CARE HOMES FOR OLDER PEOPLE
Birds Hill 25 Birds Hill Road Poole Dorset BH15 2QJ Lead Inspector
Debra Jones Unannounced 5 May 2005 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. Birds Hill D55 S20510 BIRDS HILL V225898 050505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Birds Hill Address 25 Birds Hill Road Poole Dorset BH15 2QJ 01202 671111 01202 660808 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) Mr B Seewooruthun Mr R Seewooruthun Mrs S Seewooruthun Miss S Seewooruthun Mrs Soussan Seewooruthun Care home with nursing - CRH (N) 72 Category(ies) of Old age, not falling within any other category registration, with number (OP) - 46 of places Mental Disorder, excluding learning disability or dementia - over 65 years of age (MD(E)) - 26 Dementia - over 65 years of age (DE(E)) - 26 Birds Hill D55 S20510 BIRDS HILL V225898 050505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The Merlin and Starling units may accommodate a maximum of 46 persons who require general nursing care 2. The Nightingale unit may accommodate a maximum of 26 persons who require mental nursing care Date of last inspection 30th September and 1st October 2004 Brief Description of the Service: Birds Hill cares for 72 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. Nightlingale is the unit which is home to the residents with mental health problems and dementia. There is 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. Birds Hill D55 S20510 BIRDS HILL V225898 050505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over 6.5 hours. The inspection was one of the two anticipated inspections of the year. Debra Jones and Susan Harvey undertook the inspection; neither inspector had been to the home before. Requirements and recommendations made at the last inspection were followed up. Inspectors looked around the building and at a range of records kept by the home. Shan and Seema Seewooruthun represented the management of the home and assisted inspectors in their work on the day. In addition 6 staff on duty and 22 of the residents were spoken to. All residents spoken to expressed satisfaction with the home and the care they received there. What the service does well:
A calm and relaxed atmosphere has been created for the residents to live in. The home is well maintained, well decorated, well furnished and very clean and fresh smelling. Staff are well trained and their training shows in the care they give to residents and the feedback the home gets from residents. Residents know the staff well and spoke highly of how caring and friendly they are. This shows that the home recruits people with the right attitude and skills to work with residents with this level of need. Any complaints that are made to the home are promptly and properly investigated and the complainant informed of the outcome of the investigation. A solid body of policies and procedures underpin the good practice at the home. The home is owned and run by the Seewooruthun family who have a very hands on approach to the management of the home. Residents benefit from their availability, their understanding of care and their ongoing investment in the home. The home is generally well organised and the care and contentment of residents is at the heart of the management and running of the home. Birds Hill D55 S20510 BIRDS HILL V225898 050505 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better:
The home has itself identified that they could place a greater emphasis on meeting the social and leisure needs and preferences of residents to improve the quality of their daily life. The home is shortly to employ a member of staff for each unit with an occupational therapy/ physiotherapy background. These staff will be given the time to concentrate on developing activities with residents. The home has prepared a service user guide and a statement of purpose. The home needs to make sure that people know that these documents are available on request and that they can also have a copy of the last inspection report if they want to. When the statement of purpose is next revised it would be good if it included more information about the specialist mental health service that is delivered on Nightingale unit. By improving the information and its accessibility potential, residents will have a better understanding of what the home can offer and if it will suit their needs. The home is not yet keeping their staff records in accordance with the law. For example not all staff have completed a Criminal Record Bureau check, or been checked against the Department of Health Protection of Vulnerable adults list, and not all files contain proof of the persons identity. Exploring gaps in employment histories and keeping records of the reasons for any gaps is a good idea. While these measures are not in place, residents are potentially at risk of having unsuitable staff working with them at the home. It would be good if the recruitment procedure was expanded to include all the things the home actually does and needs to do before employing people at the home.
