Inspection on 08/11/06 for Silver Birches

This inspection was carried out on 8th November 2006.

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

Other inspections for this house

Silver Birches 23/04/09

Silver Birches 14/05/08

Silver Birches 03/05/07

Silver Birches 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 Sharon Newman Unannounced Inspection 8th November 2006 10:30 Silver Birches DS0000017394.V317876.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.V317876.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.V317876.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Silver Birches Address 2-6 Marchmont Road Richmond Surrey TW10 6HH 0208 948 5423 0283327286 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.efitzroy.org.uk Elizabeth Fitzroy Support Ms Catherine Sullivan Care Home 15 Category(ies) of Learning disability (15), Physical disability (15) registration, with number of places Silver Birches DS0000017394.V317876.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. As agreed on the 21st August 2006, one (1) named service user under the age of 18 years can be accommodated. The home must contact the CSCI to remove this condition by the 29th December 2006. 17th July 2006 Date of last inspection Brief Description of the Service: Silver Birches is registered to provide accommodation and personal care for fifteen people who have a severe learning disability or a physical disability. The service is owned and managed by Elizabeth Fitzroy Support and is situated in a residential area in Richmond. The home is divided into three separate flats and a day centre that is part of the service. The Community Team for People with Learning Difficulties and healthcare practitioners offer support. Fees charged range from £196. 68 to £2.071 per week. Silver Birches DS0000017394.V317876.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two regulation inspectors conducted this unannounced inspection. Records looked at included staff files, health and safety documentation and residents’ care plans. A tour was also taken of the premises. Some staff members and residents were spoken to during the course of the visit. This home is divided into three flats and the inspection team concentrated on Flat 3 during this inspection as there were so many issues identified here. Although some requirements from the last inspection have been met, many of the requirements have been restated in this report. There are still a number of areas that need to be addressed. An acting manager has been appointed since the previous inspection who has been seconded to this home for three days a week. It is acknowledged that the manager has only been in post for a period of three weeks and it will take time to address many of the areas needing improvement. What the service does well: What has improved since the last inspection? What they could do better: Areas for improvement were discussed with the acting manager on the day of inspection. Silver Birches DS0000017394.V317876.R01.S.doc Version 5.2 Page 6 The care plans and risk assessments need to contain more detail to ensure that residents needs are met. The home also needs to demonstrate that residents are being offered choice in their daily lives this includes meals, outings, bathing temperatures and the use of restraints such as wheelchairs. This must be reflected in the care plans and daily logs. There were many concerning issues with regard to the storage, administration and recording of medication and these are detailed in the report. The inspection team were concerned about many staff members lack of knowledge of abuse awareness and further training is required in this area. Attention needs to be paid to cleanliness and hygiene in flat 3 and areas of this flat require redecoration and maintenance. Staff files need to contain all necessary recruitment information to ensure that residents are not placed at risk. Mandatory training in areas such as first aid, moving and handling and food hygiene has improved but is still not up-to-date for all staff. Staff one-to-one supervision needs to take place six times a year to ensure that staff have the direction they need for their roles. Health and safety issues were identified and these can be found within the ‘Management’ section of the report. 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.V317876.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.V317876.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): 2. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are assessed prior to coming to the home and this helps residents to decide if the home can meet their needs. Information is available for residents to help them to decide if they would like to live at the home. However there is not enough evidence to demonstrate that residents choice is respected. EVIDENCE: The service users guide is available in a pictorial format and is clear and detailed. It is easier for the residents to understand. This helps potential residents and their families decide if the home can meet their needs. Contracts were seen in the care plans that were looked at during this inspection visit. These use pictures and symbols to help the residents to understand them more easily. The assessment process is thorough with input from health and social care professionals. A new resident is due to move to the home and they have Silver Birches DS0000017394.V317876.R01.S.doc Version 5.2 Page 9 visited the home for meals, overnight stays and attended activities at the day centre. This can help them to see what the home is like and to decide if they would like to live at the home. However there was evidence that a potential resident has been required to give up their old day centre place to attend the Silver Birches day centre. There was no evidence to demonstrate that this was their choice. A discussion took place with a staff member who was unsure of why that decision had taken place. It was discussed that if that was the residents choice then this should be clearly documented. If it was not the residents choice they should not be made to give up their day centre place which is familiar to them. Some admission records within the resident’s files are old and need to be archived. Silver Birches DS0000017394.V317876.