CARE HOME ADULTS 18-65
Birling House 91 The High Street Snodland Kent ME6 5AL Lead Inspector
Jo Griffiths Unannounced 17 May 2005 10:00am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Birling House H56-H06 S23894 Birling House V221035 170505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Birling House Address 91 The High Street Snodland Kent ME6 5AL 01634 244689 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Mortimer Society Mr Neil Channon CRB Care Home 27 Category(ies) of Physical disability (18) registration, with number Learning disability (9) of places Birling House H56-H06 S23894 Birling House V221035 170505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: (1) The eighteen residents with a physical disability may also have a learning disability. (2) Including 2 residents over the age of 65 years Date of last inspection 4/1/05 Brief Description of the Service: Birling House provides care and support to adults with learning disabilities. The service specialises in the support of people with Huntingtons Disease and associated physical disability. Birling house is a large home situated in the town of Snodland. The shops and local ammenities are a short drive away and the train station is located 2 minutes away. There are also 3 vehicles for use by service users including wheelchair adapted transport. Service users can choose to occupy a single or a shared bedroom and have access to several communal lounges and a large garden. Staff support is provided 24 hours per day. Birling House H56-H06 S23894 Birling House V221035 170505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out by Jo Griffiths. The inspection focused on obtaining the views of the people that live at Birling House. For the purpose of this report the people at Birling House would like to be referred to collectively as residents of the home. The Manager, Neil Channon, provided some feedback on recent achievements at the home and a number of staff were spoken with. Time was spent talking with a number of residents and their care plans were seen. What the service does well:
Residents have their needs fully assessed before moving into the home and a detailed care plan is developed. This means that residents know that their needs will be met and that staff supporting them have all the information they need to provide consistent care. Any risks to residents are assessed and minimised with a good balance of everyday risk and independence. Residents can choose to participate in a wide range of activities both inside the home and within the local and wider community. There is an occupational therapy department that provides educational and therapy sessions including speech therapy and physiotherapy. Residents are supported to go away on an annual holiday if they wish to and are supported to go out on regular day trips to do activities of interest to them. There are lots of communal areas in the home where residents can choose to spend their time including 4 lounges, the OT centre and a fully equipped relaxation room. Residents also have access to a large well-maintained garden and a conservatory. Residents can choose to have TVs, DVD players and SKY television in their bedrooms and all residents bedrooms are fully furnished and personalised with their own belongings. Residents live in a clean and comfortable environment and are consulted on the furnishing and redecoration of their own rooms and communal areas. Residents’ safety needs throughout the home have been assessed to minimise risk to their wellbeing. Residents’ health and personal care needs are fully met. All residents are registered with a local GP and have access to other healthcare professionals who can visit the home if needed. Staff keep good records of residents health needs to ensure their ongoing wellbeing is monitored. Birling House H56-H06 S23894 Birling House V221035 170505 Stage 4.doc Version 1.30 Page 6 Residents at Birling house are supported by a team of staff who are committed to the values and philosophy of the service. Staff interact with residents in the way that they prefer and treat them with respect as individuals. There are sufficient staff on duty at all times to provide the support needed and the staff are well trained in the needs of the residents. Residents enjoy the range of meals provided and feel that their likes, dislikes and dietary needs are well catered for. Where they need support to eat this is provided in a way that meets their needs and promotes a comfortable mealtime environment. There have been no complaints received at the home and residents and their relatives have access to a clear complaints procedure. Residents know how to make a complaint if they needed to and feel confident their concerns would be listened to. What has improved since the last inspection?
