Inspection on 03/08/07 for Birkdale Park

This inspection was carried out on 3rd August 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

Birkdale Park 12/08/09

Birkdale Park 24/06/09

Birkdale Park 16/02/07

Birkdale Park 09/02/06

Birkdale Park 09/08/05

Birkdale Park 09/02/05

Birkdale Park 10/08/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Birkdale Park 6 Lulworth Road Southport Merseyside PR8 2AT Lead Inspector Mrs Margaret Van Schaick Unannounced Inspection 3rd August 2007 08:15 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 Birkdale Park DS0000017226.V346745.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. Birkdale Park DS0000017226.V346745.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Birkdale Park Address 6 Lulworth Road Southport Merseyside PR8 2AT 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) 01704 566055 Mrs Carol Patricia Cunningham Mrs Diane Furnivall Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Birkdale Park DS0000017226.V346745.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 25 OP Date of last inspection 16th February 2007 Brief Description of the Service: Birkdale Park provides nursing care for 25 older people. It is owned by Mrs C Cunningham and is managed by Mrs D Furnival. The home has been converted from a large house to a care home and is situated in a residential area of Southport. It is on the main bus route to town and is close to Birkdale village. Recreational areas comprise of a lounge to the front of the building and a conservatory overlooking the garden. This room is also used as a dining room. The home has single and double bedrooms but all rooms are currently used to provide single accommodation. There is lift access to both floors and the mezzanine level (floor not serviced by a lift) has 2 bedrooms. These bedrooms are accessed by a short flight of stairs and a chair lift has now been fitted. The home has 2 bathrooms with adapted baths to assist those who are less independent and a call system with an alarm facility. Gardens are landscaped to the front and rear; the rear garden is spacious and enclosed. The home has ample car parking space and a minibus is available for hospital appointments and trips out. Birkdale Park DS0000017226.V346745.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 two days and lasted approximately 9 hours. 22 residents were accommodated at the time of the inspection. A full tour of the premises took place including public areas and most of the residents’ bedrooms. A number of residents were spoken with and three interviewed on a one to one basis. One relative and two staff were interviewed. Discussion took place with the cook, the registered owner, deputy manager and two registered nurses. The interviewees gave the inspector their views on how the service was run. Two residents were case tracked as part of the inspection (when the inspector examines the assessment process, care plan and other care documentation in detail with regard to the three residents during their stay and gains their views of the service). Other care records including health and safety documentation were examined. All the key standards were inspected. Satisfaction forms “Have your say about….” Were distributed to a number of residents, their relatives and health professionals prior to the inspection visit. Due to problems with the post only two relatives questionnaires were returned. None of the residents’ questionnaires were completed at the time of inspection. Weekly fees range from £471-£550. What the service does well: The service has an effective and detailed pre admission process that ensures prospective residents have their healthcare and personal care needs identified. This ensures that the service is able to meet their individual needs. A relative interviewed stated, “we came here and found the surroundings homely. Diane came to see mum in hospital, there was only one empty bedroom-quite a big room”. Care plan documentation is completed well with management of health and personal care needs in detail and specific to the individual resident. One resident interviewed stated, “I’m happy with the care delivered at Birkdale Park”. Residents are protected by the services policies and procedures. The service listens to residents/relatives concerns/complaints and investigates them thoroughly. Residents interviewed stated, “ I feel quite confident that the manager would deal with any concerns”. Birkdale Park DS0000017226.V346745.R01.S.doc Version 5.2 Page 6 A resident was complimentary about the laundry service and stated, “the laundry is good, dirty washing is removed daily and washed and ironed”. The kitchen was clean and organised during the inspection visit. The last environmental health report comments were, “very good standards of hygiene”. Staff employed in the service enjoyed working there. One staff stated, “I love coming in to do my job, I love my job”. Residents interviewed were very complimentary about the staff and stated, “the girls are very good and very good nurses too, they come and say good morning to you, they are very nice”, “they are all very nice form the lowest to the highest, they are kind” Residents’ healthcare needs are generally well met. Residents looked comfortable and well cared for. Residents interviewed about their healthcare were happy with the care staff provided. One resident also stated, “staff