CARE HOMES FOR OLDER PEOPLE
The Birches 44 Hitchin Road Shefford Bedfordshire SG17 5JB Lead Inspector
Dragan Cvejic Unannounced Inspection 8th November 2005 07:30 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.V265054.R01.S.doc Version 5.0 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.V265054.R01.S.doc Version 5.0 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 Mrs Caroline Walker 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.V265054.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 22/04/05 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.V265054.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection. It was carried out after a complaint was investigated since the last inspection. The complaint investigation instigated an additional monitoring visit on 24/05/05. This inspection was carried out after a temporary manager was seconded in this home to help improve the atmosphere, regain trust and improve communication among staff. The measures taken to resolve the unsettled staffing situation had started to show results and ensured the protection of service users and consistency in the care process. During this inspection 3 service users were case tracked. Three staff members were spoken to in addition to the temporary manager. Three service users’ files were inspected, a handover was observed and the medication process was inspected in detail. Service users and staff spoke openly and cooperatively and produced the information for this report in addition to the information from written materials inspected, and the observation of care practices. What the service does well:
The home offered good care to service users. Their files contained all the information necessary for the care process. Care plans clearly stated how each individual wanted to be helped and supported. Service users were protected by well written risk assessments and measures to minimise any risk. These documents were signed by service users or their relatives. All changes were recorded and documents were reviewed regularly. Service users commented: “This is a good home. Staff are good and they always come when I call them.” “We are all happy here. I have been here for 8 years and the food was always lovely. I love reading and I have a lot of books.” “It is never boring here. Different people walk around, we talk to each other and to staff.” “I like my frame, I can walk independently with it.” A visitor spoken to stated that he was very happy with the care that his relative received. Medication process was safe and records were accurate ensuring better safety for service users. Staff were observed helping service users in the lounge and they did it with respect. The Birches DS0000014883.V265054.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by
The Birches DS0000014883.V265054.R01.S.doc Version 5.0 Page 7 contacting your local CSCI office. The Birches DS0000014883.V265054.R01.S.doc Version 5.0 Page 8 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.V265054.R01.S.doc Version 5.0 Page 9 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): 3,4 The home had an admission procedure that ensured an informed choice could be made by new service users and showed from the beginning that service users’ needs could be met. EVIDENCE: The new layout and structure of service users’ files contained documents formed and collected on admission. Recorded details were appropriate and were used to create care plans. Combination of records in care plans, risk assessments and report sheets evidenced that service users’ needs were met. Service users and a visitor spoken to confirmed that the needs of users were met. A visitor commented: “They are excellent. My relative gets all the care she needs”. The Birches DS0000014883.V265054.R01.S.doc Version 5.0 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 The care plans and other records kept in the home made a good base for practical care. The home met the health care needs of service users. Medication procedure was much improved and ensured better protection of service users. EVIDENCE: Care plans inspected were appropriately filled in and contained detailed information of service users needs and how these needs could be met. Care plans were regularly reviewed and were signed by service users or their relatives. Service users’ files and daily records indicated when service users needed help regarding their health care needs. Care plans contained recorded preferences of how service users wanted to be helped. Appropriate risk assessments were drawn up for bed rails to justify the use of this kind of restraint. Medication procedure was improved since the last inspection. Now, records were accurate and kept in one place to allow easy monitoring and auditing. The amounts of administered and stocked medication for the case tracked service users were correct. There was a risk assessment for self-medicating individuals. The home obtained a GP signature on the list of homely remedies intended for specified individuals.
