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Inspection on 14/02/06 for Silver Birch Lodge Nursing Home

Also see our care home review for Silver Birch Lodge Nursing Home for more information

This inspection was carried out on 14th February 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The procedures and management processes in place to assess and address health care needs were highly developed and individual needs were met in a supportive and caring environment. The staff team worked well together and showed a good understanding of the needs of the people living at the home. The staff team received appropriate training and guidance that provided them with the knowledge and experience needed to care for this client group. This care home put the needs of residents first and made sure residents were supported to live an independent lifestyle whenever possible. People living at the home benefited from the happy relaxed atmosphere and good relationships have been established between residents and staff.

What has improved since the last inspection?

Since the last inspection some communal areas in the home have been redecorated and refurbished and windows replaced so that residents continue to live in a well-maintained and comfortable environment. The outside patio area has been re-laid to make sure it is safe to use and accessible to all residents. The amount of training available to staff has increased so their knowledge and skill base is broader and enables them to continue to provide a good standard of care.

What the care home could do better:

The systems in place for handling medicines and making sure the policies and procedures are up to date nee more attention so that staff practice safely and in accordance with best practice. The home should continue reviewing and developing the service provided to ensure that current good practice is maintained.

CARE HOMES FOR OLDER PEOPLE Silver Birch Lodge Nursing Home Silver Birch Lodge Bold Lane Holt Green Aughton Lancashire L39 6SH Lead Inspector Anne Taylor Unannounced Inspection 9th February 2006 09:30 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 Silver Birch Lodge Nursing Home DS0000025573.V278890.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. Silver Birch Lodge Nursing Home DS0000025573.V278890.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Silver Birch Lodge Nursing Home Address Silver Birch Lodge Bold Lane Holt Green Aughton Lancashire L39 6SH 01695 424242 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) jiminorm@aol.com Holt Green Residential Homes Limited Mrs Joan Parr Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Silver Birch Lodge Nursing Home DS0000025573.V278890.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. This home is registered to accommodate a maximum of 27 service users in the category of OP (Old age, not falling within any other category). Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines which may be issued Through the National Care Standards Commission regarding staffing levels in care homes. Date of last inspection Brief Description of the Service: Silver Birch Lodge is a registered care home providing personal and nursing care. The home is registered to accommodate people over the age of sixty-five. Accommodation is provided for twenty-seven residents of either sex. At the time of inspection there were twenty-seven people living in the home, sixteen receiving nursing care and eleven receiving personal care. Mr and Mrs J Parr privately own the home. Mrs Parr, a registered general nurse is also the registered manager with overall responsibility for the day to day running of the home. All rooms are at ground floor level, fifteen of which have en-suite bathrooms. Twelve single rooms have private washing facilities. There is a lounge/conservatory and lounge /dining facilities. The home is situated in a quiet village location, set in well-kept grounds. Silver Birch Lodge Nursing Home DS0000025573.V278890.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that started at 9.30am and lasted six hours. The inspection involved discussion with the people who lived and worked at the home and visitors, examination of records, policies and procedures and a tour of the premises. What the service does well: What has improved since the last inspection? Since the last inspection some communal areas in the home have been redecorated and refurbished and windows replaced so that residents continue to live in a well-maintained and comfortable environment. The outside patio area has been re-laid to make sure it is safe to use and accessible to all residents. The amount of training available to staff has increased so their knowledge and skill base is broader and enables them to continue to provide a good standard of care. Silver Birch Lodge Nursing Home DS0000025573.V278890.R01.S.doc Version 5.1 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. Silver Birch Lodge Nursing Home DS0000025573.V278890.R01.S.doc Version 5.1 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 Silver Birch Lodge Nursing Home DS0000025573.V278890.R01.S.doc Version 5.1 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): Standard 3 was not assessed at this inspection. Standard 6 is not applicable, as Silver Birch Lodge does not provide intermediate care. EVIDENCE: Silver Birch Lodge Nursing Home DS0000025573.V278890.R01.S.doc Version 5.1 Page 9 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): 9, 10 The systems in place for handling medication were not thorough enough to ensure the continued protection of residents. Staff were sensitive to the needs of residents and made sure that residents’ rights to privacy and dignity were upheld. EVIDENCE: Polices and procedures describing the handling of medication were available within the home so staff had clear guidance to follow. However, the policies and procedures were sometimes too brief and one or two were missing. Only trained nurses were authorised to administer medication and a sample list of signatures was kept at the front of the medication file so that checks for compliance could be made. Silver Birch Lodge Nursing Home DS0000025573.V278890.R01.S.doc Version 5.1 Page 10 A recommendation has been made in relation to the application of prescribed creams to ensure that any delegated responsibility for this is properly recorded. Records of drugs administered were generally up to date. However, drugs received were not always receipted correctly and handwritten medication entries and amendments to the pre-printed dosage instructions were not independently checked and countersigned. New arrangements had been made for the disposal of medicines to reflect recent changes in legislation. A revised procedure was in place and a copy attached to the front of the medication file so that staff were all aware of the new procedures. Records showed that induction training included instruction on privacy dignity and respect so that staff had knowledge and understanding of this before they started to give care to residents. Staff spoken to were able to discuss how they put into place the home’s policies and procedures relating to maintaining the privacy and dignity of the people they cared for and how this helped to make sure that residents felt respected. Staff were observed knocking on bedroom doors before entering. They were seen to be providing care in a sensitive and caring manner, which promoted residents’ dignity. People living at the home say staff maintained their dignity and treated them respectfully. They commented, “staff are respectful and kind” and “I have a lovely room, staff always knock before they come in my room and they close the bathroom door when I am washing or bathing”. Silver Birch Lodge Nursing Home DS0000025573.V278890.