CARE HOMES FOR OLDER PEOPLE
Birkdale Park 6 Lulworth Road Southport Merseyside PR8 2AT Lead Inspector
Mrs Margaret Van Schaick Unannounced Inspection 9th February 2006 09:00 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 Birkdale Park DS0000017226.V283607.R01.S.doc Version 5.1 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.V283607.R01.S.doc Version 5.1 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.V283607.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 25 OP Date of last inspection 9th August 2005 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.V283607.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place over one day and lasted 5.25 hours. This was the second unannounced inspection carried out this year as part of the regulatory requirement for care homes to be inspected at least twice a year. As part of the inspection process some areas of the home were viewed including residents bedrooms. Care records and other nursing home records were inspected as part of the process. Discussion took place with the Deputy Manager and one to one interviews with two of the care staff. Two relatives who visited the home were spoken with on a one to one basis. Several residents were also spoken with. Three of the residents were interviewed on a one to one basis and their views of the home obtained. Satisfaction cards were left for residents and relatives to complete. What the service does well: What has improved since the last inspection? Birkdale Park DS0000017226.V283607.R01.S.doc Version 5.1 Page 6 Photographs of the residents are in place, which enables any new/agency staff to easier identify the residents. The medication fridge now has regular temperature checks with records kept. This ensures medication is stored at the correct temperature. The stock control of medication has improved and all residents prescribed Digoxin have their pulse checked prior to administration, which is good practice. A laundry assistant has also been employed, which enables care staff to have more time to care for the residents. Decoration and improvement of the home continues including residents bedrooms. What they could do better:
The Service User Guide needs to include all up-to-date details of the homes facilities. Residents need to have a contract in place which identifies costs and who meets them. A full breakdown of fees is to be evidenced. All residents admitted to the home need to have a full assessment carried out by senior staff to ensure the home can meet their assessed needs. The home needs to also include the resident or their family were agreed, to be involved in setting up their care plans. The shower room on the first floor needs to be upgraded and made accessible for residents use. Hot bath temperatures need to be checked prior to residents’ use, with records kept. The home needs to ensure that all staff employed attend abuse training so that they will be able to recognise any abuse and are able to follow the correct procedure should they be witness to any. The home would benefit for other senior staff to attend adult protection training to ensure they are up to date with the most recent procedures set up locally. There needs to be an audit carried out with regard to staff files to ensure all staff employed at the home have had all pre employment checks in place. This needs to be treated as a matter of urgency as without all pre employment checks it puts the residents who live there at risk. The home must also include induction for all new staff to ensure they are competent to care for the residents. Birkdale Park DS0000017226.V283607.R01.S.doc Version 5.1 Page 7 The Registered Manager needs to have sufficient time to audit staff files and ensure all induction/mandatory training and staff supervision are carried out as a matter of urgency. The Registered Provider has not carried out the regulation 26 visits since January 2005, which means they are unable to form an opinion of the standard of care provided in the home. The Registered Provider needs to carry out these monthly visits and a copy of the report made is to be sent into the Commission. 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. Birkdale Park DS0000017226.V283607.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Birkdale Park DS0000017226.V283607.R01.S.doc Version 5.1 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 the following standard(s): 1,2,3 assessed standard 6 not applicable The Service User Guide and resident contracts need to be updated to ensure all residents understand the facilities and services that are on offer and what the fees charged are for. The home must carry out their own assessment of the prospective residents needs prior to admission to ensure the home can meet their needs effectively. EVIDENCE: The service user guide has yet to be updated with regard to the mezzanine level and the homes facilities. Not all residents have a contract in place stating terms and conditions of residency. The contracts need to identify a breakdown of fees so that residents and their relatives where agreed understand the fee structure and who is responsible for payment. A recently admitted resident had been admitted to the home following receipt of the Social Workers assessment and information gained from the hospital staff and relative. The home did not assess them prior to admission. The home need to meet with any prospective resident for a full assessment of their
Birkdale Park DS0000017226.V283607.R01.S.doc Version 5.1 Page 10 nursing requirements to ensure that the home is able to meet their needs fully and effectively. Birkdale Park DS0000017226.V283607.R01.S.doc Version 5.1 Page 11 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 the following standard(s): 7,9 Medication records are satisfactory and storage of medication evidences good stock control, which promotes safe practice. EVIDENCE: Photographs are now in place to ensure easier identity of residents where new staff/agency staff care for them. Not all residents or their relatives are yet involved in setting up care plans and agreeing the care to be provided. The home is still in the process of facilitating this. The temperature of the medication fridge is measured daily with records kept. Aberdeen’s (medication sheets) were checked with records seen to be satisfactory. Pulses are recorded prior to administration of Digoxin now, which is good practice. At present all ‘returned’ medication is stored in the special waste bin in house until removed by the clinical waste contractor. At present the homes chemist is continuing to dispose of controlled medication. When the new system is in place, controlled medication returns need to be placed in the smaller specialist container following the manufacturers instructions with two trained staff signatures to verify disposal. Medication storage was in good order with good stock control.