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, 9 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The care plans need to contain more information to be of benefit to staff and service users. Risk assessments do not contain enough detail to ensure that residents needs can be met. Residents are not given choices in their daily lives and communication needs to improve at this home. EVIDENCE: The care plans have improved since the last inspection and are more organised. They are written in the first person and also contain summaries of residents’ need that are easy for the staff to access. New routine sheets summarising morning, evening and night activities have also been put in place. However, some of the information including personal histories and monthly reports were not in place. Also information including likes and dislikes and allergies was seen to vary between different files about the same individual. Silver Birches DS0000017394.V317876.R01.S.doc Version 5.2 Page 11 This information needs to be more consistent to help ensure that residents needs can be met and that they are not placed at risk. A seizure monitoring chart for one resident was seen to be stuck on a pin board in the flat. This information should be confidential and kept in the resident’s file. The risk assessments within the residents files were basic in content and there were no risk assessments in place regarding restraints such as the use of epilepsy helmets. These must be put in place. Two residents were seen to be left in wheelchairs, however, there was no information in the files about consent for this. A risk assessment was seen for the use of a wheelchair but it did not contain enough detail to ensure that the residents’ needs would be met, as it was unclear what assistance was needed. Also there was no evidence that the home has involved other professionals such as occupational therapists and physiotherapists in the risk assessments. Some risk assessments look at how to enable residents to be more independent, but it was unclear how this is put into practice. Residents’ choice must be reflected in the risk assessments and care plans and relatives and advocates should be involved in drawing up this documentation. Staff spoken to did not have a clear understanding of how to help residents to make choices in their daily lives. They reported that they usually made the choice for them. At one point during the inspection a maintenance person came into the lounge area of the flat and started to clean an armchair with a noisy machine. No member of staff asked the residents if they minded the intrusion or explained what was happening. There was no information to help support residents to make choices or communicate. For example there was no photo rota or pictures for menus or activities. Also there was no use of signs, symbols, easy words or pictures throughout the home. A simple photo board would help residents to understand who was on duty and a pictorial menu to understand the choices on offer with regard to meals and activities. The Service User Guide and contract do make good use of pictures and symbols but are not available to residents as they are stored within their files. Bathing temperatures for residents were seen to be inconsistent between the three flats and there was no documentation to demonstrate that residents are offered a choice of temperature. The bathing charts for two flats specified that the temperature should be 37 degrees centigrade for residents. The chart for another flat stated bathing temperatures should be between 35 to 39 degrees centigrade. The acting manager was unclear where these temperature references had been obtained from and said she would address this issue. Bathing temperatures should not normally exceed 43 degrees centigrade. Silver Birches DS0000017394.V317876.R01.S.doc Version 5.2 Page 12 During the inspection visit it was noted that a resident was wearing a plastic apron which had been secured around the back of the wheelchair. There was no reason for this or for the resident to be wearing a plastic apron. This issue was raised with the acting manager who agreed that this was unacceptable. This practice must stop, residents must not be restrained. Residents were not seen to be offered choices at breakfast time. It was discussed with staff that they could be supported to make choices by using menus in a pictorial and symbol format. Silver Birches DS0000017394.V317876.R01.S.doc Version 5.2 Page 13 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): 12, 13, 15, 16, 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ choice is not fully promoted at this home. Some residents do not participate in a variety of individual placement opportunities outside the home. Residents rights are not fully respected and they are not included in the decisions about their day to day care. EVIDENCE: All residents use the in-house resource centre and participate in a number of different activities both there and in the community. Computers are available in this centre and these have widget programmes and touch screens for easier use by the residents. However, no residents go to college or use outside resource centres. Each resident has a different timetable of activities which includes home based days. But there is limited person centred planning, for Silver Birches DS0000017394.V317876.R01.S.doc Version 5.2 Page 14 example there was little evidence of residents attending jobs or local colleges. Residents on home based days participate in activities together rather than individually. Some residents attend activities such as the local evening club once a week. One resident told reported that they enjoyed going to this club. They said that they also enjoyed swimming, going to the pub, football, shopping and sailing. Staff reported that they and the team leader decided