-care, personal risk, falls, continence, nutrition, physical health, behaviour, lifting and handling. There was evidence that reviews of assessments and plans were taking place. Throughout the home there are people with confusion, dementia and mental health problems. From time to time residents display behaviour which could be described as challenging. One particular resident on Nightingale is going through a very difficult time. Assessments and daily notes document what is happening and how staff are working with community health professionals to effectively support him whilst maintaining a safe environment for other residents and staff. Generally care plans were good but the following areas were identified for clarification and improvement. It is suggested that the additional qualified nurse who carries out the regular care planning audits on each unit does some thematic audits and works with the staff on the units to address these areas of weakness. 1) Some residents have conditions that need close individual monitoring and care e.g. diabetes. Whilst this is mentioned in care plans those seen were not specific enough to the individual to properly outline the care they needed. For example they talked of making sure that blood sugar levels were within normal range, but did not state what the normal range was for the person, or what to do if they were not. 2) One resident is sleeping on a mattress on the floor. This has been appropriately assessed and is the right thing for the resident for now. However, the care plan was not clear about the manual handling implications of this e.g. how staff were to assist the person on and off the mattress without injury to either the resident or themselves. 3) Information was seen about people’s social histories but plans could be clearer about how each individual’s social care needs are to be met e.g. how they were going to incorporate previous and current interests and hobbies into their daily lives / activities programmes. Birds Hill DS0000020510.V326362.R01.S.doc Version 5.2 Page 15 4) All care files contain risk assessments. A high number of residents have bed rails and assessments do not make it clear why these are in use for the particular individual. Some residents have call bells in their rooms and others do not. Where residents are not able to use their call bell this was covered in the risk assessment and it was clear that staff were increasing their monitoring of such residents when they are in their rooms. When asked ‘do you get the care and support you need?’ Eight of the 12 residents who returned comment cards prior to the visit replied ‘always,’ 3 said usually and one said ‘sometimes.’ Comments included ‘it’s very good here, can’t fault staff.’ When asked ‘do the staff listen and act on what you say.’ Three said ‘yes’ but qualified this with the following comments ‘they don’t always understand’ ‘depending on staff and nationality of staff,’ ‘getting better. Three people said neither yes or no, saying ‘mostly’ ‘usually good at listening’ ‘sometimes depends on staff.’ One person said no ‘depending on staff.’ Three relatives responded by comment cards. All said that they were informed of important matters in respect of their relative and two out of three said they were consulted about their care where appropriate. The GPs who returned comment cards said that if they gave any specialist advice this was incorporated into the care plan. There was evidence of community health professionals visiting residents at the home including GPs, chiropodists and community psychiatric nurses. Many residents have equipment to assist with their daily living and independence e.g. mobility / pressure relieving mattresses / bed rails. Seven residents who returned comment cards said that they ‘always’ received the medical support they need; with one commenting that it was ’very good’. One said this was the case ‘usually’. Four gave no answer but all commented that they had not needed any medical support. In February 2006 the Commission pharmacist visited the home to look at their medication systems. She made 3 requirements as a result of her visit. These were followed up at this inspection. Concerns were raised that on two units medicines were being prepared in advance of administration in un-lidded pots labelled with residents’ names. Since that time practice has been improved and this is no longer happening. Medicines are stored securely. The home has Controlled Drugs (CD) cupboards that comply with the misuse of Drugs (Safe Custody) regulations 1973. Birds Hill DS0000020510.V326362.R01.S.doc Version 5.2 Page 16 Some medicines are stored in fridges in metal boxes and the temperatures of these are monitored and recorded. When medicines come to the home they are checked by the sister in charge on each unit and the medication administration records (MAR) are signed. MARs were reviewed at the inspection and it was noted that where changes have been made to the MARs they were not always countersigned by another competent person to show the changes were correct. Most medicines are supplied in monitored dosage system (MDS) blister packs. Comparisons were made of MARs and tablets on the premises. These did not in all cases tally e.g. fourteen tablets had been dispensed in a bottle, none were recorded as having been administered but there were only 10 left in the bottle. For other medicines not in the MDS this is now a satisfactory system for providing an audit trail to confirm how many tablets should be on the premises. However, some pharmacist labels on bottles