Birds Hill D55 S20510 BIRDS HILL V225898 050505 Stage 4.doc Version 1.30 Page 7 One unit in the home is just for people with mental health needs. The majority of staff who work on this unit have had training to work with this group but there are some who regularly work there who have not. It would be good if the home targeted this specialist training on this group of staff to ensure that all the people involved in the care of these particular residents have a real understanding of their needs and how to meet them. Staff say that they are well supported at the home. Evidence was seen of supervision taking place but records did not show what was discussed at the sessions and just recorded training dates. Regular discussions about care practices with individual members of staff results in standards of residents’ care staying high. Protecting residents in the event of a fire is clearly a matter of great importance to the managers of any care home. At Birds Hill fire training takes place on regular basis and the regularity of that training is set by the fire service. In the sample of fire training records looked at we saw that some night staff were a little overdue with their fire training, which should be every three months. Fire drills also take place at the home and it would be good if what actually happens when a drill takes place was better recorded. The home regularly reviews their policies and procedures and will be looking to ensure that they reflect the actual practice in the home e.g. the recruitment procedure and at others to ensure that they are really clear in the message they are giving to staff e.g. the adult protection policy. 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. It would be good if the home looked at reviewing the way they analyse their accident information so that they are able to look for trends beyond that of the individual. 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. Birds Hill D55 S20510 BIRDS HILL V225898 050505 Stage 4.doc Version 1.30 Page 8 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 Birds Hill D55 S20510 BIRDS HILL V225898 050505 Stage 4.doc Version 1.30 Page 9 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. 6 is not applicable to this home. The home’s statement of purpose and service user guide, although pretty comprehensive, does not include details of the specialist mental health service available on Nightlngale unit. Also prospective residents are not routinely made aware of the availability of the guide, statement of purpose and last inspection report. This may result in prospective residents not having sufficient information to make an informed decision about moving into the home. EVIDENCE: The statement of purpose and service user guide contains all the information required by law and suggested by the Department of Health in the minimum standards. The home also has a brochure for the home. The service user guide is not routinely given out to residents and it is not clear in the brochure that the guide, the last inspection report and the statement of purpose are available on request. The statement of purpose does not give specific information about the mental health service delivered on the specialist unit – Nightingale. Birds Hill D55 S20510 BIRDS HILL V225898 050505 Stage 4.doc Version 1.30 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) EVIDENCE: These standards were not inspected on this occasion. Birds Hill D55 S20510 BIRDS HILL V225898 050505 Stage 4.doc Version 1.30 Page 11 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) EVIDENCE: These standards were not inspected on this occasion. Birds Hill D55 S20510 BIRDS HILL V225898 050505 Stage 4.doc Version 1.30 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17 and 18 The home has a satisfactory complaints system and evidence showed that complainants could be confident that their concerns would be taken seriously and proper investigations take place. The home ensures that residents retain their right to vote in elections and enables them to use their vote if they wish to. The home’s adult protection policy and evidence of recent staff training, provides a safe environment to protect residents from abuse. EVIDENCE: Since the last inspection one complaint had been made to the home and no complaints had been made to the Commission. Records showed that the complaint had been investigated and the complainant had been made aware of the findings and had been satisfied with how their complaint had been dealt with. The general election was on the day of inspection. The home had checked with residents who wanted to vote – all were on the register. A couple of residents said that they wished to vote and the home was helping them to and from the local polling station. 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. The policy was slightly inconsistent in part and this will be sorted out when the policy is
Birds Hill D55 S20510 BIRDS HILL V225898 050505 Stage 4.doc Version 1.30 Page 13 reviewed this summer. Records also showed that significant numbers of staff had recently had abuse training at the home. No concerns about abuse had been raised in the home. Birds Hill D55 S20510 BIRDS HILL V225898 050505 Stage 4.doc Version 1.30 Page 14 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) 19,20,21,22,23,24,25 and 26 Ongoing investment in the upkeep of the home maintains the comfortable and safe environment for the residents living there and anyone visiting. Bedrooms are well decorated, well furnished and personalised to suit the residents. Adequate facilities are available to meet the number and needs of the current residents. The home is kept clean and smells pleasant thereby making life for residents more pleasurable. EVIDENCE: The home is spacious, light and airy. It is well furnished and decorated and some rooms, 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 on balconies on the upper floors. All areas are accessible to people using wheelchairs. Birds Hill D55 S20510 BIRDS HILL V225898 050505 Stage 4.doc Version 1.30 Page 15 Over the last few months there has been significant building works on the ground floor of the home due to flooding. No residents live on this floor. A temporary kitchen has had to be used that has stood in the car park of the home just outside the main entrance. It is anticipated that the work will be completed in the next few weeks. Both staff and residents said that there had been no disruption to their daily lives while the works have been carried out. Appropriate equipment for individual residents was apparent throughout the premises. 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. 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 well-being. Residents spoken to, who are able to use their call bells, all had one nearby – in communal areas, or in reach - in their own rooms and were aware of what they were for, how to use them and what they expected if they did use them. The home was clean and smelt pleasant throughout. 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. Inspectors found a broken thermometer in one of the communal bathrooms, staff immediately took it out of use. Birds Hill D55 S20510 BIRDS HILL V225898 050505 Stage 4.doc Version 1.30 Page 16 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 and 30 Sufficient numbers of well-trained staff are employed and deployed to ensure that the needs of residents can be met. Appropriate documentation required by law is not yet in place for all staff thereby failing to offer full protection to residents from potentially unsuitable workers being employed 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 and exceeded. A suitable number of support staff are employed to make the home run smoothly e.g. as cleaners and to work in the kitchens. 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 undertaking 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 procedure is in place and files showed that staff completed
