CARE HOMES FOR OLDER PEOPLE
Silver Birch Lodge Nursing Home Silver Birch Lodge Bold Lane Holt Green Aughton Lancashire L39 6SH Lead Inspector
Mr Wesley Cornwell Unannounced Inspection 19th June 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Silver Birch Lodge Nursing Home DS0000025573.V332971.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. Silver Birch Lodge Nursing Home DS0000025573.V332971.R01.S.doc Version 5.2 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 424259 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 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Silver Birch Lodge Nursing Home DS0000025573.V332971.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. This home is registered for a maximum of 30 service users ito include:*Up to 30 service users in the category of OP (Old age not falling within any other category). 19th November 2002 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 thirty residents of either sex. 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. Residents accommodation is located at ground floor level. There is a lounge/conservatory and lounge /dining facilities. The home is situated in a quiet village location, set in well-kept grounds. The home has a Statement of Purpose and Service User Guide providing information about the care provided, the qualifications and experience of the owners and staff and the services residents can expect if they choose to live at the home. A copy of the Service User Guide and most recent inspection report is issued to all prospective residents and their relatives/representatives to help them make an informed choice whether to move into the home. The range of fees at the home are £435.00 to £575.00 covering all aspects of care, food and accommodation. The manager provided this information on the 19th June 2007. Silver Birch Lodge Nursing Home DS0000025573.V332971.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced site visit was undertaken as part of the homes Key Inspection. The site visit commenced at 10.00am and took place over 6 hours. The Inspector spoke to three staff members, three residents, two relatives and the owner/manager of the home. Comment cards were completed by fourteen relatives/visitors and one General Practitioner providing their views about the home. Staff, care, maintenance and financial records were also examined. A full tour of the premises was undertaken with the owner/manager. What the service does well:
Residents seen during the visit said they liked living at the home and felt well cared for. The residents were very positive in their comments about the staff who were described as being caring and conscientious. One resident said, “I am very happy living at the home. The manager and staff are all very kind, the food is good, I have a lovely room and I am satisfied with my care. I know I am lucky to be living in such a good home. I feel completely safe”. The relative of one service user said, “ My wife stayed at two other homes prior to moving into Silver Birch and there is no comparison in the standards being achieved. I couldn’t have asked for a better home”. Another relative said, “Silver Birch is a friendly, homely nursing home that provides the best possible care in pleasant surroundings”. The homes assessment procedures were very thorough and care plans had been structured to ensure staff recognise the diverse needs of residents. Observation of practice and discussion with staff members confirmed facilities and equipment is provided by the home to assist them in meeting the needs of residents with specific disabilities. A General Practitioner contacted prior to the site visit said the standards being achieved were excellent and couldn’t speak highly enough of the home. Meals are varied with an alternative choice available if required. Residents were pleased with the choice and variety available. The staff member responsible for preparation of meals confirmed they are provided with assessment information about all new residents so that special diets and personal preferences can be accommodated. Silver Birch Lodge Nursing Home DS0000025573.V332971.R01.S.doc Version 5.2 Page 6 Staff at the home are well trained and are competent to do their jobs. Observation of care practices throughout the day confirmed residents are treated with respect and dignity. The home has been decorated and furnished to a high standard to ensure the comfort of residents. Residents spoken to were very happy with the standard of accommodation provided. What has improved since the last inspection? What they could do better:
There have been no requirements or recommendations made of the home during this inspection process. The care provided by the management and staff is achieved by hard work and the commitment of the staff to ensure residents needs are being met. Comments received by residents, their relatives and a healthcare professional described a service that is achieving very high standards and a very pleasant environment for people to live. Staff at the home have been well trained and formal arrangements are in place to monitor the care being provided. However, the management at the home understands
Silver Birch Lodge Nursing Home DS0000025573.V332971.R01.S.doc Version 5.2 Page 7 there is always room for improvement and they must continue to work hard to ensure the high standards presently being provided continue to be met. 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. The summary of this inspection report can be made available in other formats on request. Silver Birch Lodge Nursing Home DS0000025573.V332971.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Silver Birch Lodge Nursing Home DS0000025573.V332971.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission and assessment procedures were clear to ensure the care needs of residents are met. EVIDENCE: The care plan records of three residents admitted to the home had full assessment information including the religious/cultural and relationship needs of residents. All care plans had been signed by the residents or their relatives confirming they had been involved the assessment process and agreed with the care to be provided. Staff members confirmed they had access to this information and could describe in detail the care needs of the residents. Staff responsible for the preparation of meals said they were informed about residents who had special dietary needs and these are always accommodated. This home does not provide intermediate care. Silver Birch Lodge Nursing Home DS0000025573.V332971.