Since the last inspection Birling House has successfully achieved the Investors In People award. This means that staff are valued and well supported in their roles and as such can provide better care for the residents living in the home. Another carer has achieved their NVQ award and more staff have begun working toward their NVQ, which will benefit residents by providing them with support from qualified staff. A training plan has been developed for the staff team and more training in the specialist needs of residents with Huntington’s Disease has taken place. The Manager has introduced a feedback form for staff to complete following a training session to assess their learning. Residents are now fully protected by safe recruitment procedures for staff as written references and CRB checks are obtained before employment. Supervision sessions for staff are happening more often so staff can get the support they need from their Managers to help them do their jobs effectively. Since the last inspection the Manager has carried out a quality review of the service and included feedback from relatives, staff and professionals. This feedback has been summarised into a format that can be shared with prospective residents. The rolling maintenance programme has continued and one of the lounge areas is being redecorated to the taste of the current resident group. The Manager has arranged for the replacement of one of the vehicles, which will provide more comfortable travel for residents in wheelchairs. The Manager has developed a business plan for the home giving direction and clear leadership to the staff team and a sense of vision for the residents.
Birling House H56-H06 S23894 Birling House V221035 170505 Stage 4.doc Version 1.30 Page 7 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. Birling House H56-H06 S23894 Birling House V221035 170505 Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Birling House H56-H06 S23894 Birling House V221035 170505 Stage 4.doc Version 1.30 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, Prospective residents are given the information they need to make an informed choice about moving to the home. Their needs are assessed to ensure the home can meet them fully. EVIDENCE: Residents have a copy of the residents handbook. This is clearly presented and outlines the service that is provided. Residents said that they were aware of all the services the home offers. Before moving into the home a full assessment of residents needs is carried out by the Manager or senior carer to ensure their needs can be met. These were seen in residents files and could be clearly linked to the care plan. Residents said that they felt their needs were being fully met. Birling House H56-H06 S23894 Birling House V221035 170505 Stage 4.doc Version 1.30 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 9 Residents assessed needs are reflected in the care plan and risks are assessed to promote their independence whilst maintaining their safety. EVIDENCE: Care plans are detailed and are based on the pre admissions assessment. Residents feel that their needs are being met and needs they described were seen to have been recorded in the plan. It is recommended that where possible the resident or their relative sign the care plan to agree the support that will be offered. The care plans had been reviewed frequently, but are now due another review. Risk assessments within the care plans showed that great thought had been given to balancing risk with independence. Action has been taken to reduce risks to the residents and the assessments are kept under review. A risk assessment for one resident highlighted the need to compromise the right of the resident in order to protect them and other resident. This has been discussed with the relatives and Care Manager, however there is no record of this discussion. It is recommended that those involved in the decision making process are asked to sign the care plan or risk assessment.
Birling House H56-H06 S23894 Birling House V221035 170505 Stage 4.doc Version 1.30 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14, 16, 17 Residents can choose to take part in a range of activities within the home and the community that are appropriate to their interests and development needs. Residents are provided with a balanced and varied diet that takes account of individual choice and dietary requirements. EVIDENCE: Birling House has an occupational therapy department attached to the home. This provides a range of activities for residents on a daily basis including cookery, reading, music, and arts and crafts. Residents were seen to be offered the choice of whether to attend the OT centre. Residents said that they attend a range of activities outside the home including reading and writing, cookery and woodwork and a minibus is provided for the residents to travel to their classes. None of the residents wish to be in employment, but choose to participate in a range of activities to continually develop and maintain their skills. Residents make use of the local community facilities and groups. One resident spoke of