where residents went on their home based days and who supported them. They were unsure about the concept of choice and when spoken to about this they said ‘but the residents like shopping’. Two residents were having a home based day supported by two members of staff and they all went out together shopping. This was not the residents choice and they showed no indication that they wanted to go out together. The residents did not know where they were going when asked and only found out by overhearing the staff telling the inspection team where they were going. One resident normally goes out with a relative who was unable to attend on the day of inspection. Staff said that this resident had become anxious and was waiting for their relative. However, the staff made no attempts to reassure them, ask them what they wanted to do or take them out earlier. Throughout the morning in Flat 3 the television was constantly left turned on with the sound turned down, music was playing loudly and no attempt was made to ask the residents what they would like to watch or listen to. This did not create a pleasant or homely atmosphere which was made worse by constant interruptions from staff passing through the flat. The flat was observed to be used as a thoroughfare by staff, the front door was left on the latch and the patio doors were open constantly. This raises issues of privacy, confidentiality, dignity and security. This flat did not feel homely due to staff passing through it using it as a short cut. This practice must stop, there was no evidence to demonstrate that it is the residents choice to have their home used in this manner. Silver Birches DS0000017394.V317876.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 poor. This judgement has been made using available evidence including a visit to this service. Residents are not appropriately supported to make choices about their daily lives. There is evidence of multi-disciplinary working with health and social care professionals. There are inadequacies with regard to the administration, recording and storage of medication that could place residents at risk. EVIDENCE: Care plans seen contained information and evidence of liaison with health and social care professionals such as GP’s, and dentists and the staff commented that they were well supported by the Community Team for Learning Disabilities. A physiotherapist was seen visiting the home at the time of Silver Birches DS0000017394.V317876.R01.S.doc Version 5.2 Page 16 inspection and talking at length to a staff member about interventions for a resident. However it was concerning to observe that some residents were not being appropriately supported by staff. One resident was ignored for periods of time apart from occasionally when different members of staff walked up to them to give them some food. Another resident shouted out to try to make conversation and was largely ignored. Another was told to sit down while they were eating their cereal. The staff member stated ‘why are you standing when you are eating, you must sit down.’ Later they tried to use their hands to try to get the resident to stand up saying ‘up, up.’ Staff were seen to stand over residents whilst talking to them instead of coming to their level to speak to them. One staff member stood over the resident cutting up their food and did not attempt to make conversation with them. Interactions were observed to be task orientated and staff did not initiate conversations with the residents. At one point a staff member from the resource centre came into the flat and was observed to interact with a resident in a caring manner. Three hair bands were found in the soap dish in one of the communal bathrooms. Items must not be used communally and this is also unhygienic practice. Issues regarding the storage, administration and recording of medication were found at the time of inspection. The administration procedure is to dispense into medication into containers and then carry it in open pots to the residents. This procedure is unsafe and must stop. A weekly medication audit now takes place. However, the amount of medication held at the home is not recorded on the medication administration records (MAR). it was noted that the amounts of medication received had been changed by hand and the amounts carried forward were not recorded. This would make it very difficult to audit the medication supplies. Also. excess stock of some medication was observed to be kept at the home. Two boxes of a non-soluble medication were found in the medication cabinet. This was intended for a resident whose care plan had specified that their medication must be in a soluble or liquid form. There was no risk assessment in place for this medication. Documentation for residents going on social leave did not state whether the medication had been taken or not. This practice may place residents at risk of harm. Also the documentation sheet in place for medication leaving the home did not have a section for medication returning so this medication could not be audited. Silver Birches DS0000017394.V317876.R01.S.doc Version 5.2 Page 17 There was no MAR chart in place for one resident who had medication in cabinet. They had been prescribed a cream but this was not recorded on a MAR chart, so it was unclear when this was to be given, or if it had been administered. No allergies were documented in the medication file in relation to a resident with known allergies which had been stated in their care plan. The medication cabinet was sticky and messy, attention must be paid to keeping this cabinet clean and hygienic. Medication was observed to be contained within the cabinet that had expired in May 2006. Also a labelled sample bottle was found in the medication cabinet it was unclear whether it had been used. Sticky used administration syringes were found in the cabinet and these were unlabelled. This practice is not hygienic and must stop. It was observed that a controlled drug was being stored in the cupboard in the hall. This should be stored in a secure metal cabinet. Some