Inspection on 12/06/06 for Birkin Lodge Care Home

This inspection was carried out on 12th June 2006.

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

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

Other inspections for this house

Birkin Lodge Care Home 12/04/07

Birkin Lodge Care Home 07/02/06

Birkin Lodge Care Home 01/08/05

Birkin Lodge Care Home 21/11/04

Birkin Lodge Care Home 19/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Birkin Lodge Care Home Camden Park Hawkenbury Tunbridge Wells TN2 5AE Lead Inspector Elizabeth Baker Key Unannounced Inspection 12th June 2006 10:10 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 Birkin Lodge Care Home DS0000044478.V294532.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. Birkin Lodge Care Home DS0000044478.V294532.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Birkin Lodge Care Home Address Camden Park Hawkenbury Tunbridge Wells TN2 5AE 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) 01892 533747 Four Seasons Homes (No 6) Limited (A wholly owned subsidiary of Four Seasons Healthcare) Mrs Aline Ongley Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50) of places Birkin Lodge Care Home DS0000044478.V294532.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Subject to 25 beds being used for Nursing Care, 5 of which may be used for Terminally Ill. Registration is restricted to providing care for one service user diagnosed with dementia whose date of birth is 30 March 1923. 7th February 2006 Date of last inspection Brief Description of the Service: Birkin Lodge is a large detached property set on the outskirts of Tunbridge Wells and is surrounded by gardens. Accommodation is on three floors with access to the upper stairs being enhanced by two shaft lifts. Fifteen bedrooms have en-suite facilities and all bedrooms have a staff call point, television point and some have a telephone point. The home currently provides care with nursing for 25 residents and personal care for 25 residents. The nearest shops, church, post office and hairdressers are approximately five minutes walk away and buses to the Tunbridge Wells stop nearby. A large public park is also near the home. There are areas for car parking to the front and side of the building, with a large garden and two patios for use by residents. The homes senior staffing team comprises of the Manager and Deputy Manager. The home employs nursing and care staff that work over a 24-hour roster. Current fee charges range from £510 to £585, excluding the nursing contribution paid for by the Primary Care Trust, where applicable, and hairdressing, chiropody, newspapers, toiletries and outings. A copy of the latest inspection report is kept in the entrance hall for public information. Birkin Lodge Care Home DS0000044478.V294532.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first unannounced visit to the home for the inspection period 2006/07. The inspection took over eight hours and was carried out by lead inspector Elizabeth Baker. The visit consisted of a partial tour of the premises, inspecting some records for case tracking purposes and talking with some residents and staff. Three residents, one visitor and one member of staff were interviewed in private. The manager assisted throughout the visit. The main purpose of the visit was to check the Provider’s compliance against the requirements and recommendations made at the last two visits. Some judgements about the quality of care, life and choices were taken from conversations with residents and staff, as well as direct and indirect observations. In support of this visit the Commission received comment cards about the service from two residents, nine relatives/visitors, four GPs and two care managers. At the Commission’s request the manager completed and returned a pre-inspection questionnaire. Some of the information gathered from these sources has been incorporated into the report. At the time of the visit 25 residents requiring nursing care and 22 residents requiring personal care were residing at the home. What the service does well: What has improved since the last inspection? Although compliance with two requirements made at the last two visits have not been met because authorisation is still awaited from the provider, some recommendations have been completed. As this was the inspector’s first visit to the home for many years, the inspector is unable to comment further on this. Birkin Lodge Care Home DS0000044478.V294532.R01.S.doc Version 5.2 Page 6 What they could do better: 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. Birkin Lodge Care Home DS0000044478.V294532.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Birkin Lodge Care Home DS0000044478.V294532.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 and 6 Quality of this outcome area is good. This judgement has been made using available evidence including a visit to the service. Although the provider and home have produced lots of information, more detail would assist prospective residents and their advocates in having a better picture about the home and its facilities. EVIDENCE: The manager said all residents are provided with a contract. The organisation has published a colour brochure pack. Additional inserts including a service user guide supplement this. Despite this information, one of the two returned comment cards from residents indicated that although they had received a contract they did not receive enough information about Birkin Lodge before they moved in. The home is a pre-existing care home and as such is not required to meet the environmental national minimum standards expected of new homes. Bedrooms are of varying shapes and sizes and some are quite small. Whilst room sizes are contained in the Statement of Purpose file kept in the main office, it has not been the home’s practice to include such details