Inspection on 14/05/08 for Silver Birches

This inspection was carried out on 14th May 2008.

CSCI found this care home to be providing an Adequate service.

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 21 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 03/05/07

Silver Birches 08/11/06

Silver Birches 17/07/06

Silver Birches 12/01/06

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 28/09/2008.

CARE HOME ADULTS 18-65 Silver Birches 2-6 Marchmont Road Richmond Surrey TW10 6HH Lead Inspector Sandy Patrick Key Unannounced Inspection 14th May 2008 12:00 Silver Birches DS0000017394.V362952.R01.S.doc Version 5.2 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.V362952.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 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.V362952.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Silver Birches Address 2-6 Marchmont Road Richmond Surrey TW10 6HH 020 8948 5423 020 8332 7286 silverbirches@efitzroy.org.uk www.efitzroy.org.uk Elizabeth Fitzroy Support 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) Ms Bose Ogunlolu Care Home 15 Category(ies) of Learning disability (15), Physical disability (15) registration, with number of places Silver Birches DS0000017394.V362952.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd May 2007 Brief Description of the Service: Silver Birches is registered for fifteen people who have a learning disability and may also have a physical disability. The service is owned and managed by Elizabeth Fitzroy Support, a national charity who provide residential support, day care and support for people in their own homes. The home is in Richmond, a short distance from the town centre. There are good transport links and local shops. The home has its own car park and vehicle. 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 work with the staff to offer support. The home is staffed 24 hours a day and each flat and the day centre have their own allocated staff. Fees charged range from £196. 68 to £2,071 per week. Silver Birches DS0000017394.V362952.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. As part of the inspection of Silver Birches we visited the home on 14th and 15th May 2008. The visits were unannounced. We met people who live at the home, the staff, the Manager and visitors. We looked at the building and at records. We also wrote to the residents, their visitors, the staff and other professionals and asked them to complete surveys about the home. The staff helped the residents to complete surveys. Some of the questions in the surveys were about what people thought of the staff, so we felt it would have been better if someone independent had helped the residents rather than the staff. 10 relatives and 5 professionals completed surveys for us. We asked the Manager to complete a quality assessment about the things that had happened over the last year and the things that were planned. She did this very thoroughly and provided us with a lot of information. We looked at all the information which we had received about the home since the last key inspection. This included a visit we made to the home in October 2007. As part of our inspection we took an extra special look at the procedures the staff follow to make sure everyone is safe and free from abuse. Some people told us that they thought the home was good and that people living there were generally happy. Some people thought that residents should have more choice and be able to do more things than they do at the moment. Some of the things people said about the home are: ‘Silver Birches tries to create a friendly and welcoming environment.’ ‘The atmosphere is always friendly, cheerful and positive.’ ‘We think that the home has improved considerably over the past year.’ ‘The overall care is very good and the residents are happy, well fed and occupied. The staff are caring and thoughtful and that means so much to us.’ ‘Silver Birches is very good when it really matters.’ Silver Birches DS0000017394.V362952.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: People need to be given more information and support to have more control over their lives. Everyone needs to have their own meaningful person centred plan in a format which they can understand. People need to take part in activities which they have choose and which meet their individual needs. Records about people’s care needs should be clearer. People need to be supported to wear their own clean, well maintained and appropriate clothes. The needs to be further improvements to the way in which people’s medication is managed so that they are kept safe. The staff need to improve the way they communicate so that visitors feel confident they are listened to and messages are passed on. Silver Birches DS0000017394.V362952.R01.S.doc Version 5.2 Page 7 Some improvements to health and safety are needed. 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 Birches DS0000017394.V362952.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Silver Birches DS0000017394.V362952.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4 & 5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who are thinking about moving to the home have their needs assessed and are able to visit and spend time there. The information people are given about their terms and conditions could be improved. EVIDENCE: People who are thinking about moving to the home are invited to visit and stay over night before making a decision. This person, other residents and staff can all then say how they feel about this person moving in and whether it would be a good idea. One person has moved to the home since we last visited. We saw that they had had their needs assessed and had visited and stayed over night at the home before they decided to move there. Their needs had been reviewed since then to make sure they were happy at the home. One person told us that they felt, ‘the residents appear settled and content living at the home’. Silver Birches DS0000017394.V362952.R01.S.doc Version 5.2 Page 10 The organisation has developed terms and conditions of residency using pictures and simple text to try and help people to understand these better. However, none of the terms and conditions we saw had been signed by the people they were intended for and there was no evidence that they had seen and understood these. The format for these could be improved further to help others to understand them better, for example using DVDs and other mediums. Silver Birches DS0000017394.V362952.