Birkdale Park DS0000017226.V283607.R01.S.doc Version 5.1 Page 12 Birkdale Park DS0000017226.V283607.R01.S.doc Version 5.1 Page 13 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 the following standard(s): 13,14 The home offers flexible visiting to ensure all residents are able to receive their visitors when wished. Residents are able to bring personal items of their own into the home to make their bedrooms more homely and suited to them. EVIDENCE: Residents interviewed agreed that they were able to maintain contact with their relatives and friends. During the unannounced inspection visit relatives were observed visiting their families. Residents interviewed commented “we have regular activities in the home and we can join in if we wish”. Communion is held in the home each Wednesday. The local nursery school visit the home occasionally with pre-school children entertaining the residents. The Girls Brigade also visits the home throughout the year. Relatives interviewed stated “there are no restrictions with visiting, you are made welcome and offered refreshments always”. One resident stated, “I have regular visitors”. With the residents’ permission, the inspector viewed some of the resident’s bedrooms, which were personalised with residents’ belongings. The bedrooms viewed looked homely and individual depending on how the resident wished their personal belongings to be placed. Information with regard to the Sefton advocacy service is available for residents who wish to contact them.
Birkdale Park DS0000017226.V283607.R01.S.doc Version 5.1 Page 14 Residents are encouraged to make choices for themselves with one resident very keen to mobilise with their walking aid. Staff were concerned that the resident would put himself or herself at risk of a fall or injury but in fact with staff support the resident has been able to mobilise effectively. Birkdale Park DS0000017226.V283607.R01.S.doc Version 5.1 Page 15 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 the following standard(s): 18 The home needs to ensure that all staff employed attend abuse training so that they will be able to recognise any abuse and are able to follow the correct procedure should they be witness to any. EVIDENCE: Not all staff employed at the home has attended abuse training therefore this needs addressing so that staff are made fully aware of the varying types of abuse so that they can recognise it and what procedure to be followed if a witness to any. One of the carers interviewed who have attended abuse training had a good understanding of the various forms of abuse and was confident about reporting any concerns. The home has a ‘whistle blowing’ policy in place. The Sefton Adult Protection Procedure is in place. The Registered Manager has attended POVA (Protection of Vulnerable Adults) training in 2005. Following discussion with senior staff it is apparent that further training is required to ensure the correct procedure is followed if any such allegation is raised. It would be useful for other senior staff to attend adult protection training to ensure they are up to date with the most recent procedures set up locally. Birkdale Park DS0000017226.V283607.R01.S.doc Version 5.1 Page 16 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 the following standard(s): 19,21 Birkdale Park is maintained to a satisfactory standard and provides a homely environment for the residents who live there. EVIDENCE: There are plans to enlarge the conservatory and fit a new roof therefore recommendations with regard to fitting blinds to the windows of the conservatory have not yet been implemented. Bedroom 3 has been painted and the lounge carpet has been shampooed. Bedrooms 8,9,10 and 14 have been redecorated. The shower room facility on the first floor has not yet been upgraded. This needs to be implemented in the refurbishment and maintenance plans so that the additional facility would be available for residents to have further choice in how they maintain their personal hygiene. Staff need to record the temperature of the bath water prior to bathing residents to ensure safe bathing with records kept. A laundry assistant is now employed to work Monday to Sunday 4 hours each day. Residents interviewed about this service have mixed views with comments “The laundry is a problem,
Birkdale Park DS0000017226.V283607.R01.S.doc Version 5.1 Page 17 it doesn’t get done quickly enough and we get the wrong items sometimes” and “the laundry service is very good”. Birkdale Park DS0000017226.V283607.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29,30 Staff files do not comply, as pre employment checks are not undertaken with all staff therefore this could put residents who live there at risk. Inductions are needed for all new staff to ensure they are competent to care for the residents. EVIDENCE: Standard 27 was assessed and met at the previous inspection but the inspector recommended a laundry assistant be employed which has been implemented. Staff files do not evidence full checks are carried out prior to employment. Some staff recently employed at the home has no POVA or CRB check in place and have not been applied for despite being employed as carers approximately six weeks. One staff file has one reference that indicated the carer had not actually worked for the agency but had received some training sessions. The second reference for this carer evidenced that they were only in employment for approximately three weeks and had left without telling anyone. Two other staff files checked evidenced one written reference. This is not sufficient information on which to select care staff to be employed in a Care Home. It puts the residents who are living there at risk. Two staff files checked has been employed since last July have had no induction or supervision. One staff file evidences interview notes, which is good practice. Staff induction is not evidenced in the files either so this must be addressed as a matter of urgency. All staff must receive staff induction within six weeks of employment.
