Inspection on 03/05/07 for Silver Birches

This inspection was carried out on 3rd May 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Silver Birches 23/04/09

Silver Birches 14/05/08

Silver Birches 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 09/07/2008.

CARE HOME ADULTS 18-65 Silver Birches 2-6 Marchmont Road Richmond Surrey TW10 6HH Lead Inspector Sandy Patrick Unannounced Inspection 3rd May 2007 13:30 Silver Birches DS0000017394.V340534.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.V340534.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.V340534.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) Care Home 15 Category(ies) of Learning disability (15), Physical disability (15) registration, with number of places Silver Birches DS0000017394.V340534.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th November 2006 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.V340534.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection included three visits to the service on the 3rd May, 8th May and 17th May 2007. The Inspector met with the majority of the people who live at the home and many of the staff. She spent time in each flat talking to people, observing practice and looking at records. The Inspector also met with the Manager. The Manager was asked to complete a quality assessment of the service, although this was not available before the completion of the report. The people who live at the home, their families, staff and other professionals involved with the home were asked to complete short questionnaires about the service. 11 of the residents, 12 of their relatives, 14 staff and 3 other professionals returned questionnaires. Some of the residents were helped by staff or relatives to complete these. People said that they liked living at Silver Birches and that they felt well cared for. They said that they felt safe. People generally liked the food. Some people felt that their privacy was not always respected. Some people felt that activities could be improved. All the relatives felt said that the care home always or usually met the needs of the people living there. They generally felt that they had the information they needed although some highlighted that communication was sometimes a problem. Many of the relatives praised the staff for their work and support of residents. Some of the things they said were, ‘My relative is kept safe, clean and healthy’ ‘Silver Birches has been my relative’s home since it opened 25 years ago and has always endeavoured to give them what they need to keep them well and happy.’ ‘The staff deserve praise for their hard work.’ ‘The staff are very patient.’ The health professionals who completed surveys highlighted areas where they felt there needed to be improvements. These included better communication, increasing staff awareness of disability issues and providing more choice. All three professionals said that they felt some staff were very good and provided excellent support, however this was not always consistent. In general, the staff completing questionnaires said that they felt well supported and had good opportunities for training. Some said that they did Silver Birches DS0000017394.V340534.R01.S.doc Version 5.2 Page 6 not have regular team meetings or supervision. Most of them said that they enjoyed their work at Silver Birches. What the service does well: What has improved since the last inspection? The Manager has taken up a permanent position at the home. The staff have worked with other professionals to support one person to create a guide to the care that they want and need. The staff have used photographs to help people make some decisions, for example choosing new furniture for the lounge. The staff in one flat have created a social activity folder to help people to chose they things that they do. Each person living at the home has an allocated keyworker who talks to them regularly to make sure their needs are being met. There have been some improvements to the way medication is managed. There have been some improvements to the environment. The Manager has completed a thorough audit of staff training. Training for all staff to improve their skills and awareness has been organised and is going to be provided by the Community Team for Learning Disabilities. Silver Birches DS0000017394.V340534.R01.S.doc Version 5.2 Page 7 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.V340534.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.V340534.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): 1, 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 move to the home have opportunities to visit and spend time there before they make their decision. Their needs are assessed and the staff spend time getting to know the person. Information for people moving to the home is written in different formats. But some of the people living at the home cannot understand this information in the current formats. EVIDENCE: People who completed questionnaires said that they had information about the home before they moved in. They said that they were able to decide whether they wanted to move to the home and visited before they made their decision. One person has moved to the home in the last year and the Manager and staff said that they had settled in well. There was one vacancy at the time of the inspection and the Manager said that she was liaising with placing authorities to consider people who might want to move to the home. Silver Birches DS0000017394.V340534.R01.S.doc Version 5.2 Page 10 Assessments of need have been made by placing authorities and senior staff and these have been used with other information to help form a picture of individual needs. The person moving to the home and their relatives are given information and are invited to visit and spend time at the home before they move there. The placement agreement for people living at the home and Service User Guide have been written in plain English, using easy words and symbols. This is good. But the Manager should think about how they can make these documents more accessible to the people who live at the home, making use of DVDs, computers or photographs. The placement fees do not include the cost of the house vehicle and the people who use this have to pay an additional contribution towards this. The Manager said that there is a signed agreement for this. This is being reviewed and the Manager should consult with the people living at the home and their representatives about this. Silver Birches DS0000017394.V340534.