in the service user guide. This information may be particularly useful to those Birkin Lodge Care Home DS0000044478.V294532.R01.S.doc Version 5.2 Page 9 residents whose mobility and or condition necessitates they require assistance with moving, handling and transferring with the aid of special equipment such as hoists and wheelchairs. The service user guide also informs the reader that living, recreational and dining areas for relaxing activities and entertainment are available. The provider’s colour brochure states the home has a quiet room. A resident spoken with indicated they prefer to be alone but was unaware of the reading room, which can be used for private meetings or contemplative purposes. A comment card returned from a care manager indicated they could not meet with their client in private. Having precise details of the actual facilities provided at the home would better inform prospective and current residents of the actual choices available to them. Where possible prospective residents are invited to visit the home for a halfday visit. However because of the condition of some residents this is not always possible. Generally senior staff visit prospective residents in their current environment prior to a decision of admission being offered. Information gathered at the visit is recorded on pre admission assessments. At the time of the visit a new comprehensive document had just been introduced by the organisation. The manager said this document would enable the home to obtain more detail to ensure the home can provide appropriate care. When required the home contacts healthcare professionals for additional clinical advice and support. Indeed such a visit was taking place at the time of the inspection. If appropriate, arrangements are made for the resident to receive care in a more suitable environment. The home has a contract with the local Primary Care Trust for one step-down bed. The home is not registered for intermediate care. Standard 6 is not applicable. Birkin Lodge Care Home DS0000044478.V294532.R01.S.doc Version 5.2 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 the following standard(s): 7, 8, 9, 10 and 11 Quality of this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents’ needs are generally met with evidence of good multi disciplinary working taking place on a regular basis. Residents feel they are treated with respect. EVIDENCE: Three care records were inspected as part of case tracking. Care records contained care plans and clinical risk assessments as well as a separate form signed by either the resident or their advocates indicating they had been involved in the plan of care. The daily records of a resident requiring personal care provided a good mix of the resident’s condition and quality of day experiences. However the daily records for the nursing residents, where not so descriptive. It was also noted that a particular registered nurse is not recording the actual time of the night entries, but uses the abbreviation “N“ instead, which is contrary to good practice. Although the care records generally provided information on the residents’ current condition, they were not wholly reflective of the information gathered during interviews with the residents. This included details of pain, hearing, feeding difficulties and Birkin Lodge Care Home DS0000044478.V294532.R01.S.doc Version 5.2 Page 11 personal property. Other forms were incomplete of all fields and prompts and one was unsigned and undated. A weight chart indicated the resident had lost 3kgs in a four-month period. There was no record of any action taken to investigate the cause of this. Moving and handling assessments contain references to pain the resident may experience. This is good practice and should assist staff in providing support in a way, which minimises discomfort. However one chart was not quite as reflective of the resident’s current situation. A sample of medication administration record charts was inspected. The chart for a resident who self-medicates a type of eye drop preparation did not indicate the resident actually does this. The corresponding care records did include an assessment of this procedure. However it had not been reviewed since its composition in February 2005. Another chart had a hand written amendment. There was no record of who amended the chart or indeed on whose authority. A couple of charts included pain relief medication to be administered when required. There was no corresponding care plan component of the precise administration for this. Pain assessment charts are not currently used to monitor the effectiveness of the pain relief treatment, where there is a need. A registered nurse had left two medication pots on a tray in a resident’s room. One pot contained two white tablets and the other red liquid. The registered nurse had left the room and was administering medications to other residents in their rooms. Registered Nurses must observe residents taking medicines prior to completing the chart or indeed leaving the room, to ensure the medication has actually been taken. There was some confusion as to whether the home had produced a written policy on the provision of some fruit juices interacting adversely with certain medicines. This was a recommendation made at the last visit. Whilst the manager said such a policy has been devised and is displayed on the clinical room wall, the registered nurse assisting with the visit to the clinical room was not aware such a policy was now available. None of the three care records inspected contained details of residents’ wishes and preferences in respect of death and dying. This is an important aspect of care and needs to be addressed, particularly as the home home’s registration includes terminal illness. Contact details as to how the home may go about obtaining this vital but sensitive information has subsequently