come straight away when you ring”. A relative interviewed stated, “I come here more or less every day and I’m quite impressed with the staff they treat the residents very well, I’ve not seen anything otherwise, they are all polite and seem very dedicated, I can’t speak too highly of them”. One relative commented, “from what I have seen they show a great deal of care for all their residents”. Residents’ religious needs are met. The service ensure all residents are accommodated whatever their religion. One resident stated, a new Chaplain comes here and recently gave me Communion”. The service is generally well managed and residents’ health and welfare are promoted. What has improved since the last inspection? The Statement of Purpose has been implemented and includes details as requested. The service has produced a plan of activities with reference to individual residents abilities and preferences. Training needs have been assessed and a training plan has been outlined for each staff member training with goals still to achieve with timescales and dates identified. Most of the staff has attended the mandatory training and records evidence courses attended. Staff have now attended POVA (Protection of Vulnerable Adults) training. Training schedules are well on the way to being fully completed. Residents have signed and agreed care plans as evidenced on care files. Some of the residents interviewed remembered their care plans with some not. Birkdale Park DS0000017226.V346745.R01.S.doc Version 5.2 Page 7 Residents interviewed stated, “I haven’t seen my care plan but senior staff have discussed care with me” and “yes, I have read it and signed it”. Risk assessments are in place with regard to residents who wish to have their doors open. The service is looking to the costs of providing safe door ‘catches’ Supervision is carried out and evidenced in staff files. Audits are carried out on a regular basis to monitor various areas including care plans, training and medication. Financial records are available and records evidence correct procedures are carried out. Up to date information is now going to be kept on the premises. What they could do better: One of the residents has a problem with a recurring pressure sore and this is recorded on the daily record. There is no diagram relating to this specific problem. One of the residents was prescribed two medications to be taken four times a day and was just taking it twice a day therefore the service need to review this with the GP. Medication management needs to be improved to ensure the correct procedures for all medication transactions. There is insufficient choice available for residents evening meals. Although residents were happy with breakfast and lunch they were unhappy with the evening meals. Most evening’s residents are served sandwiches. This is not satisfactory therefore the service need to ascertain residents’ personal preferences with regard to the evening meals. The menu needs to be reviewed to ensure individual residents preferences are taken into account when planning the evening menu. Residents interviewed stated, “the food is very nice but I don’t like the tea, I buy something for myself”. The service needs to ensure that residents who use the conservatory have protection from the hot sun and good ventilation to make it a comfortable place to spend time in. Recruitment practices for staff are not robust to protect the residents. References were missing in two of the staff files. Standards of care may be compromised, as care staff undertake kitchen duties. One resident interviewed stated, “I think they are short of staff”. Please contact the provider for advice of actions taken in response to this Birkdale Park DS0000017226.V346745.R01.S.doc Version 5.2 Page 8 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. Birkdale Park DS0000017226.V346745.R01.S.doc Version 5.2 Page 9 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 Birkdale Park DS0000017226.V346745.R01.S.doc Version 5.2 Page 10 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): Quality in this outcome area is good. The service has an effective and detailed pre admission process that ensures prospective residents have their healthcare and personal care needs identified. This ensures that the service is able to meet their individual needs. This judgement has been made using available evidence including a visit to this service. OP 3 was assessed. Op 6 is not applicable. EVIDENCE: Three of the residents care documentation with regard to the pre admission process was examined. The manager carried out all three assessments with her signature evidenced and date the assessments were carried out recorded. The documentation evidenced that full and detailed assessments were carried out. Information includes personal details, such as next of kin, GP, allergies, personal preferences with regard to daily routines, diet, fluids, skin integrity, mobility, appliances used, safety measures to be put in place, oral health, eyesight, hearing, history of falls, night routines and sleep pattern, Birkdale Park DS0000017226.V346745.R01.S.doc Version 5.2 Page 11 medications, previous medical history, foot care, communication, family input and the suitability of the bedroom available. Residents are also asked if they wish to have a private telephone line. Religious needs are addressed also. Residents are also asked