CARE HOMES FOR OLDER PEOPLE
The Birches 44 Hitchin Road Shefford Bedfordshire SG17 5JB Lead Inspector
Dragan Cvejic Unannounced Inspection 19th July 2006 08:00 X10015.doc Version 1.40 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 The Birches DS0000014883.V305312.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 Older People. 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. The Birches DS0000014883.V305312.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Birches Address 44 Hitchin Road Shefford Bedfordshire SG17 5JB 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) 01462 812757 01462 812264 BUPA Care Homes (Bedfordshire) Ltd Vacant Care Home 31 Category(ies) of Dementia - over 65 years of age (31), Old age, registration, with number not falling within any other category (31), of places Physical disability over 65 years of age (31) The Birches DS0000014883.V305312.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection Brief Description of the Service: The home was located in the village of Shefford and retained very good connections with the local population. Many service users used to live in the village for a number of years prior to admission to this home. The building was purpose built and provided accommodation in 31 single rooms. The home was divided in to five units and evenly spread through the building. It offered a comfortable and homely environment with lounges in each unit. Kitchenettes in each unit accommodated those who did not want to eat in the main dining room, giving privacy in these smaller areas. The garden had a paved area accessible from the bright and sunny conservatory. It extended to a grassed, well maintained area. The home accommodated mainly elderly frail people with mild dementia. The Birches DS0000014883.V305312.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a regular, planned inspection of the service and the site visit was carried out unannounced. Regular monthly reports were used as a source of information and as preparation for the site visit. On site, a case tracking methodology was the main method used. One case tracked user commented on the service as well as two other users, who wanted to speak to the inspector, but were not case tracked. A tour of the premises was used to inspect the environment. Two staff members provided their comments, in addition to the manager and one senior staff member. What the service does well: What has improved since the last inspection?
The atmosphere in the home had become more open, inclusive and relaxed since the new manager was appointed permanently. One of the units was re-decorated. Kitchen facilities were renewed. A new fridge was ordered too. The gardening contractor was present during the site visit, making a quote for tree surgery in the garden. Staff meeting also happened during the site visit and a service user was present at that meeting. Documents and files kept on service users were better designed and relevant, informative, concise and clear information was more accessible to staff and directed their work. The majority of users’ records were signed. New recruitment was carried out and two new staff were awaiting their Criminal records disclosures before they started work. The use of agency staff was also significantly reduced and ensured better consistency of care for service users.
The Birches DS0000014883.V305312.R01.S.doc Version 5.2 Page 6 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 Birches DS0000014883.V305312.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Birches DS0000014883.V305312.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. By supplying sufficient information and organising and carrying out appropriate admission assessments, the home ensured that service users could choose their home and be sure that their needs would be met, or reassessed at a later stage if their conditions deteriorate. EVIDENCE: Information about BUPA and the home was displayed in the entry foyer and made available to anyone interested. This BUPA leaflet contained all relevant necessary information. Service users’ files checked contained the assessment forms filled in. The form addressed a wide range of relevant aspects of service users’ conditions and included physical, social, mental and emotional needs. One of these files contained a detailed occupational therapist’s assessment report, used to determine the appropriateness of the home for the user’s conditions and helped in deciding if needs would be met upon admission.
The Birches DS0000014883.V305312.R01.S.doc Version 5.2 Page 9 As the existing user’s conditions deteriorated with time, reassessments were organised, well documented and used to create new care plans and risk assessments. The Birches DS0000014883.V305312.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Users’ healthcare needs were met, but the detailed care plans should have a summary that would help staff quickly identify the assessed needs and direct staff to check details in the plans. EVIDENCE: Care plans were detailed and explained conditions and actions. One plan had a very good summary in the front allowing staff to get a quick overview of the needs. Three files were checked and some inconsistency was present: two files did not have a sheet with signatures at the end of care plans, one did not have a life history filled in and two were missing a property list. The care plans contained records of users likes and dislikes, but these, which were food related, were not communicated to the kitchen staff. The manager had a list prepared to provide this information to the cook. Various charts were kept for individuals to closely monitor identified areas of concern in user’s health care. A new sitting scale was purchased. Records of external professional visits (GP, chiropody, D/N) were kept. OT was involved in
The Birches DS0000014883.V305312.R01.S.doc Version 5.2 Page 11 assessment. Skin conditions were monitored for identified cases. The falls recorded were analysed. Medication was handled appropriately. A discrepancy in the number of tablets (4 not accounted for) was addressed immediately, the investigation started during a site visit. A new audit methodology was agreed during a site visit. Dying and death were addressed in two of three checked files. The Birches DS0000014883.V305312.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The activity programme was designed for lower abilities than the users actually could and wanted to express. The programme needed further development. EVIDENCE: Two service users commented: “I would like more organised activities and more entertainment.” The home recorded individual preferences for organised activities, but the activity programme needed further development as identified by service users. The home was lively and it was observed that users would benefit from a widening of the activity programme, both in terms of quality and quantity. Personal relationships were promoted and users enjoyed socialising. One user commented: “I would like staff to talk to me more. I understand that they are busy, but it would be lovely if they stopped and talked to me for a few minutes.” The manager stated that staff were slowly adapting to this new principle recently introduced in the home, that care means emotional and social support in addition to physical personal care. Visitors were welcome and users were delighted when visited by their family members. A users stated: “This is my paper (newspaper), I pay for it”. Another user was looking for her morning paper and asked staff for assistance to locate it.
