Inspection on 12/01/06 for Silver Birches

This inspection was carried out on 12th January 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Silver Birches 23/04/09

Silver Birches 14/05/08

Silver Birches 03/05/07

Silver Birches 08/11/06

Silver Birches 17/07/06

Silver Birches 09/02/05

Silver Birches 12/09/04

Silver Birches 19/02/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Silver Birches 2-6 Marchmont Road Richmond Surrey TW10 6HH Lead Inspector Sharon Newman Unannounced Inspection 12th January 2006 10:00 Silver Birches DS0000017394.V277132.R01.S.doc Version 5.1 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 Birches DS0000017394.V277132.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 Adults 18-65. 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 Birches DS0000017394.V277132.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Silver Birches Address 2-6 Marchmont Road Richmond Surrey TW10 6HH 020 8948 6578 0283327286 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) Elizabeth Fitzroy Support Ms Catherine Sullivan Care Home 15 Category(ies) of Learning disability (15), Physical disability (15) registration, with number of places Silver Birches DS0000017394.V277132.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Ist August 2005 Brief Description of the Service: Silver Birches is registered to provide accommodation and personal care for fifteen people who have a severe learning disability or a physical disability. The service is owned and managed by Elizabeth Fitzroy Support and is situated in a residential area in Richmond. The home is divided into three separate flats and a day centre that is part of the service. The Community Team for People with Learning Difficulties and healthcare practitioners offer support. The home aims to maximise service users opportunities for independence, to support them in establishing relationships in the local community and to promote their rights as citizens while meeting their needs for care and support. Silver Birches DS0000017394.V277132.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 12th January 2006 and was conducted by one regulatory inspector. The manager was present at the time of inspection. Records sampled included care planning documentation, health and safety information and medication records. The manager, two assistant managers and another staff member were spoken to during the course of the inspection. This home is divided into three units and this inspection visit focused on Flat 3 on the ground floor. However, time was also spent talking to one of the assistant managers in The Deans which is one of the units on the first floor and also looking at two care plans within this unit. A new manager has started at the home and stated he is in the process of applying for registration to the CSCI. Staff were welcoming and helpful throughout the inspection visit. They spoke with warmth about the residents and demonstrated compassion and a genuine fondness for them. All staff spoken to stated the main reason they enjoy working at the home is because they care about the residents. The environment is comfortable and clean and this home continues to promote a friendly, relaxed atmosphere. What the service does well: There is a strong emphasis at the home on respecting residents’ choice and staff also promote and encourage independence. The home continues to provide good standards of care using a person centred approach. Residents are enabled to participate in their local community setting and are supported in fulfilling and appropriate activities. The home provides a good range of activities for residents and also ensures their healthcare needs are met. There is good liaison and communication with healthcare professionals. The home is clean, well decorated and has a homely and relaxed atmosphere. The bedrooms are decorated to each individuals taste, reflecting their likes and dislikes. Silver Birches DS0000017394.V277132.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? 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 Birches DS0000017394.V277132.R01.S.doc Version 5.1 Page 7 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 Outcomes Statutory Requirements Identified During the Inspection Silver Birches DS0000017394.V277132.R01.S.doc Version 5.1 Page 8 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 the following standard(s): 1. 2. 3. 5. As reported in the last inspection report: Resident’s assessments are thorough and this allows a detailed care planning process to develop from this documentation. This attention to detail ensures resident’s needs are met. Good information is provided about the home to residents to enable them to make decisions about their care. EVIDENCE: As stated in the previous inspection report: the Statement of Purpose contains details about who the service is designed for, the environment at the home and the admissions procedure. It has also been updated to include details of the new manager at the home. A Service Users Guide is in place and is available in pictorial format. It contains details about who the home is for, what the staff are like, how to complain and the views of the residents. However, this still requires further review to ensure it contains a statement of the main terms and conditions. However, it now makes reference to the CSCI and the last inspection report. A contract for a new resident was not in place at the home, all residents should be issued with individual contracts which should be available for inspection. This requirement remains outstanding from the previous inspection visit. Full assessments were seen in the care plans sampled at this inspection visit. Evidence was seen in the care plans of professional advice being sought from a Silver Birches DS0000017394.V277132.R01.S.doc Version 5.1 Page 9 wide range of health and social care professionals before a potential resident is placed at the home. Staff also stressed the importance of involving the resident and their family in decisions. Staff spoken to place a strong emphasis on meeting the needs of the residents and had a good knowledge of their likes, dislikes and needs. Silver Birches DS0000017394.V277132.R01.S.doc Version 5.1 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 the following standard(s): 6. 7. 8. 