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13 The daily routines were flexible so that service users were able to exercise choice, have some control over their lifestyle and maintain contact with family and friends. The range of social activities available met the expectation of people living at the home. EVIDENCE: Records and discussion with residents showed that appropriate attention was paid to helping them take part in valued and fulfilling activities that were already established or developed in and outside the home so that the lifestyle experienced by residents met their expectations and preferences as much as possible. Residents had a range of needs and ability; some were able to go out independently, whilst others were reliant on support from staff. Residents spoken to were generally satisfied with the activities available. One said, “There is plenty to do if you want it, I don’t get bored”. At the time of inspection some residents were doing group activities, others reading, watching television or listening to music. They were enjoying the activities and spoke positively about the way in which activities were organised for them. Residents spoken to said that they were able to exercise choice about what time they got up and went to bed and what clothes they wore, giving them Silver Birch Lodge Nursing Home DS0000025573.V278890.R01.S.doc Version 5.1 Page 12 some control over their lifestyle. When asked how they helped residents to exercise choice staff said, “We always ask what they want to do, when they want to get up and what they want to wear”. The statement of purpose outlined the home’s visiting policy and included a statement about residents being able to exercise choice in relation to visitors. This meant that residents and relatives knew what the home’s approach to visiting was and could comply with any policies operated by the home. Residents spoken to confirmed that they were able to see visitors in their own room or in one of the communal areas of the home so the meetings could be private if they wished. Staff discussed ways in which they tried to make visitors welcome. They were able to show that they understood the importance of residents maintaining contact with their family and friends, as they are still an important part of their life. Silver Birch Lodge Nursing Home DS0000025573.V278890.R01.S.doc Version 5.1 Page 13 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): The key standards were not assessed at this inspection. They were considered fully met at the last inspection. EVIDENCE: Silver Birch Lodge Nursing Home DS0000025573.V278890.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,25 The home was clean, comfortable, and homely. And provided an environment that was suitable for it’s stated purpose. EVIDENCE: Standards 19 and 25 were not fully assessed however; progress in meeting the requirement and recommendation made at the last inspection was monitored. The programme to cover all radiators and pipe work was complete so the risk to residents had been removed. A risk assessment regarding the outside pond had been carried out so that residents could safely use the area. Silver Birch Lodge Nursing Home DS0000025573.V278890.R01.S.doc Version 5.1 Page 15 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): 28, 30 Training was provided for new and existing staff that helped make sure they were competent do their jobs and able to practice safely. EVIDENCE: Training records showed that new staff received induction and ongoing training that provided them with the basic skills needed to carry out tasks allocated to them. Staff spoken to said that training opportunities were good and that regular training courses were held for fire safety, moving and handling and other health and safety topics so that they were kept up to date about safe working practices. National vocational training (NVQ) was available to care staff and a significant number of care staff had already achieved level two or three so that the home exceeded the fifty per cent needed to meet the national minimum standard. Silver Birch Lodge Nursing Home DS0000025573.V278890.R01.S.doc Version 5.1 Page 16 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 Residents lived in a well run home, managed by a responsible person who was able to make sure the home met its stated purpose, aims and objectives. The home was managed and organised in a way that helped make sure the service was run in the best interests of residents. EVIDENCE: Records showed that the registered manager is a first level registered nurse who has completed a relevant management course and kept up to date with clinical areas of practice so that she can meet the professional registration requirements of the Nursing and Midwifery Council. Silver Birch Lodge Nursing Home DS0000025573.V278890.R01.S.doc Version 5.1 Page 17 Discussion with staff showed that the manager provided leadership and direction so that every one knew what their role was and what was expected of them. Visitors spoken to say, “ the manager and staff are very good if you mention anything it is sorted out”. The home was able to meet its stated purpose as demonstrated by comments from residents and visitors. Residents’ comments included, “It’s very good here, we’re all well looked after” . Visitors spoken to were positive about the care their relatives received one said, “my mother’s needs are met and we are told about any changes and consulted about her care, almost every time we visit”. A system was in place to monitor the quality of service delivered so that the home could be made aware of its strengths, weaknesses and whether residents were satisfied with the service they received or not. This was achieved by sending out satisfaction questionnaires each year. The feedback obtained was collated and a summary made available to so that residents could be reassured that their views were acknowledged and contributed to the running of the home. Discussion with the manager showed that feedback from the survey was used as a means of improving and developing the service. An annual development plan was not available so the inspector was not able to confirm that feedback from residents had been included in it. Residents and staff spoken said that they were consulted about the day to day running of the home as much as they could be so that they felt involved. One resident said, “we did fill a form in and we get the chance to say if we are happy with everything”. Silver Birch Lodge Nursing Home DS0000025573.V278890.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X 3 X STAFFING Standard No Score 27 X 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X X Silver Birch Lodge Nursing Home DS0000025573.V278890.R01.S.doc Version 5.1 Page 19 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 OP9 Regulation 13(2) Requirement Policies and procedures in relation to the safe handling of medication must be reviewed and arrangements made to ensure that any missing polices are replaced. Drugs received into the home must be receipted correctly. Timescale for action 30/04/06 2. OP9 13(2) schedule 3 31/03/06 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. 3. Refer to Standard OP9 OP9 OP33 Good Practice Recommendations Nurse delegation to competent staff in relation to the application of prescribed creams should be evidenced and their responsibilities be recorded. Handwritten additions or alterations to the MAR should be independently checked and countersigned. The manager should make sure that a copy of the home’s annual development plan is submitted to the Commission as agreed. Silver Birch Lodge Nursing Home DS0000025573.V278890.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ 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 Silver Birch Lodge Nursing Home DS0000025573.V278890.R01.S.doc Version 5.1 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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