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Promotion of health is taken seriously, resident’s welfare is closely monitored and health needs were met. EVIDENCE: Individual records are kept for each resident with a plan of care setting out the action that is needed to be taken by care staff to ensure all aspects of health, personal and social care needs of the residents were met. Significant events had been recorded and daily entries made setting out the care given. The care plans were structured and were being reviewed at least once a month and updated to reflect any changing needs in the health and personal care of the resident and these were being actioned. The records of three residents were looked at and these described their healthcare needs. Discussion with staff members on duty confirmed they were fully aware of the healthcare needs of residents and these are monitored and their care plans kept up to date. Entries made on care plans showed good
Silver Birch Lodge Nursing Home DS0000025573.V332971.R01.S.doc Version 5.2 Page 11 communication between the home and healthcare professionals. One General Practitioner contacted prior to the site visit said the individual health care needs of residents were being met, residents privacy and dignity was respected and staff at the home had the right skills and experience to support the individual health and social care needs of residents. The General Practitioner said, “ Everything is done to excellence. I am always superbly impressed. It is the best home I have ever come across in 22 years as a GP. I could not speak highly enough of this home”. The relative of one resident said, “Silver Birch Lodge Nursing Home is a very well run, pleasant place to be. My mother has been there for nearly 5 years and has always been excellently cared after. The staff are unfailingly kind, conscientious and caring”. Residents who were being cared for in bed had been provided with a special mattress that was suitable for the relief of pressure and prevention of pressure sores. The relative of one resident who visits the home daily said the staff were very attentive towards his wife and provided the highest standard of care possible. Observation of practice and examination of care plan records confirmed staff were meeting the diverse needs of service users with specific disabilities and specialised equipment was readily available to assist them with their duties. Discussion with staff confirmed they were aware of the needs of the residents and the level of care that needed to be provided. Medication practices observed during this visit were safe and good records had been maintained. The staff members responsible for the administration of medicines had received accredited training to ensure they had basic knowledge of how medicines are used and how to recognise and deal with problems in use. Residents spoken to said the staff team respected their privacy and they could spend time on their own if that was their wish. Silver Birch Lodge Nursing Home DS0000025573.V332971.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Social activities and meals are both well managed, creative and provide daily variation and interest for people living in the home. EVIDENCE: Residents spoken to said routines within the home were flexible and they were able to make their own decisions about how to live their lives. One resident said, “ I moved into the home on the recommendation of a friend and couldn’t be happier. I really can’t fault the care being provided. The staff are wonderful. I like to spend time in my room listening to music. The staff are all very kind and respect my privacy”. The relative of one resident said they were very impressed with the standards being provided by the home and found the staff were kind, caring and friendly. The relative said, “ My mother had a short stay in another home before moving to Silver Birch Lodge. The staff are all very kind, friendly and helpful and I am very grateful for the care she is now receiving”. Silver Birch Lodge Nursing Home DS0000025573.V332971.R01.S.doc Version 5.2 Page 13 Residents spoken to said they were happy with arrangements in place for receiving their visitors. The relatives of two residents said they were always made welcome by the staff when they visited the home and found the staff friendly and approachable. One relative said, “ I visit every day and I am always made welcome. The atmosphere within the home is very relaxed and I really enjoy my visits”. Most residents handle their own financial affairs or these are handled by their relatives/representatives. Records being kept in respect of residents unable to manage their own finances were being well maintained. The home provides a varied and balanced diet for residents. The staff member responsible for the preparation of meals was able to confirm they had information about residents with special diets and personal preferences. Residents spoken to were happy with the choice and standard of meals available. One resident said, “ I always look forward to meal times and have never had a meal I haven’t enjoyed. The food is excellent”. The relative of one resident said, “ The food provided by the home is of the highest standard. I have been lucky enough to have meals with my wife and really enjoyed them”. Meal times were served in a relaxed and unhurried manner in very pleasant surroundings. Staff members were observed being very attentive to residents needs. Residents spoken to were very happy with the arrangements in place for social activities. These were varied and arranged individually and in groups Silver Birch Lodge Nursing Home DS0000025573.V332971.