been provided to the manager. One of the three admission assessments recorded the resident’s desire to receive Holy Communion and visits from a clergyman of their particular faith. There was no recorded evidence the resident was actually receiving these wishes and needs. Residents spoken with indicated they receive personal care and support from staff in a way, which protects their dignity and privacy. One of the two Birkin Lodge Care Home DS0000044478.V294532.R01.S.doc Version 5.2 Page 12 returned comment cards from care managers indicated they couldn’t meet with their client in private when they visit. As stated previously there seems to be some confusion as the availability of a room which can be used for private meetings, as the facility is not well publicized. The provider has instigated a central department of clinicians, for all care home staff to access when professional advice is required. This facility is supplemented by new clinical policies and procedures. Care records contained details of residents’ preferences in respect of bathing or showering. In fact the home has a variety of assisted baths and one assisted shower, for residents to choose from. However from discussions with one resident it was identified the resident is only offered a weekly bath on a certain day, and if for whatever reason that has to be cancelled, they more often or not have to wait another week for their bath. Where the resident has asked for a bath sooner, this has normally been accommodated. Birkin Lodge Care Home DS0000044478.V294532.R01.S.doc Version 5.2 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): 12, 13, 14 and 15 Quality of this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home provides a good range of activities for those residents who like to be occupied. EVIDENCE: Details of activities were seen displayed on various notice boards around the home. A comment card returned from a relative/visitor contained additional comments including “There always seems to be entertainment and they celebrate all public events enthusiastically. They work very hard to fund raise for the residents”. Residents indicated they liked their meals. There is no separate dining room, but residents can choose to eat the dining areas of the two main lounges if they so wish. Some residents spoken with said they prefer to eat in the privacy of their own rooms. A resident said how much they were looking forward to going to Hastings. The resident said other outings have been arranged for the summer months and they intend to go on every one. Sadly only a small number of residents are able to go on these trips because of the level of support required. A musical session was taking place at the home during the afternoon of the visit. Residents present seemed to be enjoying this. Birkin Lodge Care Home DS0000044478.V294532.R01.S.doc Version 5.2 Page 14 Visitors were seen coming and going throughout the visit. A visitor mentioned staff always offer them beverages, but having a facility in which visitors could make their own drinks would be very nice. The organisation has published numerous leaflets for the information of residents and/or their advocates. These are displayed in the entrance hall and are freely available. Topics include general information on care home fees and advocacy. Details of local advocacy contacts are also available from the manager. Apart from a bath list which was seen displayed on the inside door of a linen cupboard, resident and staff information is kept with due regard to confidentiality. Some residents have brought small items into the home in order to personalise their rooms. This includes TVs and furniture. However, residents’ records were not always reflective of this information. Some residents said meals are good and one said the food is excellent. Menus provided for inspection purposes included a variety of meals, with salads or omelettes available as alternative meals. One of the two comment cards from residents indicated the respondent usually likes the meals in the home. The other respondent did not comment. For information purposes a copy of the Commission’s recently published bulletin “Highlight of the day? Improving meals for older people in care homes” was handed to the manager. This should assist the home in ensuring it provides all residents with nutritional and appetising meals. The visit coincided with a very hot spell. Drinks, including water, were seen around the home in close proximity of residents. However during a conversation with a resident it transpired that it is their experience the water is only changed on an every other day basis and not all at the weekend. Birkin Lodge Care Home DS0000044478.V294532.R01.S.doc Version 5.2 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): 16 and 18 Quality of this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Although the home has a complaints procedure, not all complainants feel their complaints are listened to and acted on. EVIDENCE: Details of the home’s complaint procedure were seen displayed in the main entrance. A copy of the procedure is contained in the information booklet. However one of the nine returned comment cards from relatives/visitors indicated the respondent was not aware of the home’s complaint’s procedure. One of the two comment cards from residents indicated the respondent did not know how to make a complaint. Indeed the respondent continued that they have complained on several occasions about the cleanliness of the home but the cleaning has not improved. Since the last visit the Commission has been informed of two incidents in which it is alleged that residents have had money stolen. Whilst this information is kept in a book used to store regulation 37 notices, it has not been the home’s practice to record this in the complaints book. Including this information should assist the manager and