had been changed to reflect altered dosages. Labels should not be altered in this way and this had been raised at the Pharmacist’s visit in February 2006. Each unit has a British National Formulary for staff to consult about medicines should they need to. The additional qualified nurse employed at the home carries out regular medication audits on each unit. It is suggested that care plans include more information about medication, perhaps having a dedicated section. This would serve, amongst other things, to provide a history of changing medication and outline in what situations ‘prescribed when required’ medication might be administered i.e. where residents are unable to make / communicate this choice for themselves and the decision is left for staff to make. During the inspection staff spoke to residents with appropriate friendly tones of voice and were seen to treat residents with dignity and respect. One resident said that staff did not always knock on his door before entering, but that he did not mind this. Another said that staff were very good and always knocked. Birds Hill DS0000020510.V326362.R01.S.doc Version 5.2 Page 17 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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ lives are enriched by the social opportunities afforded by their visitors and the social activities available in the home. Visitors are made welcome at the home and can come whenever it suits the residents. Residents are helped and encouraged to exercise choice in their daily lives at the home and to retain as much independence and control over their lives as possible. The menus show that residents are offered choice and variety. Meals can be taken in the pleasant dining areas. EVIDENCE: Since the last inspection the home have successfully recruited an activities coordinator who spends 2 days on each unit every week. Usually she spends the mornings with residents in their rooms, particularly those who do not like to / or cannot spend time in the lounge. After talking with residents about the things that they like to do more activities equipment has been purchased. Birds Hill DS0000020510.V326362.R01.S.doc Version 5.2 Page 18 Structured activities take place in the afternoons. These are lead by either the activities co-ordinator or the staff on duty. On the days of the inspection visit residents were playing ball games in the lounge, watching old films and doing puzzles. Some had interesting objects to fiddle with and others things to cuddle. Some residents said that they chose to spend the days in their rooms, listening to their radios, watching TV, reading and doing jigsaw puzzles. All described this as being their choice. Each unit has an ‘activities book’ in which the main activities that the residents are involved in daily are noted. As stated above (standard 7) care plans were not very clear about how residents are to have their specific social needs met at the home and therefore how well this was being met could not be evidenced. Residents still talk of being bored and of there being nothing to do except sleep but were not clear about how they would like to be occupying their time. One said that they would like to have more trips out of the home but appreciated this was a bad time of year to be out and about. The activities co-ordinator is yet to have any training in delivering activities for either general residents or those with dementia / mental health needs. Of the 12 residents who returned comment cards 2 said that it was ‘always’ the case that there are activities arranged by the home that they can take part in and 3 said that this was true ‘usually’ with one saying ‘don’t always like to.’ Three residents said that it was the case ‘sometimes,’ and one ‘never.’ Three did not answer with comments ‘not taken part in any yet.’ ‘Don’t like activities.’ ‘Not had much opportunity – not really very keen either.’ Visitors are welcome at any time and residents can go out of the home whenever they wish. Residents talked of how their families visited and sometimes took them out. The visitors book held in reception evidences the range and number of visitors to the home. The relatives who returned comment cards said that they felt welcome in the home at any time and that they were able to visit in private. As noted elsewhere in this report references are made to personal preferences in care plans and assessments. The statement of purpose / service user guide also talks of the choices people have in the home and how these are encouraged. Residents generally said that they were happy with the choices they were able to make in their daily lives e.g. what time they get up in the morning, what time they go to bed, what they wear and what they eat. One said that he was always woken at 6.30am which was a bit early for him but was subsequently he not rushed to get up. Staff said that the night staff got most people up before the end of their shift at 8am. Night staff make and serve the breakfast on the units. At the last inspection the home was asked to check that residents choices were being respected Birds Hill DS0000020510.V326362.R01.S.doc Version 5.2 Page 19 about when they got out of bed in the mornings etc. It is suggested that this is audit is ongoing so the home does not fall into routines that are not based on the preferences of residents. Lists of the special dietary needs of residents are readily available in the nursing stations. There is always a choice of meal at lunch and in the evening. Residents choose their meals 2 days in advance. Records are kept