Inspection on 23/04/09 for Silver Birches

This inspection was carried out on 23rd April 2009.

CQC 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 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Silver Birches 14/05/08

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 10/07/2009.

CARE HOME ADULTS 18-65 Silver Birches 2-6 Marchmont Road Richmond Surrey TW10 6HH Lead Inspector Sandy Patrick Key Unannounced Inspection 23rd April 2009 09:45 Silver Birches DS0000017394.V373692.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.V373692.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.V373692.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.V373692.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th May 2008 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 £940.00 to £1,235 per week. Silver Birches DS0000017394.V373692.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. The inspection of Silver Birches included an unannounced visit to the home on 23rd April 2009 by two regulation inspectors. We met people who live at the home, staff on duty and the Manager. We looked at records, the environment and how people were being cared for. We wrote to people who live at the home, their representatives, staff and other professionals and asked them to complete surveys about the service. We asked the Manager to complete a quality self assessment. We looked at all the information we had received about the service since the last inspection. Some of the things people told us about Silver Birches were: ‘They do a superb job looking after my relative’. ‘My relative has lived at the home for a long time, there have been lots of changes, some good, some not so good, but she is happy there and enjoys her life.’ ‘They provide a friendly and relaxed atmosphere and keep my relative healthy.’ ‘I have been at Silver Birches for over 20 years and I really feel at home.’ What the service does well: People are happy living at the home. They feel well cared for and have a good relationship with each other and staff. The Manager listens to the things that people who live at the home, staff and others say about the home and makes plans to improve things to make sure everyone is happy. People are given the support they need to stay healthy. The staff have lots of good training and they feel this has helped them do their jobs better. Silver Birches DS0000017394.V373692.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Silver Birches DS0000017394.V373692.R01.S.doc Version 5.2 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.V373692.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have enough information and opportunities to visit to help them make a decision about moving to the home. They have their needs assessed to make sure the home is the right place for them. EVIDENCE: People told us that they had enough information to help them make a decision about moving to the home. They said that they had been able to visit and had short stays there before deciding to move there. Some of the things people said were, ‘my family visited the home to see if it would be suitable for my care and various needs, they visited 20 other homes’, ‘we chose the home for our relative, but she had odd days and weekends there to make sure she was happy before she moved in’, ‘my parents came to view the home and we liked it’ and ‘I had visits and short stays and met other residents and staff, got to know the routine’. We saw that people had their needs assessed by the home and by the placing authority to make sure these needs could be met at the home. We saw that people moving to the home, their relatives and other representatives were consulted about the move. Silver Birches DS0000017394.V373692.R01.S.doc Version 5.2 Page 9 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.V373692.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are given support to meet their needs and the staff are well informed about these needs through care plans, regular reviews and close work with families. People are starting to be consulted and have more choice about their lives but this is an area where they need more information and control. EVIDENCE: Everybody has their needs recorded in a care plan. Over the past few years the staff have worked hard to improve these. Information is now clearer and based around what the people living at the home want, including their personal preferences. The staff have had training and support to work in a more ‘person centred way’. This means that they have thought more about people’s individual likes, dislikes and tried to give them more control over their own lives. Some people have special communication needs and the staff are not always sure about Silver Birches DS0000017394.V373692.R01.S.doc Version 5.2 Page 11 what the person actually wants and needs. To help them they work with the families and other important people to create a ‘circle of support’, where everyone tries to create the care and support the person would chose. The local person centred approach coordinator told us that the service had implemented good person centred support plans. They said, ‘Silver Birches have been the most responsive service in the borough, who I have worked with, to implement circles of support while support planning’. Things people told us about the care and support people living at the home received included, , ‘excellent person centred approach’, ‘they communicate with relevant people about service users’ needs’, ‘we strive to maintain a good standard of care for our service users’, ‘staff follow care plans and guidelines and have a record of my relative’s likes and dislikes’ and ‘care plans are updated regularly and we are informed of any changes, there has been an improvement in the last 8 months’. People have their needs and care plans reviewed regularly. Some of the things people told us, ‘I have an annual review of my care plan with staff and my family we discuss my likes, dislikes and goals’ and ‘I was impressed when I went to a person centred review, the service user was