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 & 9 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People’s individual needs are not recorded in a clear and meaningful way, although this is an area the staff are working to improve. People have some control over their lives and are being supported to make more choices, but more information and support is needed to give people the control they should have. People need to be supported to take risks and there needs to be better evidence to show why restrictions have been placed on people. EVIDENCE: The staff are working with other professionals to help develop person centred plans for everyone. The Manager said that she wants these plans to be meaningful for the individual and recorded on a format which they can understand and use to communicate. Silver Birches DS0000017394.V362952.R01.S.doc Version 5.2 Page 12 Staff have made some improvements to care planning but there still needs to be further improvements to make the plans person centred. Where staff have identified individual wishes and interests there needed to be more detail. For example one care plan stated someone liked football. However, there should have been more information on this such as the football team they supported. There needed to be a plan which showed how this person could be supported pursue their interest of watching football and supporting their team. Some of the care plans contained photographs of different events and activities designed to help people to make choices. However, these pictures and photographs were stored within care plans in the staff office and there was no evidence that these were actually used to give this support. The people living at the home need to be more involved in creating an individual plan of care on a format which they can understand and use to show staff the support which they need. When creating new care plans the staff need to make sure they involve relatives and other people who are important in each person’s life. Someone told us, ‘We want relatives to be more involved in person centred planning.’ Another person said, ‘It can be difficult to know exactly what some residents need or want if they do not have communication skills and the family and friends play a vital role.’ Some of the terminology and words used in care planning is not appropriate or not clear and needs to be changed. For example people used the terms, ‘toileting regime’, ‘feeding regime’ and ‘stimulate vocalisation’. There were some risk assessments in place. However, these did not always show how people were enabled to take risks. There were not always risk assessments in place when restrictions were put on people and there needs to be. For example the fridge in one flat was locked so that people could not access this. Another example is that one person is made to wear an item of protective clothing at all times. These and any other decisions to restrict people’s freedom need to be fully assessed, in consultation with the resident and other professionals. Ways to minimise risks without placing restrictions on people should be investigated. Some risk assessments needed reviewing and updating. Everyone has a keyworker who makes sure the staff give the support which has been agreed in the care plans. They are a link person for families and other professionals to contact and they give extra support to make sure each person’s needs are reviewed and met. One person told us that their role as a keyworker includes making sure the person has enough toiletries, clothes and personal belongings and helping them to shop for these when they need them. Silver Birches DS0000017394.V362952.R01.S.doc Version 5.2 Page 13 The way in which people are supported by keyworkers is new and needs to be developed. Three people have an independent advocate who visits them and helps them to tell others about their needs and any concerns that they have. The Manager said that she hopes other people living at the home will be able to have independent advocates in the future. The organisation has a ‘service user forum’. This is a group of people who use the different services. They meet 4 times a year to talk about things that affect them and changes in the organisation. Their views are fed back to senior managers. Two people from Silver Birches represent the others from the home at these meetings. There are residents meetings in each flat. These are held quarterly. The Manager should consider holding these more frequently so that people can make more group decisions about the things which affect them. The minutes for these meetings were handwritten by staff and stored in the staff offices. The Manager should consider recording minutes in a more accessible format for the people who live at the home and storing these where they can access them. Some people have communication aids. The staff have started to be trained to help people to use these properly. The Manager told us that they are looking at ways to give better support to help people communicate. This includes looking at new equipment and aids and staff training. Not all the staff are trained or skilled in using Makaton. The Manager should make sure people have the training