Birling House H56-H06 S23894 Birling House V221035 170505 Stage 4.doc Version 1.30 Page 12 how she likes to go to church most Sundays and is supported to do so by the staff on duty. Another resident said he and others enjoy using the social club near the home in the evenings. Residents have the choice of where to spend their time in the home. There are a number of lounge areas with TV’s and music. A bingo session was underway and a large number of residents had chosen to join in this activity. The staff supporting the group encouraged independence during the session as well as making it fun. If residents choose to spend time in their room they can do so and most residents have TV, DVD players and SKY boxes in their rooms. One resident said that a musical singer/entertainer was visiting the home that afternoon and that “she is good”. Other residents said they too were looking forward to this activity and that she visits regularly. A music therapist also visits the home and staff said this was a popular session. Some residents spoke about their forthcoming holidays and one resident was away on holiday at the time of this inspection. Staff said that residents are usually supported on holiday by their keyworker and they can choose which other residents they would like to go away with. Where residents have difficulty expressing these choices the staff use their knowledge of positive relationships and shared interests between residents to help them plan their break. Interaction between residents and staff is positive and staff show respect for each individuals choices. Residents said they can choose when to go to bad and when to get up and entries in the daily reports showed where these choices had been respected. Residents said they enjoy the food. One resident said “Fish and Chips” is her favourite meal and that it is on the menu each week. Residents who need help to eat are supported in a relaxed and unhurried manner by staff. The food is nicely presented and a wide choice is available. The kitchen staff are aware of individual likes and dislikes and residents can request a different meal if they do not want what is on the menu. Birling House H56-H06 S23894 Birling House V221035 170505 Stage 4.doc Version 1.30 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 20 Residents are supported with their personal care needs in a way that respects their privacy, wishes and needs. They are protected by safe procedures for dealing with their medication. EVIDENCE: Residents preference of who supports them with personal care is detailed in the care plan. All personal support is provided in residents’ own bedrooms or bathrooms. Residents said that they are given the support that they need and that staff are always kind and helpful. The physiotherapist has assessed residents who require support with their mobility and the outcome of the assessment recorded in the care plan. Hoists and adaptations are provided as needed and staff are trained in the Moving and Handling of residents. Residents are protected by safe medication administration and storage procedures. Senior staff administer medicines from a monitored dose system supplied by Boots the chemist and always administer medicines with a second member of staff. All staff who administer medication have attended training and it is planned that all carers will receive training in medication. Birling House H56-H06 S23894 Birling House V221035 170505 Stage 4.doc Version 1.30 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 23 Residents are protected from abuse, neglect and self-harm. They are aware of how to make a complaint if needed and feel their concerns would be acted upon. EVIDENCE: Residents said they knew who to speak to if they had any concerns or complaints. The complaints procedure for the home is clearly defined in the Statement of Purpose and Service User Guide and is accessible to relatives and visitors. There have been no complaints received by the home since the last inspection. It is recommended that the leaflet produced by KCC Registration be removed from the downstairs notice board. This leaflet is no longer relevant and needs to be replaced by the homes own complaints procedure that includes how to complain to CSCI. Residents are protected by safe employment procedures and staff have attended training in adult protection. The adult protection policy for the home has been developed in line with the Kent and Medway Multi agency policy. Birling House H56-H06 S23894 Birling House V221035 170505 Stage 4.doc Version 1.30 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 28, 30 Residents live in a comfortable, well-maintained and safe environment that promotes their independence and maintains their privacy. They have access to a number of communal areas in addition to their personal individual space. EVIDENCE: Residents benefit from living in a well maintained and spacious home. A rolling programme of decoration is in place and one of the lounges was being decorated in colours chosen by the residents. Residents have access to a number of large communal lounges and a dining room. One of the lounge areas is designated as a smoking room as a number of residents smoke. Most residents occupy single bedrooms however some residents share bedrooms. Two residents spoken with said they had chosen to share and would not now wish to be separated, as they are close friends. Whilst the bedroom occupied by these two residents is less than the recommended size they said they were happy with it and had clearly identified their individual space. Residents’ bedrooms are well furnished and they have a choice of décor. Birling House H56-H06 S23894 Birling House V221035 170505 Stage 4.doc Version 1.30 Page 16 Birling house also has an occupational therapy unit that residents can access at any time and a snoozelen room for relaxation purposes. There is a large garden and conservatory that residents said they like to use in the summer. Residents said that they liked the home and the décor and that they were happy with their bedrooms. The home is clean and hygienic and provides a comfortable environment for the residents. Birling House H56-H06 S23894 Birling House V221035 170505 Stage 4.doc Version 1.30 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34, 35, 36 Residents are supported by an effective and competent