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 & 10 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Everyone who lives at the home has a care plan, and these have improved over the past six months. The staff have started work to help people who live at the home to be more involved in planning and recording their own care. Some of the recorded risk assessments restrict people rather than enable them. People who live at the home are not involved in assessing the risks which they take. Some people feel that they do not have control over their own lives. Not all information is stored confidentially. EVIDENCE: Other health care professionals have supported staff to create a ‘communication passport’ for one of the people living at the home. The person Silver Birches DS0000017394.V340534.R01.S.doc Version 5.2 Page 12 was involved in choosing what they wanted written about them and how they wanted this to be recorded. The document uses photographs and symbols to show the person’s likes and needs. This document is very good and the staff have started to make passports for others. The staff need to think about how they can use these to replace the current care plans. Each person has a care plan but they have not been involved in the development of these and some of the information is confusing and repetitive. Care plans need to be streamlined and the people who they are about must be involved in choosing what is written about them. Some of the risk assessments are old and do not look at how people can be enabled to take risks. Risk assessments have not involved the people they are about and are not recorded in an accessible format. Some of the restrictions have not been assessed, for example the use of restraining equipment. Some people had not had regular review meetings and some families were unhappy about this. The Manager has started to make sure everyone has a review of their care needs. These must take place regularly and must focus on what the person receiving care wants and needs. People completing questionnaires said that they made some decisions about their lives but not about everything. One person said that they did not always chose when they went to bed. They said that staff helped them to go to bed and sometimes they did this too early. Some of the relatives and health professionals completing surveys felt that care needs were not always met and people did not always have opportunities to make choices. Photographs of staff have been taken and the Manager plans to set up photographic guides to show who is on duty in each unit. These were not in place at the time of the inspection. The plan to introduce these is a good step towards giving people who live at home more information. The staff should now consider other ways they can use photographs to help give even more information, for example to support people making choices about food and activities. The residents of one flat have been involved in choosing new lounge furniture. The Manager of this flat showed the Inspector how they had taken photographs of different furniture styles and colours and the residents had used these to make their decision. There was some evidence of residents’ meetings and this is something the new Manager has encouraged. The minutes of meetings were periodic and the staff Silver Birches DS0000017394.V340534.R01.S.doc Version 5.2 Page 13 should think about how they can support residents to make more choices as a group (like they did about the lounge furniture) and as individuals. One person uses a communication device. On the first day of the inspection, this had not been charged up so the person could not use it. There communication was therefore limited and they were unable to express their choices. The staff must make sure equipment is fully functional so that people who need this can use it whenever they want. People who live at the home do not have keys for the home or their bedrooms. The Manager needs to assess individual needs and support people so that they can lock their own rooms and hold their own keys if they want to do this. The Manager said that the people who live at the home met people coming for staff interviews. The Manager should think about other ways the people who live at the home can be more involved in choosing staff. Information about one person’s dietary needs were displayed on a kitchen wall. This must be removed. Personal information must not be kept on display. Silver Birches DS0000017394.V340534.R01.S.doc Version 5.2 Page 14 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. There are a number of activities organised for people to take part in during the day, evenings and weekends. There needs to be more opportunities for people to participate in activities of their choice during the evenings and weekends. People are involved in some household tasks to an extent. But these are limited and people do not always have the opportunities to fully participate and learn new skills. Some of the staff treat everyone with respect and support them well. However, some staff need more training and support to make sure they always do this. Silver Birches DS0000017394.V340534.R01.S.doc Version 5.2 Page 15 EVIDENCE: Staff said that some people were involved in helping to prepare meals and with some household tasks. However, the Inspector observed some interactions where people were not positively involved in decision making or meaningfully involved in these tasks. In one case, a staff member walked past a resident saying, ‘do you know you are cooking today?’ Later on when the staff were preparing the meal they did not involve the person nor did they offer them any opportunities to take part. The staff need to look at individual skills and abilities and involve people in a meaningful way. This involvement should be planned and the person should be appropriately informed and involved in decision making. The home includes a resource centre where many of the residents go each day to participate in a variety of activities. Some people go to other resource centres or colleges. Everyone has a plan of daytime activities which is designed to meet their individual needs. The staff in one flat have created an activity folder which contains pictures and leaflets to help residents chose what they might like to do. There is also a record of activities. The Manager of this flat said that they were looking at alternative activities which meet individual needs, such as horse riding. Some of the things people said about activities were, ‘I like the pub’, ‘I would like to go out more’ and ‘I want to go on holiday’. Some people said that they could not do what they wanted in the day, evenings and weekends, and had to conform to the routines of the home. One person wrote that they would like to go out more and some relatives said that they would like the staff to organised more activities away from the home. This was a common concern expressed by relatives who felt that there was not enough going on at weekends and in the evenings. One person wrote that the residents were often ‘bored’ at these times. Another person wrote that residents were not able to make choices about what they wanted to do and had to do whatever the group did. One relative said that residents could not always go to church when they wanted. One health professional also highlighted this as an area the where there needed to be improvements. One person said that they felt that some organised activities were regularly cancelled at short notice and that they did not like this. The staff told the Inspector that they were organising summer holidays and that residents were able to chose where they went and who they went with. Silver Birches DS0000017394.V340534.R01.S.doc Version 5.2 Page 16 During two of the inspection visits the radio and TV in one flat were on at the same time. Staff were observed changing TV channels and music without consulting the people who live at the home. The home has recently purchased a trampoline which some residents enjoy. Some of the staff are undertaking specialist training to make sure they can support people to use the trampoline safely. The Manager said that staff are becoming more involved in proactive keyworking. This includes regular meetings between the resident and their keyworker. One person told the Inspector, ‘I like my keyworker’ There are regular relative meetings and some of the relatives said that they enjoyed being involved in organising special events. Family members said that they were generally made welcome at the home and stayed in touch with their relative. One person wrote, ‘There is always a welcome atmosphere when you visit.’ Some of the relatives who completed surveys said that they could not always get through to staff on the telephone. They said that sometimes messages were not passed on and sometimes they were not told about important things. Some people said that they had left messages on the home’s answer phone and staff had never rang them back. The Inspector saw that some of the staff supported people in a very positive way. They treated them with respect, were enthusiastic and listened to them. The atmosphere was more calm that it had been at the previous inspection and staff involved residents more in general conversations. However, some staff were not respectful, appeared apathetic in their interactions or did not offer choices or take the time to listen. One member of staff told someone they were a ‘good girl’. Another member of staff told someone where to sit and that they could not do what they wanted to do. Other staff did not offer choices or asked questions but did not wait for people to answer. This was discussed with the Manager who was aware that this is a problem in the home. She has arranged for specialist training for all staff to look at different elements of care and awareness. The training includes using video recorders so staff can look at their own practice. This is being organised by the local Community Team for Learning Disabilities. The Manager must also make sure that these issues are addressed through staff supervision. The staff support some people at mealtimes. The staff have not had training in this area. One person said that they felt some staff needed more training in order to give appropriate support. Most people said that they enjoyed the food at the home. One person said that they would like more food and to have smaller meals more often. Silver Birches DS0000017394.V340534.R01.S.doc Version 5.2 Page 17 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. Personal care needs are recorded but some people have experienced that these are not always met in the best way. People are supported to stay healthy. There have been improvements to the way medication is managed. However, there needs to be further improvements to make sure people are kept safe. EVIDENCE: Individual health and personal needs are recorded in care plans. There is evidence that the home works closely with the Community Team for Learning Disabilities and other professionals. Some of the bathrooms at the home are not homely or attractive. Care plans indicate that some people do not enjoy having baths. The staff should consider how they can make the bathroom environments and the experience of having a bath more pleasant for each person. They should consider the things Silver Birches DS0000017394.V340534.R01.S.doc Version 5.2 Page 18 that the individual likes and should think of ways of making the bathrooms feel more relaxing and attractive. Some of the relatives had concerns about the way staff supported people to get dressed. One person said, ‘Sometimes my relative is dressed in tight clothing which does not suit them. Sometimes the staff dress them in clothing which is inappropriate for the weather and occasion.’ Another person said that their relative had been given inappropriate footwear which had be the cause of an accident. The staff supporting one person to eat a meal stood next to them. They did not communicate with the person they were supporting. One relative commented that they felt staff did not always offer good support to help people at mealtimes and suggested more training was needed in this area. The Inspector observed one person had continence needs. These were referred to in their care plans, but there was not information to say how they could be supported to manage these. There was no evidence of consultation with the continence adviser or other relevant professionals. One care plan suggested that a person needed two members of staff to support them to clean their teeth. This could be intrusive and intimidating for the person and consideration should be given to reducing this support. One person wears a protective helmet at all times. This includes when they are using the sensory room and sitting on the sofa. There is no risk assessment for the use of this piece of equipment. The Manager should consult with other professionals and assess the risks for this person and there may be times when they are safe without this restraint. Three relatives wrote that they felt staff had responded well to health needs. One relative said that the staff had been very caring and involved them in supporting the resident after an accident. Another person wrote, ‘the staff have acted promptly when my relative became ill.’ One person said that the staff provided excellent support whilst residents were in hospital and had been particularly supportive when residents had had communication difficulties. There is an appropriate medication procedure and improvements have been made to administration and recording. However since the last inspection, there have been four incidents where staff have administered the wrong medication or made an error in administration. There are procedures in place to observe staff administration and check they are following the procedure. But not all staff who were responsible for these errors have been reassessed since they have made their mistakes nor have they had updated training. Different records, including the care plan, medication profile and administration records for one person showed conflicting information on that person’s Silver Birches DS0000017394.V340534.R01.S.doc Version 5.2 Page 19 allergies. The allergy section on some of the administration records were not completed. There were some gaps on some of the medication administration records. Some of the medication held at the home from month to month was not recorded on the administration records. Some of the medication profiles needed updating. There was no plan for administering PRN (as required) medication for some residents. There were no plans for management of certain health conditions. Consent forms for medical interventions had not been signed by the resident or their representatives. The medication cabinet in one flat was messy and a medicine had been spilt and had leaked over the cabinet and other packets of medicine. There was no date of opening on a topical lotion which had instructions to discard after a certain amount of time. Some medicines were not labelled with anyone’s name or administration details. There was a high number of paracetamols stored in one flat. The amount held should be reviewed and excess stock must be returned to the pharmacist. Silver Birches DS0000017394.V340534.R01.S.doc Version 5.2 Page 20 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 adequate This judgement has been made using available evidence including a visit to this service. There is an appropriate complaints procedure. This could be made more accessible to the people living at the home. Records of complaints are not always clear. Protection of vulnerable adults procedures have not always been followed appropriately. People who live at the home do not have control over their own money. EVIDENCE: Not everyone knew who to speak to if they were unhappy. Some of the relatives said that they felt staff understood non verbal signs and body language well if people were unhappy. There is a complaints procedure which includes pictures and simple words and sentences. The staff should also consider other ways to make the procedure more accessible such as using photographs and mediums. There have been a number of complaints made since the last inspection. The records of these are held in different places. Some records did not clearly show what action had been taken to address concerns or the feedback given to the complainant. The Manager should make sure there is a central record of all complaints and the action taken to address these. Silver Birches DS0000017394.V340534.R01.S.doc Version 5.2 Page 21 There are suitable procedures for protection of vulnerable adults and whistle blowing. Some areas of potential abuse have not been reported to the appropriate people and have been investigated by the Managers rather than the local authority. The Manager must make sure the London Borough of Richmond protection of vulnerable adults procedure is followed. The staff have all had training in protection of vulnerable adults. The systems used to help manage residents’ money have improved and there are more thorough checks to make sure records are accurate and residents’ money is safe. At present the Manager controls residents’ money and is the signatory for their bank accounts. The organisation should review this situation and must look at individual needs allowing people to have more control over their own money if they are able to. Silver Birches DS0000017394.V340534.R01.S.doc Version 5.2 Page 22 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, 25, 26, 27, 28, 29 & 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 the people who live there and is regularly maintained. However further improvements to some areas including better cleaning, storing equipment appropriately and making some areas more attractive would enhance the environment. EVIDENCE: People who spoke to the Inspector and those completing surveys generally liked the environment and felt that the home was clean and tidy. One person said, ‘I like my room’. The home is divided into three separate flats, each with their own facilities. There is a resource centre on the premise and a number of managers’ offices. Everyone has their own bedroom. There is an attractive garden