and are confident so that they can use this to support communication. One person told us that wanted to see Makaton used as part of everyday life at the home. We saw that the staff are more aware of how to support people to make choices and to be involved with daily activities than when we last visited. The Managers and staff have changed the way they work so that people have more support to make choices. For example we saw staff supported people to be involved in preparing snacks and making hot drinks. However, we saw some examples where the staff needed to think more about whether they were giving the right amount of support. One person was invited to help a member of staff to write a shopping list. However, the staff member did not actually discuss anything about the shopping list, they just sat with the resident while they did this. Two staff members went to the shops for the household groceries but none of the residents accompanied them. Another member of staff tried to encourage one person to make a cup of tea for others when they were chatting with a visitor, we felt that this was not appropriate and the person should have been left to spend time with their visitor rather than make tea for others. We saw that some people were supported to make choices, but we also saw that others were not. The staff need to also think about how they Silver Birches DS0000017394.V362952.R01.S.doc Version 5.2 Page 14 support everyone to be involved and to make choices rather than just some people. There is no information for residents about things that are going on at the house. For example, menus are not displayed, the staff rota and complaints procedure are only displayed in the staff office areas and there is not information about planned forthcoming events or activities. The Manager needs to think about the format and where to display this information so that the people living at the home can understand it. During our visit we heard several people asking what was for supper that evening. Three different members of staff gave three different answers to this. Some of the equipment in the home is not accessible to the people who live there and people need the staff to help them use it. The Manager said that they were investigating specialist equipment such as microwaves and computers which people will find easier to use. The staff should also look at how they can make the existing environment more accessible. For example food and crockery cupboards could be relocated or labelled so that people could identify and access them more easily. Videos and entertainment equipment could be located and presented in a way which people would see easier and find easier to access or make choices about. People do not have keys for their own bedrooms and cannot choose to secure these themselves. The Manager said that the organisation is looking at ways to empower people with interactive locks and devises which will give everyone more control over access to their rooms. We witnessed a staff member showing a visitor someone’s bedroom when the person was not at home. They should not have done this. The Manager needs to make sure people have control over who accesses their room and are assessed to see what type of locking devise is most appropriate for them to be in control about the security of their own room. Silver Birches DS0000017394.V362952.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 & 17 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People need to have more support to take part in educational and leisure activities which meet their needs. Most people have regular contact with their families, although sometimes poor communication within the staff team has meant that people are not always given the support they need. People are offered varied and nutritious meals. EVIDENCE: The organisation has reviewed the way in which the home supports people to meet their social needs. The majority of people attend a day centre provided within the building and access set activities from there. These activities are Silver Birches DS0000017394.V362952.R01.S.doc Version 5.2 Page 16 based around day time only. The organisation has recognised that people need to have more choice and variety to do the things that they want to do throughout the days, evenings and weekends. Therefore a new post has been created for a staff member to organise and coordinate individual activities. This has not started yet. There is a wide range of ages, abilities and people with lots of different interests living at the home. However, the activities offered did not always reflect these different ages and interests. People are not always supported to do the things which they have said that they would like to do. Some people have said that they would like to go to church more often. Others have identified different activities such as horse riding, theme parks and going to the seaside. Some people told us that there was not enough going on for people living at the home. One person said, ‘I feel that everyday basic physical needs are met but from my observations residents seem to spend a lot of time just sitting in the communal room.’ Another person said, ‘the residents need more stimulation.’ Another comment was, ‘the residents need more support to do activities outside 10-4pm.’ The Manager told us that the staff have had training in equality and diversity and that supporting people’s diversity was important in the home. Some people are supported to attend places of worship. However, one person told us, ‘the staff do not always respect the cultural needs with regards to food and religion.’ Visitors are welcome at any time and many of the families told us that they were made welcome by staff when they visited the home. We met one family member who said that they visited every week. We saw that they felt relaxed and were able to spend time alone with their relative. There are quarterly meetings for the families of the residents, which the Manager attends. There is a fundraising committee including family members who organise special events and raise money for the home. In the past this has helped with purchasing new furniture, equipment and improving the garden. The Manager told us that there are plans to develop a newsletter about the service to help keep in touch with relatives and friends. Some relatives said that they were involved in making decisions about the care of residents. However some relatives said that they were not. One person said, ‘I am not consulted on any aspect of my relative’s care.’ Another person said, ‘we have not always been told when our relative is ill until we phoned or visited.’ Silver Birches DS0000017394.V362952.R01.S.doc Version 5.2 Page 17 A lot of people told us that communication from staff needed to improved and that they were not always consulted or contacted. One person told us, ‘ communication to me is very poor and messages are not passed on and my requests are mostly ignored.’ One person told us that it had been agreed that staff would support their relative to have regular telephone contact but the staff seldom gave this support. Another person said, ‘the general communication is poor.’ One person said that they felt the home should use more volunteers to support people to try new things and take part in more activities. Over the past year the staff have had training and support to improve their skills and understanding of people’s rights and dignity. There have been improvements in this area and some staff have a good understanding and respect the people they support. However some people told us that not all staff show respect. One person said, ‘some staff are not suitable for the job and do not give eye contact when they are helping someone to eat their meal.’ Some people wear aprons when they are having a meal. This is not necessarily their choice. One person’s care plan stated that they wore a ‘bib to help promote their dignity’. The Manager should make sure staff respect people’s rights and dignity at all times and that they have a good understanding of this. The staff said that people living at the home made choices about what they ate and helped to prepare a menu for each flat. We saw some examples of this, however in one flat there was no menu on display and confusion about what was for the evening meal on the day we visited. The kitchens are well stocked with fresh food and meals are freshly prepared. We saw some people having a meal while we were visiting the home. The staff did not share a meal with the residents. Silver Birches DS0000017394.V362952.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People’s personal needs are not always well met and information on meeting these needs is sometimes unclear. The staff work closely with other professionals to keep everyone healthy. The way in which medication is managed has improved improvements are needed to make sure everyone is kept safe. EVIDENCE: Some people said that staff helped people with their physical care needs. The information and guidelines for meeting people’s personal care needs is not always clear and is in some cases inaccurate. For example there was not always a clear reason why charts to monitor people’s personal needs were used. Some of the recordings on these charts did not make sense. Some information had not been dated. Some guidelines had been changes and Silver Birches DS0000017394.V362952.R01.S.doc Version 5.2 Page 19 but further different records conflicted with each other. Some guidelines were unclear. For example an instruction in one person’s care plan was to ‘cover them with a blanket’. This statement is open to several different interpretations and it was not clear what exactly was meant by this. Most people told us that they felt the quality of care varied. However some people said that not all staff were good at this. One person told us that the staff sometimes dressed their relative in inappropriate clothes for the weather. Another person said that the staff did not always help their relative to get clean after a they had a meal. One person told us that the staff supporting their relative had bought clothes which the person could not manage the fastenings on. One person told us that their relative was sometimes dressed in ‘stained or inappropriate clothes.’ Another person said, ‘the staff don’t always chose the most suitable clothes and shoes.’ Someone told us that, ‘we have found residents wearing each others clothes.’ One person told us ‘There are occasional shortfalls surrounding keyworking and personal care.’ Health professionals and the local community team offer support and guidance and work with staff to make sure everyone’s needs are met. Professionals told us that the staff worked well with them and generally listened to what they said. Some of them told us that the team had accepted changes and were trying to make things better for the residents. One person told us, ‘the staff provide excellent support if people are in hospital- giving one to one care.’ Since we last visited there have been improvements to the way in which medication is managed. The cabinets where medication is stored have been improved and are better organised. The records of people’s medication are clearer. All staff administering medication are trained and have been assessed by senior staff. However, there were a number of problems which we identified which must be addressed. These included: Records showed us that some people had not always been given their correct medication when they should have been. Some medication had been removed from its original packaging and stored in different packets. There was no record of some of the medication being held. There was no recorded date of opening for one medicine which needed to be discarded one month after opening. There was an unlabelled pill crusher. Silver Birches DS0000017394.V362952.R01.S.doc Version 5.2 Page 20 The administration chart for one topical medication did not give sufficient detail about where the medication should be applied. There were some gaps on the medication administration sheets which did not indicate whether medication had been given or not. Some prescribed medication was not included on the administration charts. Some of the documents had the wrong person’s name on them and some had the wrong medication recorded. Medication plans are not accessible to the people they are written about. There is a form entitled ‘consent to treatment’. There was no evidence on this or other documents that people had been consulted or given their consent for administration of medication or treatment. There was excess stock of some medication. The allergy sections on some medication administration records had not been completed. Silver Birches DS0000017394.V362952.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People are able to make complaints and are confident that action will be taken to investigate and resolve these. There are appropriate procedures for investigating complaints and protection of vulnerable adults. Staff follow these procedures. EVIDENCE: There is a pictorial version of the complaints procedure and information about who to talk to if someone has a concern or complaint. Some of this information is kept in residents’ files which are locked away by staff. Some of the information is displayed but the location of this is not particularly accessible and clear to everyone. The staff should think how else they can make sure everyone knows what to do if they have a complaint. There is a record of all complaints and concerns and how these were investigated and resolved. Some people told us that when they had made complaints, and these had been resolved to their satisfaction. There is information on protection procedures available in each flat. The staff we spoke to had a good understanding of how to protect people from abuse Silver Birches DS0000017394.V362952.R01.S.doc Version 5.2 Page 22 and what to do if they suspected abuse. They had all read and signed the procedures and spoke about the training they had received in this area. The Manager is part of a multi agency group who are reviewing safeguarding procedures in care homes and other establishments in the borough. They are also looking at the training needs for staff around protection of vulnerable people. The Manager is able to bring her knowledge and experience from this group to the home and help support the staff there to have an even better understanding. There has been an improvement to the way in which people are supported to manage their own money. The staff hold small amounts of cash on behalf of people and the balances of these are checked regularly. Personal bank accounts and expenditure are regularly audited. Silver Birches DS0000017394.V362952.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The building meets the basic needs of those who live there and is generally well maintained and clean. Some areas of repair and decoration would improve the environment. EVIDENCE: The building and grounds are generally well maintained although some areas of wear and tear need to be attended to. These include marked paintwork, damaged kitchen work surfaces, damaged flooring and damaged tiles in one bathroom. The garden is nicely maintained. Some areas of the home have not been personalised and seem rather plain and unwelcoming. The staff should help people think about innovative ways to decorate and personalise the home. Silver Birches DS0000017394.V362952.R01.S.doc Version 5.2 Page 24 The organisation is considering changing the existing environment and building in the future in order to better meet the needs of the people who live there. People living at the home have identified some equipment which they would like, such as new TV, new dining room furniture and new curtains. The fridge in one flat was locked shut and there was no risk assessment to explain why access to this had been restricted. Silver Birches DS0000017394.V362952.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 & 36 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The staff team are generally well trained and supported. However, some people have concerns about the skills and commitment of temporary staff. The people living at the home can be confident that recruitment procedures make sure staff are suitable to work at the home and that staff are given the induction and training to carry out their roles. The staff team are not always getting the formal support they need. EVIDENCE: Shortly before our visit the organisation decided to change the staffing structure at the home. Two new posts of Deputy Manager are being created and some senior staff have been made redundant. The new posts were being recruited to. The change in staffing structure is designed to better meet the needs of the home giving more time for the managers to support the staff and to work towards addressing problems. However, the morale of the staff team Silver Birches DS0000017394.V362952.R01.S.doc Version 5.2 Page 26 was understandably affected by the fact that some posts had been made redundant. Some of the staff have achieved NVQs and the organisation is supporting others to undertake these. Some of the people who contacted us said that they felt the staff team needed additional training and skills to make sure they could meet the needs of everyone. One person said, ‘there is a very wide margin in the skills of staff and this is reflected in how well they do their jobs.’ One person said, ‘sometimes complacency is a problem and standards drop.’ Lots of people said that they felt the agency staff used by the home did not do a good job. One comment was, ‘agency staff do not have the skills to do the jobs and do not have the residents interests at heart.’ We spoke to some members of staff who had been employed in the last year. They said that they were well supported by the team and that they were given the information which they needed. Some people said that the managers were supportive but that they did not spend enough time with the staff and residents and did not always know when practice needed to be improved. Some staff said that they would like more supervision and support. There are good records of staff training and these include information on when staff need to update their training in key areas. We looked at a sample of staff recruitment records. These contained all the necessary information and showed that thorough checks are made on staff before they start work at the home. Some of the staff have had training in equality and diversity. The organisation is looking at ways to provide training in English skills for people whose first language is not English. The Manager told us that they plan to provide more specialist training for staff in the future. The organisation holds regional and national staff forums which meet quarterly. A staff representative from Silver Birches attends these. These forums allow staff to discuss the things which affect them and changes in the organisation. Their views are fed back to senior managers. The organisation provides a free confidential counselling service for any staff member who wishes to use this. Some people told us that the staff did not always communicate well with each other, relatives or other professionals and that messages and important information were not always passed on. One person said, ‘the staff need to improve their internal communication systems particularly at handover and Silver Birches DS0000017394.V362952.R01.S.doc Version 5.2 Page 27 work to improve external communication with others.’ Another person said, ‘It is not always easy to contact staff by telephone and messages on the answer phone are rarely returned.’ Another comment was, ‘the communication between staff is not always good or accurate.’ Not all staff members have regular formal supervision meetings with their manager. Silver Birches DS0000017394.V362952.R01.S.doc Version 5.2 Page 28 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The service is well managed and the Manager is committed to improving things for the people who live there. There are some risks to people’s health and safety. EVIDENCE: The Manager has been in post for two years and has been registered with the Commission for Social Care Inspection. She is experienced and has appropriate qualifications. The Manager has shown a commitment to continuous improvement of the service. She has worked with us and other agencies to identify where problems in the home. Silver Birches DS0000017394.V362952.R01.S.doc Version 5.2 Page 29 Some of the staff told us that they felt the Manager had introduced some positive changes and that things were improving for the people who live at the home. People have told us that they feel that they can talk to the Manager about their ideas and that they are listened to. The organisation has introduced a quality assurance programme which asks residents for their views and looks at the equality and diversity of the service and areas for improvement. The Manager and staff plan to start using this programme to monitor and improve the service at Silver Birches. Some of the records at the home have improved since we last visited. However a lot of information is unclear and muddled. People have made changes by hand and crossed information out. Some records are not dated and not signed. Some handwritten information is poorly written and unclear. There is a lot of duplication and this is confusing. Some records had not been reviewed when they were supposed to be. Old information has not been appropriately archived and some of this conflicts with newer information. Some guidelines and directions do not make sense or are unclear. Information for new staff is confusing, out of date and in some cases inaccurate. There was evidence that staff made regular checks on different areas of health and safety. However we identified a number of hazards which need to be addressed. Hot water pipes were exposed and people are at risk of scalding themselves. The boiler and hot water pipes in the fire escape were exposed. A staff member supporting someone in a bathroom did not take off their protective gloves when they left the bathroom and were wearing these while attending to other tasks. Cupboards storing COSHH items were left unlocked. Staff prepared food and drinks without washing their hands. Food in the fridge was not properly wrapped up or put in appropriate containers. Some first aid items had passed the expiry date. One first aid box was stored beside a radiator and was too warm. H&S Silver Birches DS0000017394.V362952.R01.S.doc Version 5.2 Page 30 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 X 2 3 3 3 4 3 5 3 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 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 2 33 3 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 3 2 X LIFESTYLES Standard No Score 11 2 12 3 13 3 14 2 15 2 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 3 3 3 X 2 2 X Silver Birches DS0000017394.V362952.R01.S.doc Version 5.2 Page 31 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 YA6 Regulation 12 15 Requirement Timescale for action The Registered Person must 31/10/08 continue to support people to develop their own meaningful person centred plans in a format which they can understand. Relatives and other important people should be consulted and involved in care planning. Previous 30/11/07 requirement 2. YA6 12 The Registered Person must 31/07/08 make sure individual needs and wishes are appropriately recorded so that people can have fulfilling and varied opportunities which they enjoy. 