involved throughout the whole process’. People are supported to take risks and try new things. assessments of the risks people face. We saw recorded The staff have tried to introduce things to help people to make more decisions about their lives. However, we felt that this was an area they could improve further. The staff use some photographs and pictures to help people decide what food they want and to help them remember where things are kept. But they need to do more of this so that people have even more information so that they can make informed choices. In some flats there were pictures to tell people which staff would be on duty, but in other flats there were not. This information needs to be clear for everyone. New notice boards have been put up in the flats, but these are silver and the pen used to write on them was green and it was difficult to read. The staff need to think about other media and use the computer to make information even clearer for people. People are now offered more choices and this is an area which has improved. One relative told us, ‘our relative’s keyworker knows them well and can tell by their expressions if they are happy or not’. Another person said, ‘the staff show a lot of respect and offer choices daily’. With further work the staff could help people to have even greater control over their lives. The manager told us that some people have advocates and staff are trying to arrange for more people to have advocate support. Silver Birches DS0000017394.V373692.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 & 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People are supported to participate in different activities and educational opportunities. This is an area the home has improved and is continuing to improve to make sure people get the support they need to do things of their choice. People are able to see their friends and families when they want, although communication between staff and families needs to improve. People are treated with respect and dignity by most staff, however some staff need to show more respect towards people. EVIDENCE: People we met seemed happy and relaxed. People told us that they liked living at the home and were able to do the things that they wanted to do. Since the last inspection the service has changed the way people are supported during the day. There is an activity centre at the home and people Silver Birches DS0000017394.V373692.R01.S.doc Version 5.2 Page 13 who live there can use the resources, which include a trampoline. The Manager said that people have been able to make more individual choices about what they want to do. People told us that they were supported to go out shopping, swimming, places of worship and to places of interest. They told us that they also did things at home like helping with the cooking. An activities coordinator has recently been employed. Their role is to create an individual plan of activities for each person. We spoke to this member of staff and they had started implementing some of their ideas to get people to try new things. Some of the things people told us were, ‘each day of the week there are different activities and outing on offer’, ‘they have made good links with outside resources’, ‘people are supported to make their own purchases’ and ‘our daughter has a weekly programme and is happy with what she does’. We saw that some of the time people did not have anything planned to do. It is good for people to have relaxation time, but we felt that the staff did not really know what to do with people during this time. In one flat, one person kept telling the staff that they wanted to go to bed. The staff responded by saying it was not bedtime, but they did not support this person to do anything else or spend time with them. It may be that a positive distraction may have helped the person focus on something else. In another case we saw a member of staff trying to engage someone in an activity which they did not appear interested in. Some staff may need some support We met with some people’s families. They told us that they visited regularly. Some of the things people told us were, ‘I generally spend weekends with my family’ and ‘I sometimes go out with my brother and sister for dinner’. Some of the family members help out at the home with activities, such as cooking and gardening. One visitor told us that they helped a small group of people prepare Italian food each week. There is a quarterly meeting for family members where they discuss planned projects for the home and arrange special events. We spoke to some of the families involved in this. They told us about some of the fun events they had held for people living at the home. These included an Easter event, an African Feast, Halloween party and Christmas parties. They told us that they organised fundraising events to help finance improvements to the building and garden and to purchase equipment. Some of the families told us that they were concerned that communication from the home was not always good. Some of the things they said were, ‘they do not always stay I touch with me or inform me about my relatives welfare. Once they took them away on holiday and did not tell me’, ‘staff do not always communicate with families and do not return emails or phone messages’, ‘the staff need to communicate more regularly with families not just about major Silver Birches DS0000017394.V373692.R01.S.doc Version 5.2 Page 14 issues but establishing a two way dialogue, we want to be involved in our relatives life and need to know the ups and downs’ and ‘the staff need to be more positive about families and family involvement – if they only contact us when there are difficulties they may feel criticised, they need to share the positives too’. The manager told us that she thought this was something which had improved at the home. However, with such a high number of people telling us they felt it was a problem and some highlighting a concerning lack of contact, this is an area which needs further improvement. We saw that many of the staff were