and well kept flower beds. Some areas of the home have been redecorated but other areas look worn and would benefit from some maintenance. In particular the carpet Silver Birches DS0000017394.V340534.R01.S.doc Version 5.2 Page 23 in one flat which is very stained and window frames in one flat which are cracked and rotten. There are plans to buy some new furniture and replace carpets. The staff should also consider how they could make some of the flats more homely and attractive, in particular corridors and bathrooms. The dining chairs in one flat are very low and consideration should be given to providing chairs which support people to sit at a comfortable height to dine. The light switches and surfaces in the flats are not low level and some people use wheelchairs. The organisation should make adaptations to give the people who live in the home more control. Equipment including hoists, wheelchairs and a commode are stored in the lounge of one flat. The Manager must look at alternative storage for these items. Some of the bathrooms would benefit from deep cleaning as floor were stained, plug holes and showers were covered in limescale. Some tiles were dirty and cracked and some of the floors were sticky. Silver Birches DS0000017394.V340534.R01.S.doc Version 5.2 Page 24 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. The recruitment procedures for staff are thorough. The training audit at the home is good and shows areas where some staff need updated training. There are systems in place to offer staff support to do their jobs, although some people feel they would like more support. EVIDENCE: The majority of people completing questionnaires said that the staff treated them well. Some of the relatives and health care professionals felt that communication was a problem. They said that staff did not always pass on messages and did not always communicate appropriately with them. This was also the subject of a recent complaint. Some relatives felt that the home had trouble recruiting and retaining good staff. Silver Birches DS0000017394.V340534.R01.S.doc Version 5.2 Page 25 Several of the relatives and staff felt that there were not enough staff employed at the home. They said that this affected weekend activities and sometimes residents could not do the things they wanted to do because there was not enough staff. Some of the staff said that they could not provide individual support. Staff described thorough recruitment procedures and said that they had been given a good range of training. The Inspector examined five staff recruitment records. In some of these the references were not from previous employers and in one case references were not from the people named on the application form. Some references were written by friends of the employee. However, these files were from people employed some time ago. The Manager assured the Inspector that appropriate checks were now made on staff including thorough and appropriate reference checks. The Manager was in the process of recruiting some new staff at the time of the inspection. She said that she and senior staff had viewed application forms. Those invited for interview had a formal interview at the home and a written test. The people living at the home also have the opportunity to meet candidates and have an informal chat and spend some time with them. The Manager has audited staff training and has a plan to address training needs. This audit is good and shows that some staff need to have updated manual handling and fire safety training. Not all staff have had epilepsy or diazepam training. Some staff who have consistently made errors in administration of medication should be retrained. The Manager has organised for all staff to have training in the ‘Essence of Care’. This is a series of sessions which has been designed by the Community Team for Learning Disabilities specifically for the staff at the home aimed to raise their awareness and skills. The training is a positive example of the Manager recognising areas of need in the home and looking at how these needs can be addressed. The health professionals involved in providing this training highlighted that there had been problems in care delivery and supporting people to make choices. They said that they were happy to be involved in the training and pleased that the Manager had identified these concerns and was taking steps to address them. They said that they felt it was important to raise staff awareness and for staff to have a more consistent approach. The majority of staff completing questionnaires said that they felt supported and some complemented individual managers. Some people described regular Silver Birches DS0000017394.V340534.R01.S.doc Version 5.2 Page 26 team meetings although others said that they did not have regular team meetings or supervision. Silver Birches DS0000017394.V340534.R01.S.doc Version 5.2 Page 27 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. The service is well managed and the new Manager has made a great deal of improvements. Staff find her approachable and supportive. Improvements to record keeping have started, although further improvements are needed. Appropriate quality assurance and health and safety monitoring take place. EVIDENCE: The Manager has been in post since December 2006. She was originally seconded from another home to manage Silver Birches whilst a permanent manager was found. However she has decided to stay at the home as the new Silver Birches DS0000017394.V340534.R01.S.doc Version 5.2 Page 28 Manager and was in the process of applying for registration with the CSCI at the time of the inspection. She is appropriately qualified and experienced and the staff said that they felt well supported by her. Some of the staff spoke enthusiastically about changes she had introduced saying that these had improved the home. Over the last few years there have been a number of management changes. Some of the staff and relatives said that they felt the turnover of management staff was high and that this had had a negative impact of the service. The Manager said that the organisation has introduced a quality assurance system which looks at outcomes for residents. The home had