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements for complaints are handled well and taken seriously ensuring people feel listened to. EVIDENCE: The home has a detailed complaints procedure, which is made available to all residents on their admission. Residents spoken to were aware of how to make a complaint and felt these would be listened to and acted upon. The relatives of two residents also said they were aware of the complaints procedure but hadn’t had any cause to make a complaint about the home. At the time of this site visit no complaints had been received by the home or referred to the Commission for Social Care Inspection. The home has a procedure in place for dealing with allegations of abuse. The manager and staff spoken to had a good understanding of the procedures to be followed in the event of any allegations or suspicion of abuse or neglect. Staff members on duty said abusive practices and how to recognise these had been covered during training provided by the home. Silver Birch Lodge Nursing Home DS0000025573.V332971.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home has a planned maintenance and renewal programme for the redecoration and refurbishment of the home to ensure residents live in a comfortable, homely, clean and safe environment. EVIDENCE: The home has been well maintained and decorated for the comfort of residents. Since the last inspection three new bedrooms with en-suite facilities have been built increasing occupancy levels from twenty seven to thirty. A new sun lounge has been built, four bedrooms have been redecorated and refurbished, the grounds landscaped and a summer house was being built. In addition the kitchen has been extended providing extra storage and facilities for catering staff and a new emergency call bell system fitted to assist staff to
Silver Birch Lodge Nursing Home DS0000025573.V332971.R01.S.doc Version 5.2 Page 16 respond to requests for assistance from residents. The manager said the refurbishment of the home was ongoing and there were further plans for refurbishment throughout the home to ensure the present high standards are maintained. Residents and their visitors were very pleased with the improvements being made. A tour of the building confirmed resident bedrooms had been personalised with their own belongs and decorated and furnished for their comfort. All residents spoken to were happy with their rooms and said they had the choice of spending time on their own or in the lounge area’s. Hot water temperatures throughout the home were checked and found to deliver water at a safe temperature in line with health and safety guidelines. It was observed during the visit the home was clean and hygienic ensuring a pleasant environment in which to live. Silver Birch Lodge Nursing Home DS0000025573.V332971.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. The homes recruitment procedures are robust and these provide safeguards for the protection of residents. EVIDENCE: Staffing levels were sufficient for the number of residents living at the home. Residents said they were happy with the care they receive from the home and were well treated by the staff. The relative of one resident said, “I can’t speak highly enough about the home. The staff are always friendly, polite, patient and very attentive to my wife. My wife can be difficult but the staff are brilliant with her. I have seen a massive improvement in her health since her admission to the home. I couldn’t wish for better care”. The relative of another resident said, “The care mother receives at this home is outstanding”. All residents and their visitors seen during the visit said the staff were very quick to respond whenever called upon. Staff spoken to said they were clear about their role and work well as a team to ensure the individual and collective needs of residents are met. Records show all staff members have access to a structured training and development programme ensuring the residents are being cared for by a well trained and competent staff team. In addition 60 of staff members have achieved
Silver Birch Lodge Nursing Home DS0000025573.V332971.R01.S.doc Version 5.2 Page 18 National Vocational Qualifications (NVQ) ensuring the residents are in the safe hands of qualified and competent staff. Examination of staff records showed good systems were in place for obtaining relevant documentation for staff members employed by the home ensuring the protection of residents. Silver Birch Lodge Nursing Home DS0000025573.V332971.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has policies and procedures in place to ensure the health and safety of residents and staff are promoted and protected. EVIDENCE: The manager of the home is a Registered General Nurse and has achieved a relevant management qualification. Records seen confirmed the manager has access to training to ensure her knowledge and skills are updated so that she continues to meet the professional registration requirements of the Nursing and Midwifery Council.
Silver Birch Lodge Nursing Home DS0000025573.V332971.R01.S.doc Version 5.2 Page 20 Residents and their visitors were very positive in their comments about the manager and her staff who were described as being friendly, approachable, very helpful and professional. The home has effective quality assurance systems in place to monitor the level of service being provided for its residents. An annual quality assessment of standards is undertaken by a professionally recognised organisation who completes an audit of the care being provided and seek the views of residents and their relatives. In addition the home has in place its own quality assurance systems in place to gather the views of residents and keep them informed about events being organised by the home. Residents and their relatives confirmed they are consulted about any changes taking place within the home and kept fully informed about forthcoming events being organised. Inspection of records for residents finances were well maintained and up to date ensuring residents interests are safeguarded. Inspection of maintenance records confirmed facilities and equipment was being maintained as required by health and safety legislation to provide a safe environment for residents and staff. Silver Birch Lodge Nursing Home DS0000025573.V332971.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Silver Birch Lodge Nursing Home DS0000025573.V332971.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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. 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. Refer to Standard Good Practice Recommendations Silver Birch Lodge Nursing Home DS0000025573.V332971.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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