polite, caring and respectful towards people who live at the home. We saw that they communicated well about what they were doing, asked for people’s views and opinions and gave them choices. We saw that most of the staff knocked on people’s bedroom doors before entering. However, we overheard a number of staff talking inappropriately and three different members of staff referred to people living at the home as ‘good girl’ and ‘good boy’. This is not appropriate and is patronising. The staff must address people by their preferred name. We saw a number of staff walking into one of the flats without knocking or ringing the bell and then talking only to the other staff not the people who lived in the flat. We heard one member of staff tell a person to ‘come’ when they wanted them to go somewhere else. We felt that some of the staff needed to show more respect to people and show proper respect for the fact they are in their home. People who live at the home are involve din choosing, shopping for and preparing meals. All food is freshly prepared. We saw that kitchens were appropriately stocked with fresh food and fruit. We saw staff offering people meals, snacks and drinks. Some of the things people told us about the food at the home were, ‘quality home made meals’ and ‘the staff do their best to provide a variety of food suitable for specialist diets’. Silver Birches DS0000017394.V373692.R01.S.doc Version 5.2 Page 15 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 are supported to stay healthy and have their personal needs met. Although communication with health care professionals needs to improve. People are supported with their medication, although there needs to be improvements to the way this is managed to make sue people are not at risk. EVIDENCE: People’s personal needs are recorded within their care plans. These are monitored and records show that people are getting the support they need. We did not see anything that caused us concern about the way in which people’s personal care needs were met. However one member of staff raised a concern with us by stating, ‘sometimes people are left sitting in urine or have not had any breakfast or a drink by 10am – depending on which staff are on duty. Some staff do not care’. Although we did not see evidence of this ourselves the manager needs to make sure people’s needs are met at all times and they are not neglected, because a member of staff raised this concern and it is of such a serious nature. The staff should be aware that this is not an Silver Birches DS0000017394.V373692.R01.S.doc Version 5.2 Page 16 appropriate way to raise such allegations and they should be following the home’s procedures on safeguarding adults. People have health care plans and are supported by other health care professionals. One relative told us that they felt people were kept healthy and staff gave good support. They said, ‘when my relative had to go into hospital I was very impressed with the care and support they received from the staff’. A number of health care professionals contacted us and they said that the staff worked well with them and gave people the support they needed. Some of the things they said were, ‘the staff respond to the advice I give about service users’, ‘the staff actively sought my advice and input’ and ‘carers have responded well to advice given’. However some of the professionals said that communication within the staff team about medical appointments and health care needs needed improving. Some of the things they said were, ‘sometimes clients do not keep their medical appointments and we are not contacted to warn us’, ‘it can be difficult to contact the home and we do not have a direct line through to the patient’s carer’ and ‘communication between staff and the managers need to improve, support workers are often unaware of the plans we have put in place with management to care for people’s health needs’. There is an appropriate medication procedure and all staff responsible for administering medication are trained and assessed. We saw that storage of medication and records had improved. However we found that some information was recorded in a confusing way and this meant that it was difficult to audit. This meant that some people may be at risk. We found that some old medication which had not been needed, including some from July 2008, was still held at the home and was not properly recorded. We found that some medication administration records had not been completed properly. We saw that the pharmacist who supplies medication makes checks on storage and records at the home. They had a number of recommendations about recording and administration at their last visit in February 2009. In one flat the place where medication was stored and staff were asked to administer this was dimly lit. It is important that staff have good light to see what they are doing when they are administering medication and the organisation should consider improving the lighting in this area or relocating the medication cabinet. Silver Birches DS0000017394.V373692.R01.S.doc Version 5.2 Page 17 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 a complaint and feel confident that they are protected by the home’s procedures and staff training. EVIDENCE: People told us that they knew how to make a complaint and who to talk to if they were unhappy about anything. There is an appropriate complaints procedure and a record of all complaints. The organisation has procedures on abuse and whistle blowing. The staff are aware of the local authority procedures and have had training in this area. The staff demonstrated a good understanding of what to do if they suspected abuse. However, one member of staff made reference to other staff behaving in a way which neglects people in one of our surveys. They did not give any details. All the staff need to be aware that they have a responsibility to raise any such concerns using the whistle blowing and safeguarding procedures. Silver Birches DS0000017394.V373692.R01.S.doc Version 5.2 Page 18 