provider in determining any adverse trends for quality assurance purposes. A sensitive matter affecting a resident was dealt by the manager to the resident and their advocate’s satisfaction. Birkin Lodge Care Home DS0000044478.V294532.R01.S.doc Version 5.2 Page 16 A staff member interviewed said they had received elder abuse training. The returned pre-inspection questionnaire indicates Protection of Vulnerable Adults training is being arranged. Birkin Lodge Care Home DS0000044478.V294532.R01.S.doc Version 5.2 Page 17 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, 20, 21, 22, 24 and 26 Quality of this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Significant investment would greatly improve the home making it a more comfortable place for residents to live. EVIDENCE: Some corridors are narrow and are not suitable for wheelchair users. The home accommodates many wheelchair users. This has resulted in doors, doorframes and walls being contact damaged. Some corridor carpets, although hoovered clean, are stained by continuous wear and tear. The manager said additional monies are required from the provider to carry out the work. A request has been made but a firm start date has not been received. In the meantime the manager continues to work from her own budget allowing her to carryon with the replacement programme for the double rooms including floor covering and furniture. Most radiators seen had been protected by decorative covers. The radiator covers in the lower ground floor lounge had Birkin Lodge Care Home DS0000044478.V294532.R01.S.doc Version 5.2 Page 18 not been painted or varnished. These now give a dirty appearance as various items, which have been placed on them, have stained the tops, which are used as shelves. The home has a variety of bathrooms and toilets. A dirty toilet seat was seen in one toilet; part of the walls in this toilet was stained with spillages. Some toilet brushes seen around the home were dirty and worn. There is no racking in the sluice rooms to hygienically store clean continence aids. Two commode pots were standing on a windowsill containing vases and a urine bottle had fallen on the floor beside a sluice machine. The stainless steel sluicing sink in one room was corroding and does not provide for effective cleaning. Where equipment has been changed, walls and flooring has not been made good. An unpleasant odour was noted in a certain area of the first floor. Hand washing facilities are available around the home for staff and visitors to use. A member of staff said they normally have sufficient protective equipment but if there is a shortfall items can be quickly obtained. The manager said a 2002 copy of Kent and Medway Infection Control Unit guidelines was available on site. As this edition has been recently been updated it was suggested the home contact the health protection unit direct to acquire a current edition. The home has received two separate inspections by officers of the Health and Safety Executive, Ashford (November 2005) and the Environmental Health, Tunbridge Wells (March 2006). In both cases the visits resulted in requirements and recommendations being made. The manager said all the matters have now been addressed. A resident expressed satisfaction that a separate grab rail had been provided in their bedroom to assist them in moving around the bed. Handrails were seen in corridors. However as mentioned previously some of the corridors are narrow and some bedrooms small, which may present difficulties to residents moving safely around, as well as presenting hazards to staff when providing assistance. To ensure the home’s facilities are appropriate for current and future residents with physical disabilities, expert advice from a suitably qualified person such as an occupational therapist should be sought. This may assist the home in identifying areas and facilities, which could be improved to better serve less able residents. The College of Occupational Therapists retains a list of private Occupational Therapists. The College can be contacted on 0207 357 6480. This information has subsequently been provided to the manager. It has been previously reported that the size of the home’s laundry is not adequate for the volume of washing and ironing of personal clothes and linen generated by this home. This matter has been repeatedly identified and on the last two occasions the provider was required to submit plans to the Commission on how the matter can be rectified. Despite this the laundry remains the same. However the manager said the laundry has now been surveyed, but to date nothing definite has been said. The standard of linen seen in the laundry and in one linen cupboard was poor, in that some towels Birkin Lodge Care Home DS0000044478.V294532.R01.S.doc Version 5.2 Page 19 were ragged and sheets were very thin. This situation could compromise residents’ skin integrity. Birkin Lodge Care Home DS0000044478.V294532.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 and 30 Quality of this outcome area is good. This judgement has been made using available evidence including a visit to the service. Staff morale is good resulting in an enthusiastic workforce that works positively with residents to improve their quality of life. EVIDENCE: As well as care staff, staff are employed for cooking, cleaning, administration and maintenance. An activities coordinator is used on a regular contractual basis. Rotas demonstrate the home is staffed 24 hours a day. The numbers of registered nurses for the 25 residents requiring nursing care complies with the staffing notice issued by the former regulatory health authority. Residents spoken with said response times to call bells are normally good. Since the last inspection five members of staff have left the home’s employment and seven have commenced. Three of the nine returned comment cards from