about preference of female or male carer preferences in relation to personal care. Outcomes of the assessment process are also recorded with the arranged admission date and time recorded where agreed. Reference is also made with regard to the next of kin [NOK] being advised of the decision. One of the residents care documentation also evidences a copy of the continuing care assessment. Residents interviewed with regard to the pre admission process stated, “my daughter fetched me to look around and I met with the matron” and “my daughter came and looked at the home, she chose the bedroom, there was no assessment”. Documentation relating to this residents assessment is in place. One other of the residents interviewed was unable to view the service prior to admission therefore their nok did this on their behalf stating, “the home was chosen for me by … and she went round a few when it was obvious that ….was going to close. A relative interviewed stated, “I was given a list of homes by the hospital. We came here and found the surroundings homely. Diane (manager) came to see mum in hospital, there was only one empty bedroomquite a big room”. Birkdale Park DS0000017226.V346745.R01.S.doc Version 5.2 Page 12 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): Quality in this outcome area is good. Residents’ healthcare needs are well met, and acted upon. This judgement has been made using available evidence including a visit to this service. OP 7,8,9,10 were assessed. EVIDENCE: The two residents care plans and documentation case tracked, evidenced clear and detailed plans of care. Care plans showed that regular monthly reviews of the care needs are in place. Care planned is specific to the individual residents needs. There is documented evidence of residents’ signature and dates to agree the care recorded. In some cases the residents relatives do so on their behalf. One file evidenced a letter from the resident’s family regarding previous and present assistance required in detail for their care. Some of the residents interviewed were unsure of the care plans with some agreeing that care needs are discussed with senior staff. One resident interviewed stated, “I haven’t seen the care plan but senior staff have discussed care with me”. Another resident interviewed stated, “yes, I have read it and signed it. I’m happy with the care delivered at Birkdale Park”. Birkdale Park DS0000017226.V346745.R01.S.doc Version 5.2 Page 13 One staff interviewed stated, “ I have seen the care plans, read them all, we are encouraged to especially with new residents”. Care plans are set up on admission to the service on a typed format. The care plans viewed evidenced a comprehensive list of possible needs including personal care, diet, fluid intake, sleep pattern, communication, sexuality, mobility, and skin integrity. Individual residents health and care needs are added to the basic format and provide a detailed plan of care. Additional areas are also looked at including, further rehabilitation for residents, additional equipment needed to ensure resident comfort and safety and personal preferences. Individual activity plans are also in place and are signed and agreed by the resident/relatives. One viewed was signed by manager and son with the specific interests and future plans and rehabilitation of the resident including family input and support. Residents’ documentation also evidences incontinence advice referral, social work reviews of care, eyesight appointments and treatments including chiropody. Professional visit records also evidence GP, speech therapy, physiotherapy, hospital appointments and community psychiatric nurse input. Residents interviewed agreed that their individual care needs were being met and stated, “the Doctor has been twice, I’m on antibiotics for a chest infection, I’ve had an eye test and the optician has given me new glasses, they visited me here, the chiropodist comes every so often and “It’s alright, they are quite decent and nice, I have to stop in bed as I have a break in my leg, it’s improving. I’m on analgesia (pain relief) for it”. A relative interviewed confirmed that a specialist physiotherapist has been accessed for his mum and stated, “there has been a great deal of improvement. the plan is to have mum back at home, we will try the weekends at first for a few months, we are kept informed I’m here every day. The Doctor comes he came last week as mum has a bad chest. If I ask can mum see a Doctor they are pretty “good at it”. Risk assessments are in place including, Waterlow scores (tool to measure risk of developing pressure sore) falls risk and the management of this. Accident records are in place and completed correctly. Manual handling assessments, bed rail assessments, (bed rails are in place where agreed and ‘bumpers’ are in place to provide protection for residents), nutritional assessments, weights or girth measurements are recorded. These are reviewed monthly or sooner where needed. There is also evidence that care summary reviews take place with family input where agreed. Where residents have a problem with a recurring pressure sore they are well managed however diagrams would assist staff with the overall treatment. Birkdale Park DS0000017226.V346745.R01.S.doc Version 5.2 Page 14 Medication records were viewed. A monthly stock check is carried out and only medication needed for the next month