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. People live in a generally well maintained and clean environment. EVIDENCE: The building is divided into three flats. Each flat is decorated and furnished according to the needs and wishes of the people living there. The building is generally well maintained with some areas of wear and tear. Since the last inspection a lot of decorating had taken place in particular the main communal areas. Hot water pipes are being boxed in. There are new kitchen tops and sinks in units, new dining tables, and new large Flat Screen TVs in all three flats. There is a newly built summer house and plans for a sensory garden. Silver Birches DS0000017394.V373692.R01.S.doc Version 5.2 Page 19 There are plans for further improvements to the building, including bedroom doors with locks which the people who live there can operate, a new quiet sitting area in one of the flats and widening the front door. One of the family members helps maintain the garden, which is attractive. Some people showed us their bedrooms and we saw that they had personalised these. One of the flats within the home is sparsely furnished and has very few pictures or soft furnishings. The manager told us that the needs of people who lived there meant that they were unable to have ornaments, pictures and soft furnishings. The staff should think of creative ways to make this flat feel more homely. People told us that they liked the home and that it was kept fresh and clean. We found that the home was clean on the day of our visit. Silver Birches DS0000017394.V373692.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People are cared for by suitably recruited staff who are well trained and have information about their roles. Some of the staff feel that they do not get the support they need to carry out their jobs. EVIDENCE: Some of the things people told us about the staff were, ‘the permanent staff seem to have the right skills and experience’, ‘there are good relationships between the staff and service users, recognising individual needs’ and ‘I was very impressed with the staff’s attitude’. One professional told us that they would like the organisation to employ more staff who reflected the needs and interests of people living at the home. The Manager said that the staff team were supportive and worked well together. One member of staff said, ‘we always work as a team and communication is very important’. Another member of staff told us, ‘communication has improved over recent months’. Silver Birches DS0000017394.V373692.R01.S.doc Version 5.2 Page 21 One member of staff felt that the staff team did not always work well together and they said, ‘half the staff are committed but a handful are lazy and uninterested and this affects the committed staff’. Since the last inspection the staffing structure has changed and two new deputy manager posts have been created. A new activity officer post has also been created. The Manager told us that she had held staff interviews shortly before the inspection and was in the process of recruiting new staff. We looked at some staff files. We saw that there are appropriate procedures for recruiting staff, including checks on their suitability and records of interviews. One member of staff told us, ‘the staff are not allow to start until their CRB and references have been received’. The staff team all seemed to think that training provided by the organisation was very good and comprehensive. They said that they had a thorough induction into their roles and good training on a regular basis. Some of the things they told us were, ‘very excellent induction and training, but they are not quick in supporting us to do NVQ’, ‘the induction covered everything I needed to know’, ‘the staff have regular training to up date their knowledge’, ‘good training was provided in my induction’, ‘they always help me with good training and information to do my job’, ‘I have done all the training and just finished my NVQ Level 2’, ‘when I started work I had a week of induction then 2 weeks shadowing staff – everyone was very supportive and answered questions I had’, ‘the training I have had has been informative and relevant’ and ‘when there is a new policy we are trained on this’. We saw that there were clear records that showed when staff had undertaken training. We saw that they had received a good range of training and this was up to date. We saw that there were some areas of training which staff had not received, such as training on the new Mental Capacity Act. The manager should organise this training to help all the staff have a better understanding of this. We looked at a sample of 11 staff files. We saw that some staff had regular supervision meetings with their manager. We saw that 1 person did not have any record of supervision meetings with their manager, 6 people had infrequent supervisions and some of these people had not had a recent meeting. One person had not had a supervision meeting since January 2008. Some members of staff said that they did not have the support they needed from managers and did not have regular supervision meetings with them. Some of the things they said were, ‘some of the supervision is cleverly worded and staff feel threatened by the content of them’, ‘the manager meets with the staff once a year for an appraisal, if they need support on other occasions they arrange a meeting’. Other members of staff said that they did feel supported and met regularly with the team and their manager. Some of the things they Silver Birches DS0000017394.V373692.R01.S.doc Version 5.2 Page 22 said were, ‘we have weekly meetings in our flat with the staff and manager’, ‘as a member of staff I am treated with dignity and well and that is how we should treat the service users’ and ‘I meet with my manager for support and development every month’. Some of the staff told us that communication had improved and that all staff had to use a communication book. One member of staff told us that they had regular team meetings. We saw that the staff had a verbal and written handover of information