staff team. Safe recruitment procedures are in place to protect residents and staff are supported in their roles ensuring residents receive consistent care. EVIDENCE: Staffing levels in the home meet the needs of the current group of residents. Residents said that there are always plenty of staff around. Staff said that they felt well supported by good staffing levels and infrequent staff sickness. The rota showed effective planning and consistent staff allocation and a senior member of staff is always allocated to each shift. A number of staff have achieved their NVQ or are working toward it and they said they have been well supported to do this. A full programme of training is provided at Birling House ensuring residents differing and complex needs can be met. The training courses include; Eating and Swallowing, Huntington’s disease, Epilepsy, Moving and Handling, Adult Protection, First Aid, Skin Care, Dying, Medication and Communication. The training records showed that the majority of staff have completed these courses and that further training is planned for this year. Staff spoke highly of the training and support provided to them to help them do their job. They said they have supervision sessions at least every 3 months
Birling House H56-H06 S23894 Birling House V221035 170505 Stage 4.doc Version 1.30 Page 18 and they attend regular team meetings. A system for handover between staff is in place and this is lead by the senior staff member. This has resulted in good communication between staff and a consistent approach to care for the residents. Residents are protected by safe recruitment procedures. Staff files contain CRB checks, written references and proof of identification. Contracts for staff are in draft form and will be issued soon. Since the last inspection the Investors In People award has been achieved by Birling house. Birling House H56-H06 S23894 Birling House V221035 170505 Stage 4.doc Version 1.30 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39, 41, 42 Residents’ benefit from a competent and approachable Manager who provides clear leadership to staff. Whilst their views are welcomed at any time they have not yet been included in the annual quality review of the home. Residents’ health, safety and welfare are protected and their rights are safeguarded by effective record keeping. EVIDENCE: The Manager, Mr Channon, has many years experience in managing services for this group of residents. He is working to achieve the NVQ4 in Management and aims to complete this by August 2005. Mr Channon undertakes regular training to keep his own skills and knowledge up to date and is booked to attend a “train the trainer” course in Moving and Handling to ensure residents are supported by trained and qualified staff for their mobility needs.
Birling House H56-H06 S23894 Birling House V221035 170505 Stage 4.doc Version 1.30 Page 20 Residents said they would speak to Mr Channon if they had any concerns or complaints. Staff said they felt well supported in their roles and the home has a clear line management structure and accountability. Mr Channon has developed a business plan for the home and meets regularly with staff and residents to share the values and direction of the home. The views of residents, relatives and others are welcomed and a quality assurance survey has been carried out since the last inspection. This focused mainly on the views of relatives and professionals and it is recommended that a way of including residents be explored. The use of pictorial questionnaires or simple tick boxes was discussed. Effective record keeping systems are in place although some records including meal charts had not always been completed. Residents’ needs are clearly recorded on a daily basis and monitoring of significant events in the home is in place. It is recommended that all entries on records are signed and dated. Residents’ health and safety needs have been identified and risks assessed within the care plans with actions to reduce the risk implemented. Where a new risk arises this has lead to a new risk assessment. The general environment of the home does not present any health and safety concerns and equipment has been provided such as hoists to prevent injury to staff or residents. Mr Channon said he walks through the building weekly to check for health, safety and maintenance issues. Birling House H56-H06 S23894 Birling House V221035 170505 Stage 4.doc Version 1.30 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 x x Standard No 22 23
ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 x x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 x 3 x 3 Standard No 11 12 13 14 15 16 17 3 4 3 3 x 3 3 Standard No 31 32 33 34 35 36 Score x 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Birling House Score 3 x 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 2 x 2 3 x H56-H06 S23894 Birling House V221035 170505 Stage 4.doc Version 1.30 Page 22 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement Timescale for action 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. 3. 4. Refer to Standard YA 6 YA22 YA39 YA41 Good Practice Recommendations Residents or their relatives should sign the care plan to agree the content. An up to date complaints procedure should replace the out of date one on the notice board. Residents views should be obtained as part of the quality assurance process. All entries in residents care plans, daily records and significant events log should be signed and dated. Birling House H56-H06 S23894 Birling House V221035 170505 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection The Oast, Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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