unlabelled foot powder and creams were found to be stored in one of the bathroom cabinets. These must not be stored in communal areas as they are not for communal use. All creams and medications must be clearly labelled with the name of the resident and the directions of administration. A senior staff member stated that the home has now improved upon other areas of the procedure for example all staff are now assessed by senior staff prior to giving out medication. However, they were unaware of who assessed the senior staff. Silver Birches DS0000017394.V317876.R01.S.doc Version 5.2 Page 18 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 poor. This judgement has been made using available evidence including a visit to this service. Many concerning issues remain regarding the management of complaints and abuse allegations. Some staff do not have the knowledge to know what constitutes abusive practice. Procedures are not followed to protect residents from risk of abuse and the lack of abuse awareness training may place residents at risk. It is unclear how allegations are followed up and investigated. EVIDENCE: Since the last inspection visit, folders containing information about the protection of vulnerable adults (POVA) have been introduced into each flat for the staff to read so that they are aware of these procedures. Each folder contains a copy of the London Borough of Richmonds’ POVA procedures, the No Secrets Guidance, a copy of the organisational abuse policy and a copy of the organisation’s whistle blowing policy. The acting manager reported that staff training has been taking place in the area of abuse awareness. However, this training was provided by the organisation and evidence was seen during the inspection that some staff are unaware of what constitutes poor or abusive practice. This included staff not offering residents choices about their daily lives such as activities or food choices, tying a resident to their wheelchair with a plastic apron, poor Silver Birches DS0000017394.V317876.R01.S.doc Version 5.2 Page 19 medication practice, storing items in communal areas instead of individually and poor hygiene practice with relation to cleaning the home. If staff are failing to recognise that certain practices are abusive then additional training is needed in abuse awareness. This training should be provided by the London Borough of Richmond so that all staff are aware of the Local Authorites procedures in this area. The Commission for Social care Inspection (CSCI) were notified about a Protection of Vulnerable adult’s issue that arose following the last inspection visit. However, staff at the home reported that they had been requested to investigate this matter by the London Borough of Richmond. This is not satisfactory as all allegations of abuse should be investigated by the ‘Lead agency’ which in this case is the London Borough of Richmond. Previous allegations of abuse were identified at the last inspection visit and it is still unclear from records seen at this inspection visit how this was investigated. The inspection team also became aware of a concerning issue that had not been adequately followed up. All staff need to be aware that they have a duty to protect residents from risk of harm and abuse and must follow the appropriate procedures if abuse is suspected. It was discussed with the acting manager at the time of inspection that the system for managing residents money needs to be formalised and better organised. The records of three money tins examined were correct, but the procedure for withdrawing money from accounts is not clear. Staff said that one resident could sign but that they are not a signatory for their own bank account. They should be supported to sign for their account if they have the ability to do so. It was noted that residents pay for their own meals out even though this is already paid for as part of their funding. The acting manager reported that she has started to look at the finances and is going to put a better system in place. The complaints log was examined and complaints were clearly documented and also recorded the proposed action at the time. However there was no follow up recorded to demonstrate what happened next. Clear outcomes must be recorded. Silver Birches DS0000017394.V317876.R01.S.doc Version 5.2 Page 20 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 poor. This judgement has been made using available evidence including a visit to this service. Areas within the home need redecoration, as it does not present as homely and comfortable. The quality of the environment in flat 3 has deteriorated. The lack of security at the home presents a risk to residents. Some areas of the home are not clean and hygienic. EVIDENCE: There are many areas that need to be addressed as regards the environment in this home. During this inspection visit Flat 3 was looked at in detail. It was noted that there has been a deterioration of standards in this area. The carpets in the lounge and hallway areas in this flat were stained and marked, the inspection team were informed that they have been cleaned, Silver Birches DS0000017394.V317876.R01.S.doc Version 5.2 Page 21 however they remain marked. There are broken tiles around the fire surround in the lounge and these must be replaced as they are unsightly and could present a risk to residents. One bathroom had an offensive odour and had not been cleaned adequately and the flooring was marked and peeling in places which could present a health and safety hazard. The showerhead did not look as if it had been cleaned adequately and was covered on limescale. These issues must be addressed. Storage also appears to be an issue at the home as another bathroom contained four large pieces of hoist/bath chair equipment. There was marked paintwork above the radiator in this bathroom and this needs redecoration. This flat did not present as clean and hygienic. The issues were discussed with the acting manager and regional manager who stated that they felt it may be better to employ cleaning staff