3. YA7 12 The Registered Person must 31/07/08 make sure staff use communication aids, photographs and other equipment to help people to DS0000017394.V362952.R01.S.doc Version 5.2 Page 32 Silver Birches make choices, communicate and have control over their lives. 4. YA6 15 The Registered Person must 31/07/08 make sure the words and terminology used in care plans are clear, jargon free and appropriate. 5. YA9 12 13 The Registered Person must 30/06/08 make sure risk assessments are made to show why restrictions have been placed on people. The process of risk assessment should involve the opinions of the person and other relevant professionals where appropriate. Risk assessments must be recorded and regularly reviewed. (Previous timescales 01/12/06, 30/06/07 31/01/08 not met) of and 6. YA7 12 The Manager needs to make sure 30/06/08 everyone is supported in a meaningful way so that they are involved in all aspects of daily life at the home and decision making. Previous timescale 30/06/07 7. YA7 12 The Manager must make sure 30/06/08 people are given the information they need everyday in a format which they understand. This should include their menu, staff rotas and how to make a complaint. Silver Birches DS0000017394.V362952.R01.S.doc Version 5.2 Page 33 8. YA7 12 The Registered Person must 31/08/08 make sure everyone is able to lock their bedroom, unless this presents a risk which has been assessed and recorded. The Registered Person must make sure residents and not staff make the choice about who accesses and sees their bedrooms. Previous timescale 30/06/07 & 31/01/08 9. YA11 YA14 12 16 The Registered Person needs to 31/08/08 make sure everyone is given the opportunity to pursue educational and social activities which they like and have chosen, are appropriate to their age and ability. Previous timescales 30/06/07 & 31/01/08 10. YA15 YA32 12 16 The Registered Person must 30/06/08 improve the way in which staff communicate with relatives, professionals and each other so that messages are passed on, and people are given the information they need. The Registered Person must 30/06/08 makes sure staff respect people’s cultural needs at all times. The Manager should make sure staff respect people’s rights and dignity at all times and that they have a good understanding of 11. YA16 12 Silver Birches DS0000017394.V362952.R01.S.doc Version 5.2 Page 34 this. Previous timescale of 30/06/07 & 31/01/08 12. YA18 12 15 The Registered Person must make sure guidelines and 31/07/08 information about meeting people’s personal needs are clear and accurate. The reasons for any monitoring and interventions must be clearly recorded. Monitoring charts and records of incidents must be clear. The Registered Person must 30/06/08 make sure people are dressed appropriately in their own clean and well maintained clothes. 13. YA18 12 14. YA20 13 The Registered Person must 30/06/08 make sure medication procedures are followed appropriately. Medication must be stored, labelled, administered and recorded correctly. Previous timescales of 08/12/06 and 30/06/07 and 31/01/08 15. YA24 23 The Registered Person must 30/09/08 attend to the identified areas of repair, in particular repairing damaged flooring, tiles and surfaces in bathrooms and kitchens. The Registered Person must 31/08/08 make sure all staff have opportunities for regular formal DS0000017394.V362952.R01.S.doc Version 5.2 Page 35 16. YA36 18 Silver Birches supervision meetings with their managers. 17. YA41 17 The Registered Person must 31/07/08 make sure records are accurate, up to date, clear and reviewed as necessary. The Registered Person must 30/06/08 make sure all exposed hot water pipework and the boiler are made safe and the risks of people scalding themselves are minimised. The Registered Person must 30/06/08 made sure the staff adhere to all health and safety procedures. 18. YA42 13 23 19. YA42 13 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 YA5 Good Practice Recommendations The Service User Guide, complaints procedure and placement agreements should be developed in different formats which are meaningful to the people who live at the home. 2. YA7 The keyworking system needs to be developed and reviewed so that people feel confident that they are getting the individual support they need. 3. YA7 The Manager should try to get independent advocate support for everybody. DS0000017394.V362952.R01.S.doc Version 5.2 Page 36 Silver Birches The Manager should make sure independent advocates or family members assist people to complete quality surveys rather than staff. 4. YA7 The Manager should consider holding residents meetings more frequently so that the group can make more decisions about the things which affect them. Resident meeting residents. minutes should be accessible to 5. YA7 All staff should be trained in using Makaton and should use this to support communication with the people living at the home. 6. YA7 The Manager must make sure people are given the correct information about their daily lives from staff. 7. YA7 The Manager should consider how best the current environment and equipment can be adapted so that people find it more accessible. The Registered Person needs to make sure people are supported to contact their relatives. The staff and residents should sit down together to share meals. The Manager should make sure all staff, including temporary staff, give a high quality level of support. 8. YA15 9. YA17 10. YA32 Silver Birches DS0000017394.V362952.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 © 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.V362952.R01.S.doc Version 5.2 Page 38 - 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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