Birds Hill D55 S20510 BIRDS HILL V225898 050505 Stage 4.doc Version 1.30 Page 17 application forms, were interviewed and where staff were from overseas appropriate work permits and visas were in place. Regular checks with the National Midwifery Council of the qualified nurses Personal Identification Numbers are made and proofs kept. However, some documents, required by law, were missing from those staff files sampled. Not all files had proof of the person’s identification, some did not have 2 references and many did not have CRB (criminal record bureau) disclosure certificates, or proofs of checks against the POVA (Protection of Vulnerable Adults) list. Some forms were said to be with the CRB and others had not been applied for as the staff had only just come into this country. Not all files contained full employment histories and the reasons for gaps were not noted in the interview notes. The home has a recruitment procedure but it is very brief and does not cover the full processes that the home goes through before appointing any staff. Staff talked of the good quality training that they had had since working at the home. Records are kept of training that staff undertake. These showed that staff have access to a good range of basic training including manual handling, infection control, emergency aid, abuse, medicines and care. Some staff had had training in dementia but not all those employed on the specialist mental health unit – Nightingale. All qualified staff that work on the specialist unit have qualifications appropriate to their work. Evidence was seen of staff completing induction training. The induction programme is of a recognised standard. 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. Birds Hill D55 S20510 BIRDS HILL V225898 050505 Stage 4.doc Version 1.30 Page 18 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) 31,32,33,35,36 and 38. The home is generally well organised and the care and contentment of residents is at the heart of the management and running of the home. Supervision records need to be able to demonstrate that sessions have a wider focus than just training to ensure that the care of residents’ remains at a high level. Fuller records of fire drills needs to be made and fire training needs to be at an adequate regularity to ensure that residents are offered the best protection in the event of a fire. EVIDENCE: Birds Hill is owned and managed by the Seewooruthun family with Soussan Seewooruthun also being registered as the manager and being the matron of the home. She is experienced in care home management and knowledgeable about the needs of older people. She is well supported in her role by the other members of the management team. Mr Shan Seewooruthun and Ms Seema
Birds Hill D55 S20510 BIRDS HILL V225898 050505 Stage 4.doc Version 1.30 Page 19 Seewooruthun are studying for the registered manager’s award and both hope to attain this qualification in the next 18 months. 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 held on each unit of the home. 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. Residents and staff can also make suggestions at any time through the use of the suggestion box. A report of this years quality assurance activity is yet to be compiled. Policies and procedures are regularly reviewed annually and will next be reviewed in the summer of 2005. Action has been taken to address the requirements and recommendations made in the last inspection report. Where the home has any involvement with handling residents’ money records are kept of income, expenditure and balances. Supervision records show the training that staff have had but do not demonstrate that the sessions have covered all aspects or practice, philosophy of care in the home and career development needs. Messrs Seewooruthun are yet to cover supervision in their registered manager’s award. Accidents are recorded in an old style accident book. Some analysis takes place but this is linked to the individual and the current format does not lend itself to look at other trends that may emerge e.g. common places where accidents take place/ trends in time of day when accidents occur etc. Training records show that staff have had training relevant to keeping residents healthy and safe. Fire records sampled showed that some night staff were a little overdue with their fire training. Fire equipment test records were up to date. Records of fire drills do not give detail of how the drill was conducted and how effectively staff responded to it. A health and safety policy is in place. Birds Hill D55 S20510 BIRDS HILL V225898 050505 Stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x
COMPLAINTS AND PROTECTION 3 3 3 3 3 2 3 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 3 3 3 3 3 3 x 3 x 2 2 Birds Hill D55 S20510 BIRDS HILL V225898 050505 Stage 4.doc Version 1.30 Page 21 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 4 and 5 Requirement All residents and prospective residents should be made aware of the availability of the service user guide, the last inspection report and the statement of purpose for the home. All staff records required by law must be held on file i.e. proof of Identification, CRB disclosures and POVA and POVA first checks. (previous timescale of 31/10/04 not met) All night staff are to have fire training every 3 months. Timescale for action 1 October 2005 2. 29 19 1 July 2005 3. 38 23 1 June 2005 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 1 Good Practice Recommendations When the statement of purpose is next revised it is recommended that more detailed information is included about the service delivered on the specialist mental health unit - Nightingale. Where there are gaps in employment histories of prospective staff it is recommended that these be explored at interview and the reasons for the gaps noted.
D55 S20510 BIRDS HILL V225898 050505 Stage 4.doc Version 1.30 Page 22 2. 29 Birds Hill 3. 4. 5. 29 30 36 6. 38 It is recommended that the recruitment policy and procedure be updated to reflect the actual practice in the home. It is recommended that all staff working on Nightingale have training relevant to their work in respect of mental health and dementia. It is recommended that more detailed records are made of supervision sessions with staff covering aspects of practice, philosophy of care and career development needs. It is recommended that more detailed records are kept of what happens at fire drills. Birds Hill D55 S20510 BIRDS HILL V225898 050505 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole Dorset BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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