is ordered. A medication ‘returns’ book is in use and records amounts, strengths and dates of medications. Cupboards are locked and medication stock is in date and fairly organised. Eye drops are dated on opening, which is good practice. A medication fridge is in use and temperatures are recorded. A short medication audit was carried out during the visit and all medication was accounted for. One of the residents was prescribed two medications to be taken four times a day and was just taking it twice a day therefore the service need to review this with the GP On the 2nd day, medications were signed for only after completing the full medication round. The nurse’s pen had run out. There were no missing gaps anywhere else on the records just for the signatures earlier that morning. Therefore it is recommended that the manager review the medication procedures. Residents interviewed confirmed their medication was always given and on time. One resident interviewed stated, “yes, the medicines are given on time”. Residents do not share bedrooms. Many of the residents have their bedroom doors wedged open. Risk assessments are carried out with regard to this, agreed by residents, their relatives and documented in care files. Residents interviewed stated, “I like my door open all the time, staff always knock on the door”. A relative interviewed stated, “Mum gets concerned about going to the toilet and having to wait”. Other residents interviewed stated, “staff come straight away when you ring, they’ve been told not to leave people in wet pads as your bottom gets sore-I’ve had no trouble that way” and “I only have ladies to help with personal care, I only want a lady. I like staff to come and wash me early. I have drinks in the night, and staff answer the buzzer quickly”. Birkdale Park DS0000017226.V346745.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Residents are consulted with regarding social activities, and activities are prepared in accordance with their wishes. Evening meals have insufficient choice available for residents, which is a negative focal point for people in the home. This judgement has been made using available evidence including a visit to this service. OP12,13,14,15 were assessed. EVIDENCE: A staff member has been appointed to carry out a review of activities and this person has carried out a detailed plan with regard to individual residents abilities. The record shows suggestions for activities that would suit the individual resident. A large amount of effort has gone into this review of residents and include alternatives such as reminiscence, gentle movements/exercises, exploring senses, discussions, pamper days with foot spas were appropriate, craft days, games days and entertainment. A weekly programme has been set up and a full programme of activities has been planned for 2007. This was viewed. The plan identifies residents whose physical abilities match the activities. It is due to commence in the afternoons. The programme also evidences materials and costs have been identified. Birkdale Park DS0000017226.V346745.R01.S.doc Version 5.2 Page 16 A relative interviewed stated, “they have started doing activities in the afternoons, the piano a few afternoons and a guitar in the conservatory, the sisters do occasionally talk to mum”. One resident interviewed stated, “the residents all seem happy here”. Residents interviewed stated, “I’ve heard some activities going on but I like my own company”, “there’s not really much to do here, I’ve got my own telly” and “someone plays the organ on Wednesday afternoons, this Wednesday a lady came to sing”. Many of the residents stay in their own rooms all day with little interaction. When asked how some of the residents mix with others one resident stated, “there is a lot with senile dementia, I’ve been introduced to other residents but none have spoken to me”. Another resident stated, “I go home on Sunday for the day and have tea. Every day I go out for a walk in my wheelchair (with family)”. Relatives and other visitors are encouraged to visit the service when wished. Residents interviewed stated “there are no restrictions with visiting, they come when they want to” and “visitors can come at any time they are offered a drink when the drinks are going round”. Religious needs are addressed and residents can chose to take Communion with ministers of local churches. One resident interviewed stated, “a new chaplain comes here and recently gave Communion”. Residents are asked about personal preferences and how they like to spend their time during the assessment process. Residents interviewed stated, “I’m an early riser, I like to get up at about 7.30am, have breakfast in my room and I have lunch in the conservatory and tea in my bedroom. It gets very hot in the conservatory with all that glass, I don’t like the heat it makes me feel sick”, “I’m ready for bed at 6pm and usually go at 7pm, I’m so tired” and “I retire to bed at 10-10.30pm, when I wish to”. Residents are able to eat their meals in the conservatory or their own rooms. Residents interviewed stated, “the food is very nice but I don’t like the tea, I buy something for myself, I know it’s extra money but I like to enjoy my food, I can ask for scrambled eggs or beans, we get a good dinner it’s very good and a pudding, breakfast is very good”, “the food is very good, I take what is given, I’m sure we do have a choice it’s very nice though, staff often ask me if I would like a drink if I’m awake at night, the evening meal is usually sandwiches and something sweet” and the food is quite good, a proper dinner and sweet (at lunchtime), sandwiches and a sweet at night and a drink at suppertime with biscuits, you can get a choice if you want, I’m quite satisfied with what I’m getting. A relative interviewed stated, “she’s not unhappy here but would like to be at home, the foods okay they tend to make sandwiches (at tea time), mum is buying her own food for the afternoon as there is no choice”. Birkdale Park DS0000017226.V346745.