rather than expecting the care staff to carry out the cleaning. As reported previously there are issues of security at the home due to the patio doors being left open and the front door left on the latch in Flat 3. Silver Birches DS0000017394.V317876.R01.S.doc Version 5.2 Page 22 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): 32, 34, 35, 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The lack of one-to-one supervision for staff members does not enable staff to have the support and direction they need to carry out their roles. Staff training in mandatory areas such as manual handling, food hygiene, first aid and health and safety is improving but is still not up-to-date for all staff members. Inadequacies in staff files may place residents at risk. Not all staff support residents to make decisions and choices in their daily lives. EVIDENCE: Some staff were unsure of how to offer choice to residents in their daily lives and did not interact with residents in a manner that promoted their dignity. This was discussed with the acting manager and the regional manager. They reported that this would be addressed. Silver Birches DS0000017394.V317876.R01.S.doc Version 5.2 Page 23 More staff are now up-to-date with mandatory training such as moving and handling, first aid, food hygiene and health and safety due to the effort of the acting manager. However, there was still not enough evidence to demonstrate that all staff are up-to-date in these areas. Also, the manager reported that she is frustrated by staff not attending the training that is booked for them. She pointed out that this training is paid for by the company and staff attend in work time, so they are not expected to attend training in their own time. The recent health and safety training had to be cancelled due to lack of staff attendance. All staff must attend the mandatory training to ensure the safety of the residents and the staff. It was difficult to see which staff had attended training, and it was discussed with the manager that a clear log of staff training needs to be in place. She reported that she was addressing this. As reported in the previous inspection report staff recruitment files still need attention to ensure that residents are not placed at risk. A criminal record check (CRB) could not be found for one staff member. One CRB check was found to contain concerning information. The acting manager reported that she had evidence to demonstrate that his was no longer valid. However, this evidence could not be found on the day of inspection. Although staff supervision has started to improve due to the intervention of the acting manager, there is still not enough evidence to demonstrate that staff are receiving supervision up to six times a year. Staff need to have supervision to ensure that they have the support and direction they need to carry out their roles. The staff rotas contained many corrections and alterations, this made them very difficult to read and find out which staff were supposed to be on duty. Silver Birches DS0000017394.V317876.R01.S.doc Version 5.2 Page 24 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, 39, 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are several outstanding requirements from the previous inspection and many areas that still need to be addressed at this home. There are health and safety issues which need to be attended to as they may place residents at risk. There is no quality assurance system at present to ensure that the views of the residents are taken into consideration. The financial procedures regarding residents money is not satisfactory and may place them at risk of financial abuse. EVIDENCE: The overall quality of this standard remains poor as there are so many issues that need to be addressed and there are also requirements outstanding from Silver Birches DS0000017394.V317876.R01.S.doc Version 5.2 Page 25 the last inspection. However, it is recognised that the acting manager had only been working at the home for approximately four weeks at the time of this inspection visit and has inherited many outstanding issues. She is working at the home only three days a week and does not currently know how long she will be working there. The post of manager has just been advertised for the third time. This home needs a full-time manager to ensure that the issues are addressed, staff are given appropriate support and to help to improve overall standards. The staff are pleased with the work of the acting manager and feel that the home is better organised now and is ‘going in the right direction’. Although there is currently an acting manager in post the home must ensure that a manager is in place at the home that is registered with the Commission for Social Care Inspection. The manager reported that she is ‘re-educating’ staff on how to complete records. Her main work so far has been to put more structure into the home and organise records more efficiently. She has introduced regular checks on health and safety and reported that good management is to put structure in place which everyone follows. A quality assurance programme is not fully in place at the home. The acting manager reported that they would address this issue. This needs to be in place to ensure that residents, relatives and other interested parties have a say in the running and development of the home. A first aid box contained out of date sterile bandages and open plasters. This box must be checked monthly and any out-of-date contents must be discarded and a new supply ordered. Fridge and freezer temperatures are not always checked daily and they must be to ensure the safety of the residents. An up-to-date gas safety certificate was available, however, up-to-date certificates need to be obtained for the portable appliance testing check and legionella testing. As reported previously in this report the system for managing residents money needs to be formalised and better organised. This is to ensure that the chances of any financial discrepancies are minimised. Silver Birches DS0000017394.V317876.