9. Care plans are detailed and informative. They are tailored to each individual’s needs, likes and dislikes. The person-centred approach to care planning continues to help promote high standards of care. Staff have a good knowledge of residents support needs. EVIDENCE: Four care plans were looked at in total, two in one unit and two in another. They were detailed and informative and reflected the residents’ needs, likes and dislikes. They contained information about health needs, dietary requirements, eating support needed, mobility, communication needs, personal care skills, family, friends and advocates and spiritual needs. A person centred approach to care planning is used at the home to help ensure that residents needs are met. The assistant manager on one unit showed the inspector a Person Centred File she had compiled with a resident. She said the resident really enjoyed completing the information in the file. It contained photos and pictures about important people in their life, hopes and dreams, goals and action plans and a diary of weekly activities. Silver Birches DS0000017394.V277132.R01.S.doc Version 5.1 Page 11 There is also a ‘need to know’ file on each unit which contains information about all the residents and this can help ensure that new staff are aware of about their needs, likes and dislikes. Risk assessments are also contained in the care plans and are tailored to each individual. They addressed areas including: use of the bath/shower, risk of injury due to use of the wheelchair, risk of choking, travelling on public transport and sitting in the sun. Most of the risk assessments had been regularly reviewed but some were seen to require review. However, staff were aware of this and said they were updating this documentation. Any restrictions in place on choice and freedom are well documented. As stated in the last inspection report a key worker scheme is in place at the home to assist residents in the decision making process. Staff all spoke of the importance of respecting the residents’ choices and decisions. Silver Birches DS0000017394.V277132.R01.S.doc Version 5.1 Page 12 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 the following standard(s): 11. 12. 13. 14. 15. 16. Links with the community remain good and these enrich resident’s social and educational opportunities. The home provides a good environment for them to develop their social skills. Staff continue to encourage and support residents to be as independent as possible. EVIDENCE: As stated in the previous inspection report many of the residents attend daycentres and local colleges and they are consulted individually about what interests they want to pursue. Full records of activities were seen in the residents’ care plans – some of which had been completed by the residents themselves. Residents also visit the local shops, Richmond Park and the theatre. Many activities and outings were arranged around the Christmas period and the home also holds themed nights occasionally, with multicultural influences such as Caribbean or Canadian. Residents may also go to discos at the Octopus club if they wish. The Resource Centre attached to the home is available for the use of residents and activities are also on offer some weekday evenings. Computers are Silver Birches DS0000017394.V277132.R01.S.doc Version 5.1 Page 13 available for residents use in the Resource Centre and have widget programmes and touch screens. Family involvement continues to be encouraged at the home and group meetings are held for them four times a year. A range of music, television and video equipment was available for residents use in the three lounge areas. Silver Birches DS0000017394.V277132.R01.S.doc Version 5.1 Page 14 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 the following standard(s): 19. 20. 21. The health and emotional needs of residents are well met and there is evidence of good communication with community health and social care professionals. There is a well-organised system in place for the ordering and receipt of medication and it is stored appropriately at the home. However, allergies are not recorded on medication records and this may place residents at risk. EVIDENCE: The care plans contain evidence of liaison with community health and social care professionals. The local community specialist team provides support to the home and residents have access to dentists, chiropodists, speech and language therapy, specialist nurses and doctors. The manager spoke about how important it was to ensure that the residents have good access to healthcare. The medication cupboard was seen to be locked securely at the time of inspection. There is now a medication ‘in and out’ book in place, where relatives taking medication out of the home can sign for it. All Medication Administration Records (MAR) were seen to be fully completed with no omissions noted. The assistant manager in Flat 3 maintains a schedule of when medication should be requested from the chemist and what should be received back into the home. Full records are kept and she reported that this enables her to prove what is requested and received. She demonstrated a very good Silver Birches DS0000017394.V277132.R01.S.doc Version 5.1 Page 15 knowledge of the medications the service users are taking. The MAR sheets did not contain details of resident’s allergies and this issue must be addressed. The manager and staff all spoke of the recent death (in hospital) of one of the residents and how it had affected them and the other residents. They talked movingly about the affect this had had on the home and the importance of helping the residents understand and come to terms with this sad loss. The staff obviously cared about this resident very much and it was evident that they place considerable significance on helping residents to maintain their dignity when they are ill. Silver Birches DS0000017394.V277132.R01.S.doc Version 5.1 Page 16 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 the following standard(s): 22. 23. There is an appropriate complaints procedure and complaints are investigated fully in accordance with this procedure. Resident’s rights are protected and systems are in place to protect service users from abuse. EVIDENCE: The home follows the London Borough of Richmond’s’ Protection of Vulnerable Adult Procedures (POVA) a copy of which is kept at the home. It also has an organisational abuse policy and a whistleblowing policy. A staff member spoken to had a good knowledge of these procedures. The home followed their POVA procedures for a recent issue that arose. The manager said this situation has now been resolved. A complaints policy is in place it is available in pictorial format and there is a copy in the Service Users Guide. The manager said there have been no formal complaints since the last inspection visit. Silver Birches DS0000017394.V277132.R01.S.doc Version 5.1 Page 17 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 the following standard(s): 24. 