relatives/visitors indicated in their opinion there is not always sufficient staff on duty. One respondent added, “Main area of dissatisfaction for residents is “queuing” to be taken to the toilet, again the result of pressure on staff”. The home is striving to ensure 50 of untrained care staff are trained to NVQ level II care. To date 25 of untrained care staff have attained this qualification and 25 are currently undergoing the training. Birkin Lodge Care Home DS0000044478.V294532.R01.S.doc Version 5.2 Page 21 The pre inspection questionnaire indicates some staff have received training in the last 12 months covering inhouse manual handling and fire training; infection control, health and safety, wound care, healthy eating, food hygiene and diabetes. Future planned training includes customer care, care planning and documentation, Parkinson’s disease, dementia and challenging behaviour and wound care. The form also states all new staff undergo a 3-day induction programme. Because of time constraints staff files were not inspected on this visit. judgement of standard 29 has been made. No Birkin Lodge Care Home DS0000044478.V294532.R01.S.doc Version 5.2 Page 22 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, 32, 33, 36, 37 and 38 Quality of this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The manager has a good understanding of what needs to improve in the home, is receptive to advice given and is actively working to achieve compliance. EVIDENCE: The manager, who is a Registered General Nurse, has been in post for approximately four years. She has over 10 years experience of working with the elderly and has successfully completed the Registered Management Award course. Residents, visitor and staff spoke openly about their experiences of living, visiting and working at the home. Meetings are arranged to obtain residents’ views on services and facilities provided at the home. The provider’s Birkin Lodge Care Home DS0000044478.V294532.R01.S.doc Version 5.2 Page 23 representative visits the home regularly to ensure the home is operating appropriately. Where the manager is able to, requirements and recommendations made in inspection reports are generally met. Disappointedly though this is not always the case where the provider’s authority is required. The provider has not yet instigated a system of carrying out annual audits of the home for quality assurance purposes in order to measure all residents’ expectations against their experiences of living at Birkin Lodge. Residents and visitors are encouraged to complete questionnaires, which are freely available in the entrance hall. However not all residents get a visitor and not all residents are able to access the entrance hall. The manager said questionnaire take up is poor. The home has just introduced a quarterly newsletter, which should be useful in keeping residents up to date with information and changes in the home. Care staff now receive regular supervision and meetings dates are recorded on a matrix for ease of reference. The Code of Practice issued by the General Social Care Council has been made available to staff. The provider has recently published new policies and procedures. These cover all aspects of running a care home. Because of time constraints, records in respect of residents’ money were not inspected on this visit. Following a fire brigade call out, an officer of Kent Fire and Rescue Service subsequently visited the home in January 2006. The manager took the opportunity of showing the officer the home’s fire safety assessment. A number of suggestions were made to the document. The manager said the document has now been completed to the Fire Brigade’s satisfaction. The pre inspection questionnaire indicates servicing and testing of the home’s equipment is generally up to date. However it is of a concern that the home’s electrical fixed wiring survey, which was last carried out on the 29 January 2001 and validated for five years, had expired. The manager said arrangements have subsequently been made and the inspection survey is due to start on the 19 June 2006. Accident records are now kept in accordance with the requirements of the data protection act. However a review of the counterfoils highlighted that not all staff have included the name of resident and in a couple of cases neither the name nor date of the accident had been recorded. The individual accident forms were not inspected on this visit. Birkin Lodge Care Home DS0000044478.V294532.R01.S.doc Version 5.2 Page 24 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 3 3 2 X 2 X 1 STAFFING Standard No Score 27 3 28 2 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X X 3 2 1 Birkin Lodge Care Home DS0000044478.V294532.R01.S.doc Version 5.2 Page 25 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 OP26 Regulation 23(2)(a) Requirement As has been identified in previous inspections under the Care Standards Act 2000: The registered person shall having regard to the number and needs of the Residents ensure that:The physical design and layout of the premises to be used as the care home meets the needs of the residents.The registered person must provide an adequately size laundry to provide clean and dirty areas with safe and good infection control and ventilation for the registered 50 residents. Plans to be submitted to the commission and An action plan stating when the work commencing and estimated completion date. (Timescales 31/12/05 and 12/03/06 not met). 2. OP26 23(2)(d) The registered person shall have regard to the number and needs of the residents ensure that all parts of the home are kept clean and reasonably decorated. With particular attention concentrated DS0000044478.V294532.R01.S.doc Timescale for action 31/10/06 31/10/06 Birkin Lodge Care Home Version 5.2 Page 26 on communal areas and damaged corridors. An action plan is to be submitted to the commission of the work commencing and estimated completion date. (Timescales 31/12/05 and 12/03/06 not met). 