when they changed over. We saw that plans for each day told the staff what tasks were assigned to them. Silver Birches DS0000017394.V373692.R01.S.doc Version 5.2 Page 23 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): 37, 38, 39, 41 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a service which is well managed. They have opportunities to contribute their ideas and be involved in monitoring and developing the service. EVIDENCE: The Manager is experienced and has been in post for over two years. She previously managed another home. She is appropriately qualified. People told us that the Manager was supportive and had made improvements to the home. Some of the things people said were, ‘the manager supports us to ensure we work in a professional manner’, ‘the service responds well to individual needs and gaps that need attention’, ‘I think the new manager is trying hard to set Silver Birches DS0000017394.V373692.R01.S.doc Version 5.2 Page 24 up good systems’ and ‘my line manager is always very helpful and quick to support me’. The Area Manager was visiting the home on the day of the inspection. The Manager told us that she was in regular contact and was a good support for the home. We saw copies of the monthly visit reports conducted by senior management. Some people did not feel supported and told us things which showed that they felt they were not managed well. Some of the things that they said were, ‘the staff are not consulted they are talked at, the staff have views and talents of their own and the management do not explore this’, ‘there needs to be a more positive management team approach with better leadership’, ‘there is covert and obvious bullying by the managers and the staff are too scared to say anything’ and ‘there needs to be better communication between the managers and staff so we can understand things better’. We spoke to some of the families who were visiting the home when we were there. They told us that they thought the manager had brought about positive change and improvements to the service. The manager has updated and improved some of the records at the home. However some records needed to be archived as older information was mixed up with newer information and this was confusing. There is an up to date fire risk assessment and evidence of regular checks on fire safety equipment and fire drills. However some checks on safety equipment were not being made weekly and should have been. We saw evidence of other health and safety checks. The recent inspection of gas safety indicated some improvements needed to be made to pipework. The manager needs to make sure this is completed. We found a cupboard containing cleaning products was left open and unlocked. People could be at risk if they misused these products and they should be safely locked away. Silver Birches DS0000017394.V373692.R01.S.doc Version 5.2 Page 25 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 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 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 2 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 3 3 3 X 3 2 X Silver Birches DS0000017394.V373692.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes 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 YA15 Regulation 12 16 Timescale for action The Registered Person must 30/06/09 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. Previous requirement 30/06/08 The Registered Person must make sure all staff show people respect through their interactions with them and respect the fact they are working in their home. The Registered Person must make sure they investigate the concerns made by a member of staff regarding people’s personal care. The Registered Person must make sure the staff communicate clearly with each other about health needs and support people to make all their medical appointments as planned. The Registered Person must make sure medication is stored, recorded and disposed of DS0000017394.V373692.R01.S.doc Requirement 2. YA16 12 31/05/09 3. YA18 12 13 31/05/09 4. YA19 12 31/05/09 5. YA20 13 31/05/09 Silver Birches Version 5.2 Page 27 appropriately. 6. YA23 13 The Registered Person must 31/05/09 make sure all the staff follow appropriate procedures if they suspect abuse or neglect. The Registered Person must 30/06/09 make sure all the staff have regular, planned, supervision meetings with their manager. Previous requirement partly met 31/08/08 The Registered Person must 31/05/09 make sure all the staff have the support they need to do their job and do not feel bullied, threatened or intimidated. The Registered Person must 31/05/09 make sure the exposed hot water pipes are covered so that they do not present a risk to people. Previous requirement 30/06/08 partly met. The Registered Person must 31/05/09 make sure checks on health and safety and fire safety are carried out regularly and recorded. The Registered Person must 31/05/09 make sure all COSHH products are stored safely and securely. 7. YA36 23 8. YA36 12 9. YA42 13 10 YA42 13 11. YA42 13 Silver Birches DS0000017394.V373692.R01.S.doc Version 5.2 Page 28 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 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. The Registered Person should make sure people are given the information they need everyday in a format which they understand The organisation should consider improving the light around the medication cabinet in the Deans, or relocating the cabinet to a place where there is better light. The staff should think of creative ways to furnish and make flat 2 feel more homely. The manager needs to make sure all records are accurate, up to date and appropriately archived. 2. 3. 4. 5. YA7 YA20 YA24 YA41 Silver Birches DS0000017394.V373692.R01.S.doc Version 5.2 Page 29 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 03000 161616 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk © This report is copyright Care Quality Commission (CQC) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CQC. 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