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 1 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 1 X 1 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 3 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 3 1 X 2 X 2 X X 1 X Silver Birches DS0000017394.V317876.R01.S.doc Version 5.2 Page 27 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15 (2) (b) Requirement The Registered Persons must ensure that: 1. Care plans and risk assessments are regularly reviewed and kept up-to-date. Timescale of 01/08/06 not met. 2. Care plans demonstrate the involvement of the service user and their relatives. The registered persons must ensure that the service users care plan fully reflects their needs and is sufficiently detailed to ensure that their needs are met. The registered persons must ensure that residents choice and decisions are respected and are documented including areas such as daily activities, meals and bathing temperatures The registered persons must ensure that risk assessments are place and are sufficiently detailed to ensure that residents needs are met. The registered provider must ensure that service users are offered the opportunity to attend a variety of local DS0000017394.V317876.R01.S.doc Timescale for action 01/01/07 2 YA6 12 (1) (a) (b) (2) (3) 15 (1) 01/12/06 3 YA7 12 (2) (3) 01/12/06 4 YA9 13 (4) 14 (1) (a) 01/12/06 5 YA13 12 (2) (1) (b) 01/02/07 Silver Birches Version 5.2 Page 28 6 YA16 13 (7) (8) 7 YA18 12 (1) (2) (3) (4) 8 YA18 12 (4) (a) 9 YA20 13 (2) 10 YA20 13 (2) 11 YA20 13(2) 12 YA20 13(2) 13 YA20 13 (2) placements to meet individual needs. This could include local colleges, day centres and work placements and to become part of local community if they wish. The registered person must ensure that service users are not restrained in their chairs by use of a plastic apron. The registered provider must ensure that staff provide sensitive and flexile support to maximise service users dignity, privacy, independence and control over their lives. The registered person must ensure that personal items such as hair bands and creams and lotions are not kept in communal areas. The registered persons must ensure that the allergies section on medication administration sections is fully completed. Previous timescale of 01/02/06 and 17/07/06 not met. The registered persons must ensure that all medication records are up to date and maintained accurately. Previous timescale of 01/08/06 not met. The registered persons must ensure clear directions for administration are available for all medication. Previous timescale of 01/08/06 not met. The registered persons must ensure there is a detailed procedure for the supply of medication to residents on leave from the home Previous timescale of 01/08/06 not met. The registered person must ensure that staff follow safe methods of medication DS0000017394.V317876.R01.S.doc 08/11/06 01/12/06 01/12/06 08/11/06 08/11/06 08/11/06 08/11/06 08/11/06 Silver Birches Version 5.2 Page 29 administration 14 YA22 22 The Registered Persons must ensure that there is a full complaints log in place with full details of action taken and outcome. Previous timescale of 01/08/06 not met. The registered person must ensure that: 1. All staff receive full and upto-date training in abuse awareness and adult protection. (previous timescale of 01/09/06 not met) 2. The appropriate protection of vulnerable adults procedures are followed. The registered persons must ensure that all environmental issues in standard 24 are addressed. The registered persons must ensure that the home is kept clean and hygienic and free from offensive odours. The Registered Persons must ensure that staff files contain all the information required in Schedule 4 of the Care Homes Regulations 2001. Previous timescale of 01/08/06 not met. The registered persons must ensure that all mandatory staff training is up-to-date. Refresher training must be provided for staff as required with regard to Moving and Handling, First Aid and Food Hygiene. Previous timescale of 01/09/06 not met. The registered persons must ensure that all care staff receive one-to-one supervision at least six times a year. (Pro-rata for DS0000017394.V317876.R01.S.doc 01/12/06 15 YA23 13 (6) 08/11/06 16 YA24 23 (2) (b) (d) 16 (2) (k) 13 (3) 23 (2) (d) 19 (4) 01/03/07 17 YA30 08/11/06 18 YA34 01/01/07 19 YA35 18 (1) 01/02/07 20 YA36 18 (2) 01/01/07 Silver Birches Version 5.2 Page 30 21 YA37 9(1)12(1a& b) 22 YA39 24 23 YA42 13 (4) 24 YA42 13 (4) 25 YA42 13 (4) 26 YA42 13 (4) part-time staff). Previous timescales of 01/03/06 and 01/08/06 not met. The registered persons must ensure that there is a manager in place who is registered with the Commission for Social Care Inspection. Previous timescale of 01/11/06 not met. The registered persons must ensure that there is a quality assurance system in place which seeks the views of the residents, relatives/advocates and interested stakeholders. The registered persons must ensure that an up-to-date legionella certificate is obtained. Previous timescale of 01/09/06 not met. The registered persons must ensure that an up-to-date portable appliance testing certificate is obtained. The registered persons must ensure that fridge and freezer temperatures are carried out daily. The registered persons must ensure that the first aid boxes are checked monthly. 01/03/07 01/04/07 01/01/07 01/12/06 08/11/06 08/11/06 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 YA20 Good Practice Recommendations It is recommended that the quantity of medication left each month is counted and recorded on the administration record for item not supplied in the monitored dosage system. It is recommended that a secure metal cabinet is obtained DS0000017394.V317876.R01.S.doc Version 5.2 Page 31 2 YA20 Silver Birches that complies with relevant legistlation. Silver Birches DS0000017394.V317876.R01.S.doc Version 5.2 Page 32 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.V317876.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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