The Birches DS0000014883.V305312.R01.S.doc Version 5.2 Page 13 Users had the option to eat where they wanted. They chose the menu at their monthly meetings and were generally very satisfied with the food. The Birches DS0000014883.V305312.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. 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 home was open to suggestions and comments from users, relatives and visitors with an effective procedure in place that ensured protection of service users. EVIDENCE: There were no complaints since the last inspection. The complaints procedure was displayed in the entry foyer, with comment cards. The company, BUPA, set the system and the accounts to support and help service users with their finances. Three users stated that they were happy with the system in place. This system ensured the financial protection of service users. The Birches DS0000014883.V305312.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was clean and bright and comfortable for service users. Cleaning staff worked efficiently to resolve any problem or outstanding cleanliness related issue straight away. EVIDENCE: The company invested into a regular renewal and replacement programme. The home had got a new washing machine, a tumble drier was on order and some kitchen equipment was renewed. One unit was redecorated and there was a plan to redecorate the next. The major work planned for the near future was external decoration and tree surgery in the garden. The staff meeting agenda contained the item: “renewal” and the manager checked with care workers if there was an equipment related issue in individual bedrooms. Service users spoken to confirmed their satisfaction with the environment including their bedrooms. The Birches DS0000014883.V305312.R01.S.doc Version 5.2 Page 16 On a day of site visit there was a strong offensive smell in one small area in the home. The cleaner identified it, and started work in the area immediately. He visited at a later time and the area was clean and without offensive odour. The Birches DS0000014883.V305312.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. 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. Competent and trained staff were working in the home in sufficient number to respond effectively to the needs of service users. EVIDENCE: The rota displayed showed sufficient cover. Staff and users spoken to commented that the staffing level was appropriate to meet the needs of service users. Night cover was provided by a combination of permanent and agency staff, but the use of agency staff was minimal. Staff were trained in all mandatory training topics, apart from Moving and Handling, which was planned for the near future. Only 8 staff held NVQ qualifications, but there was a list of the next intake that would bring the percentage of trained staff to the required 50 . Recruitment was organised following the company’s (BUPA) policy and procedure. This ensured vetting of all new workers prior to setting a start date. Staff files contained all required documents including POVA and CRB checks. The Birches DS0000014883.V305312.R01.S.doc Version 5.2 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The safety and welfare of service users were promoted and ensured by clear policies and procedures set and monitored by BUPA and by the home manager. The stable manager improved the safety and protection of service users. EVIDENCE: A permanent manager was now employed and the staff felt relieved after having been managed by acting managers seconded here on a temporary basis. This stability reflected a more relaxed atmosphere for both staff and service users in the home. The new manager’s credentials will be covered when an application for registration is submitted after her induction. Quality assurance review is organised once a year and carried out by an external facilitator employed by the company, BUPA.
The Birches DS0000014883.V305312.R01.S.doc Version 5.2 Page 19 Financial arrangements are organised through BUPA’s finance department and the home’s allocated budget is managed by the manager. Service users have the option to arrange with their families or with BUPA to help them and support them to deal with their finances. BUPA’s system ensures the safety and protection of users’ money. The supervision plan is displayed in the office and supervision notes are held in staff’s individual files. The current record kept on a calendar demonstrated regular two monthly supervisions. Records needed consolidating in terms of content: some care plans did not have the last page with signatures, some files did not have a property list, some life histories were not filled in and the audit and consolidation of users files would bring record keeping to the required standard. Safe working practices were in place and were monitored in the home and at a higher management level within the organisation. The Birches DS0000014883.V305312.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 2 3 The Birches DS0000014883.V305312.R01.S.doc Version 5.2 Page 21 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 OP12 Regulation 13 Requirement The home must review the activity programme, consult service users and devise a programme suitable for users’ abilities and preferences. Timescale for action 30/09/06 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 OP7 OP37 2 OP28 Good Practice Recommendations The users’ files and care plans should be unified and contain similar relevant documents: the sheet with signatures, property lists, summary sheets and other general documents related to each individual. The home should aim to retain the ratio of NVQ qualified staff at the level of 50 or higher all the time. The Birches DS0000014883.V305312.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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