just started to use this. Senior managers also visit the home and conduct monthly inspections of the service. Shortly before the inspection the organisation employed financial auditor to make checks on how money was managed at the home. This included residents’ money. Some of the records at the home are poorly organised and need updating and reviewing. Some information needs archiving. Some records include messy entries and some include inappropriate terminology such as, ‘toileting’, ‘feeding regimes’ and ‘grooming’. Some records were repetitive. Some guidelines and risk assessments had not been signed by staff to show that they had read and understood these. Some of the records in staff files were in the wrong people’s files. The Manager said that she was auditing all paperwork and files and that this process was taking a long time. She has also introduced some new records and is continuing with this. The staff carry out regular checks on health and safety and these are recorded. The water temperatures recorded in one flat are very low and there is a risk of legionellas as well as the temperatures in the shower being unpleasantly cold. The Manager said that the hot water system is having work to improve this. This work must be prioritised and the Manager must make sure temperatures are safe and appropriate at all times. Silver Birches DS0000017394.V340534.R01.S.doc Version 5.2 Page 29 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 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 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 3 2 2 LIFESTYLES Standard No Score 11 2 12 3 13 3 14 2 15 3 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.V340534.R01.S.doc Version 5.2 Page 30 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 YA6 Regulation 12 15 Requirement Timescale for action The Registered Person must 30/11/07 make sure residents (and their representatives where appropriate) are involved in the development of their own care plans. The Registered Person must 31/07/07 make sure risk assessments are in place wherever restraints or restrictions are made. Residents should be involved in assessing the risks that they take and should be enabled to take risks. Previous 01/12/06 requirement 2. YA9 12 13 3. YA7 12 The Registered Person must 30/06/07 make sure people living at the home have the opportunity to make choices about their lives and that these choices are upheld. DS0000017394.V340534.R01.S.doc Version 5.2 Page 31 Silver Birches 4. YA7 12 The Registered Person must 30/06/07 make sure people have access to the equipment they need to help them communicate whenever they need this. The Registered Person must 30/06/07 make sure people can lock their bedroom doors if they wish to and can hold their own keys. The Registered Person must 30/06/07 make sure all information on residents is stored confidentially. The Registered Person must 30/06/07 make sure people living at the home have the opportunity to be meaningfully involved in household tasks and the running of the home. The Registered Person must 30/06/07 make sure residents have the opportunities to pursue the social interests they chose and that events are not cancelled at short notice. The Registered Person must 30/06/07 make sure that staff support residents respectfully. The Registered Person must 30/06/07 make sure personal care needs are met appropriately and according to the wishes of the person receiving the care. DS0000017394.V340534.R01.S.doc Version 5.2 Page 32 5. YA7 12 6. YA10 12 17 7. YA11 12 8. YA13 12 16 9. YA16 12 10. YA18 12 Silver Birches 11. YA20 13 The Registered Person must 30/06/07 make sure medication procedures are followed appropriately. Medication must be stored, labelled, administered and recorded correctly. Staff who make errors in administration must be reassessed. Previous 08/12/06 requirement 12. YA23 13 The Registered Person must 30/06/07 make sure the local authority protection of vulnerable adults procedures are followed. Previous 08/11/06 requirement 13. YA23 12 13 The Registered Person must 31/08/07 review the current procedure for controlling residents’ finances and people who are able to must be given the opportunity to control their own finances and sign for their own bank accounts. The Registered Person must 30/09/07 make sure staff have the training they need for their roles. Previous 01/02/07 requirement 14. YA35 18 15. YA41 17 The Registered Person must 30/06/07 make sure records are accurate and entries are appropriate. DS0000017394.V340534.R01.S.doc Version 5.2 Page 33 Silver Birches 16. YA42 13 23 The Registered Person must 30/06/07 make sure hot water temperatures are maintained at safe levels. 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 way in which the house vehicle is financed should be reviewed and people who contribute towards this should sign an agreement which they fully understand. Communication passports created by the person they are about should replace existing care plans where ever possible. The staff should consider innovative ways to support people to make choices about their lives. The staff should make sure they communicate appropriately so that families and other professionals get the information they need and so that messages are passed on. The staff should give consideration to how they could make baths a more pleasant experience for the person receiving the care. 2. YA5 3. YA6 4. 5. YA7 YA15 6. YA18 Silver Birches DS0000017394.V340534.R01.S.doc Version 5.2 Page 34 7. YA24 The environmental repairs identified should be attended to. The Registered Person should consider what adaptations could be made to the home to give residents more control. 8. YA29 9. YA29 An alternative to the storage of equipment in communal areas should be arranged. Areas of the home need thorough cleaning. In particular bathrooms. All staff must have access to regular supervision and team meetings. 10. YA30 11. YA36 Silver Birches DS0000017394.V340534.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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.V340534.R01.S.doc Version 5.2 Page 36 - 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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