3 OP9 13(2) The registered person shall make suitable arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Residents should be observed taking their medicines. The registered person shall make suitable arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Handwritten amendments to medicine administration record charts must contain details of the transcriber and on whose authority the instruction changed. The registered person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. Clean continence aids must be hygienically stored; Sluice room fitments must be of a standard which enables effective cleaning The registered person shall having regard to the size of the care home and the number and needs of service users keep the care home free from offensive odours and make suitable arrangements for the disposal of general and clinical waste. DS0000044478.V294532.R01.S.doc 12/06/06 4 OP9 13(2) 12/06/06 5 OP26 13(3) 31/07/06 6 OP26 16(2)(k) 31/07/06 Birkin Lodge Care Home Version 5.2 Page 27 7 OP26 13(3) 8 OP38 23(2)c The odour on the first floor must be investigated and eradicated. The registered person shall make 12/06/06 suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. Toilets must be kept clean The registered person shall 30/06/06 having regard to the number and needs of the service users ensure that equipment provided at the care home for use by service users or persons who work at the care home are maintained in good working order. The home’s fixed wiring installation must be surveyed routinely as directed by suitable electrical installation contractors 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 OP7 Good Practice Recommendations It is recommended that daily write ups in care plans contain overall well-being, social interaction, health and care given, so as to give a clear picture of the residents overall not just recording the care given by staff. Partly met. It is strongly recommended that a survey and assessment by a qualified occupational therapist be carried out regarding specialist equipment and management of the smaller rooms, corridors and specialist assisted bathing equipment. The manager stated that this continues to be discussed with Four Seasons. Nothing formal has been submitted for work to be completed. Contact details provided. It is strongly recommended that a survey and assessment by a qualified occupational therapist be carried out DS0000044478.V294532.R01.S.doc Version 5.2 Page 28 2 OP19 3 OP21 Birkin Lodge Care Home 4 OP19 regarding specialist equipment and management of the smaller rooms, corridors and specialist assisted bathing equipment. The manager stated that this continues to be discussed with Four Seasons. Nothing formal has been submitted for work to be completed. Contact details provided. It is recommended that staff be provided with adequate break out area away from the communal areas of the home/garden. Not discussed on this occasion. It is strongly recommended that advice and assessment be sought from the Environmental Health Officer and Kent and Medway Infection Control Unit with regard to the most suitable and functional layout of the laundry room to meet the needs of 50 residents. The action plan from the last inspection 19th May 2004 stated that this has been undertaken and that alternative laundry facilities are being explored by Four Seasons. The commission strongly recommends advice from Infection Control team to appropriate infection control and separation of dirty and clean laundry for those shared. Not discussed on this occasion. It is recommended that due to the size of the home, internal adaptations and heavy damaged to corridors and communal areas consideration to increasing handy person allocation or external contractor should be explored to assist in maintaining internal decoration. Hours remain the same. The service user guide must contain precise details of the homes facilities, including bedroom sizes and type and location of all day rooms. Residents care plans must be kept up to date to reflect the residents’ actual condition and needs. All daily records must provide meaningful statements of residents’ day and experiences; Daily records must state the actual time of the entry. Pain assessment must be introduced and completed for those residents with an assessed need. Unexplained weight losses must be investigated. Clinical risk assessments must be regularly reviewed. Medication administration record charts must state whether a resident is self-medicating or not. Care plans must provide precise administration details of medicines administered on an as required basis. All residents should be able to have a bath or shower as often as they wish. DS0000044478.V294532.R01.S.doc Version 5.2 Page 29 5 OP26 6 OP38 7 8 9 10 11 12 13 14 15 OP1 OP7 OP8 OP8 OP8 OP8 OP9 OP9 OP10 Birkin Lodge Care Home 16 17 18 19 20 OP11 OP15 OP16 OP24 OP33 21 22 OP28 OP37 Residents care plans must record details of their wishes and preferences in respect of death and dying. All residents must be provided with fresh water every day. All types of complaints and adverse events should be recorded centrally for effective quality assurance monitoring. All linen for residents’ use must be of a good standard. An effective quality assurance system must be introduced to ensure all residents and their advocates can be surveyed for their opinions on the home, facilities and care. 50 of untrained care staff must be trained to NVQ level II. All records relating to residents must be accurately maintained. Birkin Lodge Care Home DS0000044478.V294532.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Birkin Lodge Care Home DS0000044478.V294532.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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