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is good. Residents are protected by the services policies and procedures. The service listens to residents/relatives concerns/complaints and investigates them thoroughly. This judgement has been made using available evidence including a visit to this service. OP16,18 were assessed. EVIDENCE: A copy of the complaints procedure is in place with contact details of the Commission. A relative interviewed stated, “I think I’ve seen the complaints procedure in the handbook”. Residents interviewed stated, “I presume if I was concerned I would speak to the sister”, “there is a complaints procedure in the home, if I were worried I would be able to talk to senior staff” and “I feel quite confident that the manager would deal with any concerns”. The complaints log was viewed. There have been two complaints in the past year. Both complaints have been fully investigated and outcomes have been recorded. No complaints have been raised with the Commission. Care staff interviewed confirmed that they had attended pova (protection of vulnerable adults) training recently with training files confirming this. Through discussion with staff it is evident that they have a satisfactory knowledge and understanding of various forms of abuse and are aware of the procedures for reporting it. Staff interviewed stated, “I feel confident that senior management would deal with it”. Birkdale Park DS0000017226.V346745.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is adequate. The temperature in the conservatory becomes very hot in the sun and is posing a risk to the residents who use it. This judgement has been made using available evidence including a visit to this service. OP19,26 were assessed. EVIDENCE: A tour of the service took place, including most residents’ bedrooms and public areas. Residents do not use the sitting room to the front of the service at present as many of the residents are poorly and on bed rest. It would be of benefit to the other residents who are well enough to use this facility as it offers a quiet area overlooking the front garden. Three residents were sitting in the main conservatory and this large room is used for residents to watch television and dine also. The room overlooks the rear garden and offers a pleasant aspect. The conservatory was warm and there is no ventilation as there are no windows. A fan was available but not switched on. There are no blinds to protect residents from the hot sun. Birkdale Park DS0000017226.V346745.R01.S.doc Version 5.2 Page 19 This has been brought up at previous inspections and nothing has been done about it. The service needs to monitor the temperatures and provide some form of shade for residents. One of the residents interviewed during the visit told the inspector that the conservatory was too hot and made her feel sick. Residents interviewed stated, “I have brought some of my things into my bedroom but not a lot” and “I like my bedroom but would like it a bit bigger, it has too much in it”. Bedrooms are personalised and most are comfortably furnished. There are some areas that need attention including one bedroom, which had an unpleasant smell. All other areas of the service were clean and odour free. Bedroom 15 fire exit door was sticking to the floor therefore difficult to open, the fire escape route to the external landing on the first floor was partially blocked with three old mattresses and these were removed before the 2nd day visit, a further bedroom was very cluttered on the first day of inspection, but had been resolved by the 2nd day visit, the carpet in one bedroom is worn near the bed and sink area. Ramps give residents access to the garden grounds. A maintenance person is employed full time and records show that a maintenance schedule is in place. The maintenance person also carries out additional duties such as housekeeping duties. The laundry area is separate from the kitchen facility. Residents interviewed about the laundry service stated, “the laundry is very good” and “the laundry is good, dirty washing is removed daily and washed and ironed”. The walls and floors are all tiled and liquid soap and hand towels are available for staff. The laundry was reasonably well organised and satisfactorily clean. The kitchen is tiled throughout including walls and floors and all are intact and clean. The small fridge in the main kitchen needs replacing as the bottom shelf is badly damaged. The owner advised the new fridge had been ordered and was due the next day. The kitchen was clean and organised during the inspection visit. Birkdale Park DS0000017226.V346745.