Birkdale Park DS0000017226.V283607.R01.S.doc Version 5.1 Page 19 Birkdale Park DS0000017226.V283607.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 To audit staff files and ensure all induction/mandatory training and staff supervision are carried out to ensure staff are competent and capable when working with the residents. The Registered Provider has not carried out the regulation 26 visits since January 2005 therefore they are unable to form an opinion of the standard of care provided. EVIDENCE: The Registered Manager has been in post for approximately 9 years now. She has many years experience in a senior capacity in the care sector. The Manager has attended mandatory training in the last year including health and safety, risk assessments, flu vaccines and fire training. The Manager and Deputy Manager have completed the Level 4 NVQ Registered Managers Award. The Registered Provider needs to ensure that the Registered Manager and other senior staff have sufficient supernummery time in which to make sure all staff records, induction, training and supervision is in place.
Birkdale Park DS0000017226.V283607.R01.S.doc Version 5.1 Page 21 The Registered Provider reports have not been carried out since January 2005. At the end of 2005 residents, their families and staff were canvassed with regards to their views of how the home was run. The inspector was able to view the results of these questionnaires. The response to the questionnaires was generally positive. The negative issues raised was concerning cold plates serving hot food, laundry issues and the lack of cleanliness of the home. The home has also gained an external Quality Assurance Award. Positive responses related to the staff employed at the home with comments including “staff are caring and kind”. The Deputy Manager has stated that she carries out monthly quality reviews and meetings unfortunately the evidence was not available to see. The home has an external quality assurance award, which is due for renewal in March 2006. A development plan is in place for the home and this identifies decoration programme, lift maintenance, and training for staff employed. Policies and procedures are in place. Residents’ relatives deal with personal allowances. A safe is in place to secure any valuables. A valuables book is in place. The inspector recommends the valuables book have a receipt facility so that residents and their relatives can have a receipt for whatever is held. Chiropody, hairdressing and newspapers are invoiced on a regular basis to the resident or their family. A lockable facility is available in bedrooms. Staff supervision is not yet in place for all staff. This needs to be addressed as a matter of priority. Birkdale Park DS0000017226.V283607.R01.S.doc Version 5.1 Page 22 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 2 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X 2 X X X X X 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 3 X 2 X 3 2 X X Birkdale Park DS0000017226.V283607.R01.S.doc Version 5.1 Page 23 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. 2. Standard OP1 OP2 Regulation 5 5 Requirement The Registered Provider must ensure the Service User Guide is updated to include all facilities. The Registered Provider must ensure that all residents have an agreed contract in place, which includes a full breakdown of fees. The Registered Provider must ensure that an appropriately qualified person to ensure the resident’s needs are met with regard to the services provided at the home assesses prospective residents. The Registered Provider must ensure all residents or their relative, where agreed, are fully involved with setting up the care plan. The Registered Person must ensure the shower room on the first floor is made usable for the residents use. The Registered Provider must ensure that all pre employment checks are in place prior to offering staff employment. Two authentic written references
DS0000017226.V283607.R01.S.doc Timescale for action 05/06/06 05/06/06 3. OP3 14 13/03/06 4. OP7 15 05/06/06 5. OP21 23 05/06/06 6. OP29 19 13/03/06 Birkdale Park Version 5.1 Page 24 7. OP30 18 8. OP33 26 9. OP36 18 must be in place also. The Registered Provider must ensure that all new staff has an induction within six weeks of employment. This must be evidenced through documentation. The Registered Provider must carry out monthly visits to the home and provide the Commission with a copy of their written report. The Registered Provider must ensure that staff at the home receives appropriate supervision with records kept. 13/03/06 13/03/06 13/03/06 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. 2. Refer to Standard OP25 OP35 Good Practice Recommendations The inspector strongly recommends that hot bath water temperatures are taken and recorded prior to residents use. The inspector strongly recommends that a receipt type book be used for records of valuables kept so that residents and their relatives have a copy. Birkdale Park DS0000017226.V283607.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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