of what people select to eat. The menu is displayed on the board in the dining rooms on each unit. The menu changes each week and is on a four-week cycle. The lunchtime meal is cooked in the main kitchen. Suppers are prepared on the units by care staff. On the first day of inspection lunch was cod in batter or poached fish in parsley sauce, or a cheese omelette. This was served with a range of vegetables. Dessert was Swiss roll with custard or yoghurt and fruit. There is a pleasant dining room on each unit at the home though few residents eat in them. At the last inspection inspectors reported back views of residents about food. Suggestions included having fruit and fruit juices - not just the already diluted fruit drink, having more chicken on the menu. Since then real fruit juice has been introduced and is served daily. Chicken is on the menu and fruit is available on request from the kitchen. Some residents were seen to have fruit in their rooms. One said his family brought this in. Opinions on food are encouraged in the annual questionnaires sent to residents. In the quality report it is noted that the home is intending to revise their menus in Spring 2007. It is hoped that by this time the National Association of Care Catering will have published their menu and planning manual and their recommendations can be incorporated. Should it not be covered in this manual it is suggested that the chef and other appropriate staff obtain training in ‘nutrition in the elderly’ and ‘nutrition and dementia.’ Of the 12 residents who returned comment cards 3 said they ‘always’ liked the food at the home ‘excellent’ with 1 saying they liked it ‘sometimes’ and 7 saying ‘usually’ ‘but sometimes not hot enough.’ One said they never liked the food and described it as ‘dull and boring, not enough variety.’ Birds Hill DS0000020510.V326362.R01.S.doc Version 5.2 Page 20 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A system is in place to deal with complaints that are made by residents and their representatives. The home’s adult protection policy and ongoing staff training demonstrates the homes commitment to understanding abuse and of protecting residents. EVIDENCE: Since the last inspection no complaints have been made to the home or to the Commission. The comment cards sent to residents asked the question ‘Do you know who to speak to when you are not happy?’ Twelve residents sent back cards. Six answered ‘always’ to this question, one of which said ‘never been unhappy,’ Two said ‘sometimes’ and one ‘never.’ In respect of knowing how to make a complaint 2 said yes ‘always,’ 6 ‘usually,’ 2 ‘sometimes’ and 1 ‘never.’ One person commented ‘I don’t want to complain- haven’t asked.’ Two of the 3 relatives who returned comment cards said that they were aware of the complaints procedure. None had made a complaint. Birds Hill DS0000020510.V326362.R01.S.doc Version 5.2 Page 21 The home has an adult protection policy to guide staff as to how to recognise signs of abuse and to tell them what to do about it if they do. Records show staff are getting adult protection training. It is suggested that this training is extended to all staff at the home e.g. including maintenance staff. No concerns about abuse have been raised in the home in the last 12 months. Birds Hill DS0000020510.V326362.R01.S.doc Version 5.2 Page 22 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 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The standard of the environment is excellent providing residents with an attractive and comfortable place to live. Bedrooms are decorated, furnished and personalised to suit the residents. Adequate facilities are available to meet the number and needs of the people living there. The home is kept clean and smells fresh thereby making daily life for all in the home more pleasurable. EVIDENCE: The home is spacious, light and airy. It is well furnished and decorated. Some bedrooms and all communal lounges, have stunning views of Poole harbour. Outdoor space is available on the ground floor to the side of the car park and Birds Hill DS0000020510.V326362.R01.S.doc Version 5.2 Page 23 on balconies on the upper floors. All areas are accessible to people using wheelchairs. Since the last inspection all lounges and dining rooms have been redecorated and new pictures and paintings have been put up around the home. New bedroom furniture has been fitted i.e. bedside cabinets, wardrobes and drawers. Most bedrooms are single occupancy. The bedrooms visited were warm and comfortable and it was clear that residents are able to bring in personal possessions. Furniture and fittings provided by the home are in good repair and much has been recently replaced. Appropriate equipment for individual residents was apparent throughout the premises. Most rooms have en suite facilities. There are also a number of communal bathrooms and toilets, with appropriate aids and adaptations, available in the home. An emergency call bell system is fitted throughout the home in both bedrooms and communal areas. Some residents have been assessed as not able to use bells and appropriate systems are in place to monitor their wellbeing. On the two days of inspection the home was clean and smelt pleasant throughout. The home is asked to give some thought to the dementia unit and see if they can incorporate any good practice ideas in respect of environments for people with dementia. Laundry rooms were clean and tidy. There is one on each floor of the home. All laundry is done on the premises in the units. The arrangements for the ironing of residents’ clothes were not clear and it is suggested that this is clarified with staff. Eleven of the 12 residents that returned comment cards said that the home is ‘always’ fresh and clean, with the other saying that this was the case ‘usually.’ Birds Hill DS0000020510.V326362.R01.S.doc Version 5.2 Page 24 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 & 39 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient, well-trained and qualified staff are employed and deployed to ensure that the needs of residents can be met. Recruitment procedures are in place to protect residents from the risk of unsuitable staff working at the home. EVIDENCE: Clear rosters are in place that show who is on duty, on which unit and when. The notice in respect of staffing issued by the previous registration authority is still being adhered to and exceeded. Since the last inspection the home has increased the number of care assistants on Nightingale by one in the afternoons 7 days a week. They have also recruited an activities co-ordinator and an additional nurse (3 days a week) who is dedicated to monitoring, reviewing and improving care related documentation. A suitable number of support staff are employed to make the home run smoothly e.g. domestic, kitchen, maintenance and administrative staff. The number of maintenance and cleaning staff have also been increased since the last inspection. Birds Hill DS0000020510.V326362.R01.S.doc Version 5.2 Page 25 Residents were asked on the comment cards sent out from the Commission are the staff available when you need them? Six who responded said ‘always’ 5 said ‘usually’ and 1 said ‘sometimes.’ People commented ‘they come quickly when called.’ ‘When using the call bell it’s always answered straight away.’ All the relatives who returned comment cards to the Commission said that in their opinion there were always sufficient numbers of staff on duty. At present the Department of Health target is that 50 of care staff should hold an NVQ in care at level two. Twenty seven of the 45 care staff employed at the home are reported to hold this qualification. This is clearly in excess of the target set by the Department of Health. Birds Hill is recognised by the Nursing and Midwifery Council to undertake adaptation courses to enable nurses from overseas to register in this country. Prior to completing the course the candidates are employed in the home as health care assistants. This means that the calibre of the staff in respect of their knowledge and nursing experience is high. Staff files are kept for all the people working at the home. A thorough recruitment process is in place and files showed that staff completed application forms, were interviewed and, where staff were from overseas, appropriate work permits and visas were in place. Evidence is kept of how staff from abroad have performed in English language tests demonstrating how well they can speak, listen and read. The home has a written recruitment policy / procedure which has been reviewed and expanded since the last inspection. All documents and information required by law in respect of staff was available in the home. Evidence of appropriate pre employment checks were seen. Regular checks with the National Midwifery Council of the qualified nurses Personal Identification Numbers are made and records kept of when they are due to expire to prompt further checks. Staff said that they thought they got good training and were taught good things. The way that staff were conducting themselves in the home and working with the residents demonstrated that the training that they had had been understood and was being applied in practice. Records are kept of training that staff undertake. These showed that staff have access to a good range of training. Recent training has included nutrition, bowel care, catheter training, continence, oral hygiene, managing challenging behaviour. This is in addition to the essential training that staff must have e.g. manual handling, infection control. Records are kept of the content of training course delivered at the home. Most staff have had some training in dementia. All qualified staff that work on the specialist unit have qualifications appropriate to their work. Birds Hill DS0000020510.V326362.R01.S.doc Version 5.2 Page 26 It is suggested that qualified staff on the specialist unit and the nurse who is reviewing their care documentation receive more in depth dementia training to keep their practice up to date. Evidence was seen of staff completing induction training. The induction programme is of a recognised standard. Birds Hill DS0000020510.V326362.R01.S.doc Version 5.2 Page 27 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, 37 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well organised and the daily management and running of the home centres round the care and contentment of residents. Good management practice, systems in place, and records kept, confirm the health and safety of all in the home. EVIDENCE: Birds Hill is owned and managed by the Seewooruthun family with Soussan Seewooruthun being registered as the manager and acting as matron of the home. Soussan Seewooruthun is experienced in care home management and knowledgeable about the needs of older people. She is well supported in her Birds Hill DS0000020510.V326362.R01.S.doc Version 5.2 Page 28 role by the other members of the management team. Mr Shan Seewooruthun and Ms Seema Seewooruthun take very active part in the day-to-day management of the home and are both studying for the registered manager’s award. Staff spoken to said that they felt supported by the management team and had all the things they needed to do their jobs. Staff meetings take place and minutes of these meetings are made. Staff at the visit said they felt ‘well supported and Seema gives us good guidance.’ A formal quality assurance system is in place. The recent responses to the annual survey showed that residents were generally happy with the home in respect of care, staff, management and facilities. A report of this year’s quality assurance activity has been compiled and is very thorough. It is clear about how the management have responded to any issues raised by residents and relatives in the questionnaires along with what improvements have been made at the home in the last year and those that are planned for next. The home will be expanding their quality audit next year to include other stakeholders e.g. seek views beyond those of residents and relatives. It is suggested that the report include how the home has responded to requirements and recommendations made by the Commission. Policies and procedures are reviewed annually. The last review was in November 2006. It is suggested that when these are next reviewed references to the Protection of Vulnerable Adults list are included in appropriate policies e.g. that staff are checked prior to appointment and could be referred should they be sacked for abusive practice etc. Actions have been taken to address the requirements and recommendations made in the last inspection CSCI report. The home now has very little involvement with handling residents’ money. Over recent years they have moved towards a system whereby the home invoices residents / relatives for any money spent by residents, after it has been spent. All records requested were made available. All files sampled contained a recent photograph of the resident. Accidents are recorded in an old style accident books, not compliant with data protection legislation. Summaries of accidents are compiled monthly and where residents are having concerning numbers of accidents these are discussed and plans are put in place to minimise further risk. Fire equipment test records were up to date, as were records of fire drills and staff training. A new fire alarm system was installed in June 2006. Birds Hill DS0000020510.V326362.R01.S.doc Version 5.2 Page 29 Dorset Fire and Rescue Service last visited the home in February 2006. A health and safety policy is in place. There was evidence to show that the home take their health and safety responsibilities seriously. Maintenance and associated records are kept. Proof was seen of recent contracts and records of equipment inspections and services. A food hygiene inspection took place in August 2005. This assessed the home as having good practices and procedures. The premises were found to be in a clean condition. Medicines and Healthcare products Regulatory Agency guidance was shared with the home in respect of the use of bedrails. The home was agreeable to adding regular maintenance checks of the bed rails to their other regular health and safety checks. Birds Hill DS0000020510.V326362.R01.S.doc Version 5.2 Page 30 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 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 3 3 Birds Hill DS0000020510.V326362.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 15 Requirement The registered person shall prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. This must include the following Being clear about how residents’ specific health conditions are to be monitored and responded to e.g. diabetes. Improving clarity over how each individual’s social care needs are to be met e.g. how the home is going to incorporate previous and current interests and hobbies of residents into daily lives / activities programmes. Timescale for action 01/03/07 2. OP7 13 1) The registered person shall 01/03/07 make suitable arrangements to provide a safe system for moving and handling residents. e.g. for the resident who is sleeping on a mattress on the floor the care plan needs to be clear about the manual handling implications of this e.g. how staff were to assist the person on and off the mattress without injury to either the resident or DS0000020510.V326362.R01.S.doc Version 5.2 Page 32 Birds Hill themselves. 2) The registered person shall ensure that no service user is subject to physical restraint unless restraint of the kind employed is the only practicable means of securing the welfare of that or any other service user and there are exceptional circumstances. e.g. A high number of residents have bed rails and assessments do not make it clear why these are in use for the particular individual. 3. OP9 13 (2) The Registered Person shall 01/04/07 make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received in the care home including: • Recording the administration of medicines accurately and countersigning the MAR chart to confirm the directions and the quantity received are correct. • Not altering pharmacist labels on bottles. Birds Hill DS0000020510.V326362.R01.S.doc Version 5.2 Page 33 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 OP9 Good Practice Recommendations The home should replace the metal boxes they keep medicines in in the fridges with plastic lockable boxes. Birds Hill DS0000020510.V326362.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 Birds Hill DS0000020510.V326362.R01.S.doc Version 5.2 Page 35 - 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. 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