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is adequate. Recruitment practices are not robust to protect the residents. Standards of care may be compromised, as care staff has to undertake kitchen duties. This judgement has been made using available evidence including a visit to this service. OP 27,28,29,30 were assessed. EVIDENCE: The duty rota was viewed and evidences staff employed in the service. The cook is on duty 9-2pm each day. The weekend cook works from 10-2pm on Saturday and 8-2pm on Sundays. Care staff have to work in the kitchen in the mornings to prepare and serve breakfasts. The cook prepares the evening meal but care staff have to go into the kitchen to serve the teas. There are also many residents who need full assistance of staff at meal times. Staff still have to provide care to residents during these times. This is not satisfactory. Care staff should be free to provide care to residents and assistance with personal care throughout the day. Staff interviewed confirmed they spent time in the kitchen and stated, “Sandwiches are prepared in advance by the cook but other stuff, like scrambled eggs have to be done by the care staff. Care staff prepares breakfast, cereals and toast. There is a risk of cross contamination during these times. The service needs to look at how they can manage mealtimes better. Since the inspection the service have re arranged breakfast times and the manager confirmed that additional staff are in the process of being recruited to assist in the kitchen. Birkdale Park DS0000017226.V346745.R01.S.doc Version 5.2 Page 21 Staff interviewed were confident that residents needs were not compromised but valuable time that needs to be spent with residents is being compromised. A relative interviewed stated, “they could probably do with more staff, possibly when they are feeding, when going to the toilet, mum gets concerned if she has to wait”. Laundry and domestic cover is supplied daily and the service shows that most areas of the service are clean and hygienic. 6 care staff are qualified to level 2 NVQ and 4 are working towards it. One carer is qualified to level 3. Two staff files were examined. Not all pre employment checks are carried out. One file evidences one reference but this person has been employed for 6 years and there have been no problems during employment. The other file has no references in place. This person has been employed since February this year. The owner explained that this employee was known to them and had already worked for the family. CRB (Criminal Record Bureau) and POVA checks have been carried out. There is evidence of supervision and annual staff appraisals. Training records evidence Induction, mandatory and POVA training with most up to date. The training for the service has been reviewed and training schedules are well on the way to being fully completed. Certificates of attendance are in place. A training and development plan is evidenced for each and a record is kept of training needs, goals still to achieve with timescales and dates. One of the staff interviewed confirmed they had an induction and stated, “my induction lasted two months and I was supervised by a senior carer and Nurse”. The content of the induction needs to be documented in the staff files. Staff interviewed confirmed that they had attended mandatory and other training. Staff interviewed expressed an interest in attending Dementia training. Equality and diversity training has not been addressed. Staff interviewed stated, “I like it here, you get attached to the residents, it’s good for the residents who have been here for years who have become poorly, they know and recognise me, I think the residents get good care”, “it’s alright, I like it, staff are nice to work with” and “I love coming in to do my job, I love my job”. Staff interviewed discussed the hours worked. One staff stated, “I don’t want to work any more than my regular hours but I am often put on the duty sheet for more hours and I don’t want them, sometimes there are lots of extra hours, there is not enough staff”. Birkdale Park DS0000017226.V346745.R01.S.doc Version 5.2 Page 22 Residents interviewed were very complimentary about the staff and stated, “Staff are very good, the girls are very good and very good nurses too, they come and say good morning to you, they are very nice”, “staff are very nice, they are all very nice form the lowest to the highest”, “I’ve met Diane the manager, can’t fault any of them really”, “Diane is quite nice, Geri is very good at her job”, “staff are nice, they all speak good English, they are kind and “I think they are short of staff”. A relative interviewed stated, “I come here more or less every day and I’m quite impressed with the staff they treat the residents very well, I’ve not seen anything otherwise, they are all polite and seem very dedicated, I can’t speak too highly of them”. One visitor to the service commented, “from what I have seen they show a great deal of care for all their residents”. Birkdale Park DS0000017226.V346745.