25. 26. 27. 28. 29. 30. The environment at this home is clean, comfortable and homely. Residents live in a safe, well-maintained environment. Residents’ bedrooms are well personalised and attractive. The home is clean and hygienic. EVIDENCE: The home is purpose built and is situated in a residential area in Richmond. It is divided into three separate flats and a day centre that is part of the service. Lounge and dining areas were observed to meet the needs of the residents and found to be well decorated, bright and comfortable. All bedrooms seen on the day of inspection were well personalised to individual residents taste. They were seen to contain solid good quality furniture and attractive furnishings and they looked homely and comfortable. They contained adaptations necessary to help promote the residents independence. These included: ceiling hoists where needed and adapted sinks and beds. There is ample room for the use of wheelchairs at the home. Silver Birches DS0000017394.V277132.R01.S.doc Version 5.1 Page 18 Toilet and bathroom facilities are sufficient to meet the needs of the current service users. They contain adaptations including ceiling hoists and specialised baths to help meet the needs of the residents. There is also a walk-in shower available for their use. The broken detergent drawer on the washing machine will need to be repaired and this was discussed with the manager at the time of inspection. The home was clean and hygienic on the day of inspection. Silver Birches DS0000017394.V277132.R01.S.doc Version 5.1 Page 19 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32. 33. 35. 36. Staff are conscientious and caring. They are also enthusiastic and committed to delivering high standards of care and have a good knowledge of residents’ needs. Staff are well supported by management and each other and they work well as a team. EVIDENCE: A staff member reported that they liked working at the home and that ‘there is a good staff team’ there. They said the home provides ‘very good mandatory training including food hygiene and fire safety.’ They also commented that they had attended training in medication administration and the person-centred approach to care planning both of which courses they had found valuable to their work at the home. Records of staff training were seen displayed on an office wall. This staff member commented that they receive regular one-to-one supervision and are ‘well-supported’ at the home. Two further staff members also reported that this was the case. One of them reported that the staff team were ‘a very supportive set of people.’ In discussion with the manager he said he recognised the area of one-to-one staff supervision needed improvement and that he is going to improve upon the frequency of this supervision to ensure all staff receive at least six one-to-one sessions a year. Also, there was no clear evidence that staff meetings are taking place on a regular basis and this will need to be addressed. Silver Birches DS0000017394.V277132.R01.S.doc Version 5.1 Page 20 One staff member said that ‘the residents are very well looked after’ and they spoke of the importance of ‘emotional nurturing’ for the residents. All staff members spoke with warmth about the residents. Another staff member reported ‘I love it here and the management team is good.’ Silver Birches DS0000017394.V277132.R01.S.doc Version 5.1 Page 21 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37. 38. 42. Residents’ benefit from a well-run home. The manager is caring and places the residents’ needs first. EVIDENCE: There is a new manager at the home, he reported that he has completed the NVQ Level 4 and the Registered Managers Award. He stated that he is going to apply for registration with the CSCI. The manager said that he feels well supported and has access to regular supervision. He also discussed areas that he wished to improve upon including the frequency of staff supervision and looking at staff training to ensure staff have access to relevant courses. Up-to-date certificates were not available for portable appliance testing, gas safety and the five yearly electrical check. These will need to be obtained. Silver Birches DS0000017394.V277132.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 Standard No Score 1 3 2 3 3 2 4 x 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 x 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 2 3 3 3 x x x 2 x Silver Birches DS0000017394.V277132.R01.S.doc Version 5.1 Page 23 YES 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 YA3 Regulation 5 (1) Requirement The Registered Persons must ensure that the Service Users Guide contains all information as required by Regulation 5 (1). Previous timescale of 01/10/05 not met. The Registered Persons must ensure that copies of Placement Agreements are obtained for any service user placed by a Local Authority. Previous timescale of 01/11/05 not met. The Registered Persons must ensure that the allergies section on medication administration sections is fully completed. The Registered Persons must ensure that the broken drawer on the washing machine is repaired. The Registered Persons must ensure that regular staff meetings are fully recorded. The Registered Persons must ensure that all care staff receive one-to-one supervision at least six times a year. (Pro-rata for part-time staff). The Registered Persons must DS0000017394.V277132.R01.S.doc Timescale for action 01/04/06 2. YA5 5 (3) 01/05/06 3. YA20 13 (2) 01/02/06 4. YA24 23 (2) 01/03/06 5. 6. YA36 YA36 21 18 (2) 01/04/06 01/03/06 7. YA42 13 (4) 01/03/06 Page 24 Silver Birches Version 5.1 ensure that up-to-date certificates are obtained for portable appliance testing, the five yearly electrical check and gas safety. 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 Birches DS0000017394.V277132.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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 Birches DS0000017394.V277132.R01.S.doc Version 5.1 Page 26 - 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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