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is good. The service is generally well managed and residents’ health and welfare are promoted. This judgement has been made using available evidence including a visit to this service. Op31,33,35,38 were assessed. EVIDENCE: The registered manager has been in post for approximately 10 years. The manager is a registered nurse and has gained the registered managers award in 2004 and NVQ Level 4. The training matrix evidences what courses the manager has attended in the last year including mandatory training, risk assessment and medications. Staff interviewed stated, “Diane is alright, I’m confident approaching matron and senior staff”. Friends who visit the service commented, “we were pleased with the efforts made by the manager/nurse Diane to enable ….to settle in her new home” Birkdale Park DS0000017226.V346745.R01.S.doc Version 5.2 Page 24 An external quality assurance system is in place and it was reviewed again in March 2007. The manager carries out an internal quality assurance. Responses from residents’ questionnaires are generally positive. The service does not hold residents meetings at present and instead arranged an invitation to families to join the residents for a buffet in May of this year. Letters were sent out to all the relatives with a few attending. The staff found the event to be positive and were able to communicate with the relatives of the residents on an informal basis. The service has thank you letters and cards from families expressing their thanks for the care their relative received whilst at Birkdale Park. The service has a regular staff and residents newsletter printed every 3-4 months. The inspector was available to view the January 2007 edition. Staff meetings are held on a regular basis throughout the year. The last full staff meeting was held in May this year to discuss various issues. Minutes were viewed and included such areas as staff training, CSCI inspections, thank you letters and new equipment. Registered nurse meetings are held also with the most recent in March this year with minutes viewed and areas discussed include staff levels, staff shifts and items needed such as new sheets. Residents interviewed about their personal finances stated, “…. and …. (NOK) look after my money”. One relative interviewed stated, “I see to mum’s money”. The owner is appointee for one of the residents whose financial records were viewed. Mrs Cunningham brought the financial records in to the service. The records evidence weekly allowance, expenditure and running balance. Signatures are evident and receipts are kept of all financial transactions. Another resident’s financial records were examined also. The records show all areas as above. All well documented. Most mandatory training is up to date with just one or two staff remaining to attend sessions planned later this year. The manager carries out audits for many areas including care plans, medication, activities, training, health and safety, laundry, maintenance, food safety and housekeeping. The most recent audit in July 2007. All servicing of all appliances and equipment used in the service has been carried out and is up to date as evidenced through certificates held. There is a planned maintenance schedule for the year with dates recorded on file. Birkdale Park DS0000017226.V346745.R01.S.doc Version 5.2 Page 25 The fire alarm system records were viewed from 28/4/07 to 4/8/07. Various fire alarm points are checked throughout the service on a regular basis. The fire bell is checked each Monday and this was witnessed during the 2nd day of inspection. Hot water temperatures are checked regularly at various outlets and recorded. Thermostatic valves are fitted throughout the premises. Hazardous substances are stored outside in a lockable store and data information is included. The file was viewed. First aid boxes are situated in the office, kitchen and treatment room. Birkdale Park DS0000017226.V346745.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 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 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Birkdale Park DS0000017226.V346745.R01.S.doc Version 5.2 Page 27 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 OP15 Regulation 16 (2) (i) Requirement The registered person must ensure that residents have a choice of meals in the evenings and individual preferences are catered for. The registered person must ensure that sufficient staff are employed to ensure that residents care needs are not compromised. This is an outstanding requirement from the previous inspection 16/2/07. The registered person must ensure two written references are obtained prior to staff being employed in the service, to ensure residents are not placed at risk. Timescale for action 01/09/07 2. OP27 18 (1) (a) 01/09/07 3. OP29 19 (1) b (i) 01/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000017226.V346745.R01.S.doc Version 5.2 Page 28 Birkdale Park 1. 2. 3. 4. 5. 6. Standard OP8 OP9 OP9 OP19 OP19 OP30 It is recommended that diagrams of wounds or pressure sores should be implemented. This will assist staff with the overall treatment. It is recommended that a review of the medication procedures should take place to ensure correct procedures are followed. It is recommended that the resident who is prescribed two medications 4 times a day but is only taking it 2 times a day should have this reviewed with their GP. It is strongly recommended that the service should monitor the temperature in the conservatory and provide shade for the residents. It is recommended that the carpet in bedroom 18 should be replaced, as it is very worn. It is recommended that staff should attend equality and diversity training. Birkdale Park DS0000017226.V346745.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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