The Birches DS0000014883.V265054.R01.S.doc Version 5.0 Page 11 Privacy and dignity were fully respected and promoted. Service users’ preferences on how they wanted to be helped were recorded. Staff were observed treating service users with respect and promoting their dignity by respecting their individuality. Service users’ files contained recorded wishes in case of death. Three files had records of last wishes and for the one that did not, a key-worker stated that this discussion would upset the service user and showed how dignity was respected. A service user stated: “I have lost two friends recently, they passed away, but they were here with me almost to the very end.” She stated that she would like to be treated the same …”when my time comes”. The Birches DS0000014883.V265054.R01.S.doc Version 5.0 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): 12,15 The home offered a choice of leisure activities, daily routine, food and personal and social relationships. Service users could voice their views, wishes and preferences and they were happy with the provisions and arrangements for their social life. EVIDENCE: Daily life in the home was arranged taking into account service users’ preferences and abilities. Apart from the displayed list of activities, the home kept records of service users taking part in activities that suited them. Service users spoken to stated that activities matched their expectations. A service user sitting around the corner in the lounge said:” I do not feel bored here, different people come all the time. The staff does not forget me here, they come and they always get me what I need.” All service users spoken to commented that the food was very good. A visitor added that he was happy with the food provision for his relative. A cook knew the preferences of service users that were in the home for some time, but stated that it would be a good idea to copy a list of dietary needs from care plans for the kitchen staff. This sheet from care plans contained information of any special dietary needs and service users preferences and, as it was filled in at a very early stage of life in the home, would provide an excellent source of information for all kitchen staff. The Birches DS0000014883.V265054.R01.S.doc Version 5.0 Page 13 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): none These standards were not inspected on this occasion. EVIDENCE: The Birches DS0000014883.V265054.R01.S.doc Version 5.0 Page 14 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): 19,20,25,26 The purpose built building was well maintained, equipped and arranged in a pleasant, domestic style and offered a comfortable living environment to service users. EVIDENCE: Located in a village, the home provided accommodation to many local residents. They remained in the known area and kept contact with their families and friends. There was an example where a service user had moved from another home to be in with her husband. The facilities in the home helped create a homely and domestic style environment. The home was well maintained. Renewed furniture in the dining room pleased service users. The manager stated that many other renewals were planned and approved by BUPA’s renewal programme. Shared areas were nicely furnished and service users enjoyed their time in the communal areas. The heating and lighting were appropriate for service users needs. The home was reasonably clean, the cleaners were working during the inspection and the
The Birches DS0000014883.V265054.R01.S.doc Version 5.0 Page 15 cleaned areas were distinctively cleaner than the ones the cleaners did not get to by the end of the inspection. Infection control measures were in place. The laundry room had got new flooring since the last inspection. Sluices were located out of the way from where food was stored, prepared and consumed. Polices and procedures regarding infection control were in place and ensured a safe and comfortable environment. The Birches DS0000014883.V265054.R01.S.doc Version 5.0 Page 16 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): 27,28,29 The home employed skilled and experienced staff that were able to meet the needs of service users. A manager on a secondment had started re-building the team atmosphere and trust that would ensure protection and good service to service users. EVIDENCE: The staff had all the necessary qualities to meet the needs of service users. The previously disturbed atmosphere was much improved, although there was still a way to go before completely stabilising team work and staff team. The manager created a new rota that was still to be tested. The new rota was supposed to better cover peak hours. The use of agency staff was minimal. Training, and especially NVQ training helped staff to better respond to the needs of service users. There were 9 staff with completed NVQ programmes, two more had just started and 4 staff were on induction following Skills for Care principles. The manager stated that the best results for their recruitment came from an advertisement displayed in front of the building. Staff that applied for advertised vacancies were from the local area and would be able to provide cover when needed, reducing the engagement of agency staff. Thus, the continuity of care would be ensured. The manager followed the company’s procedure for recruitment ensuring all required documents and checks were obtained prior to offering employment to new staff. A new staff member stated that she was happy working here, she was well supported and her induction provided her with clear guidance of the expectations from her.
The Birches DS0000014883.V265054.R01.S.doc Version 5.0 Page 17 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): 31,32,35,36 The home was being managed by an experienced manager appointed there on a temporary-secondment basis to help the home stabilise the staffing situation and re-build communication and atmosphere. This stability is necessary to ensure better protection for service users. EVIDENCE: The manager was seconded to this position on a temporary, but not time determined basis. Her experience and skills contributed to the beginning of stabilisation process. She was working in this home 4 days a week. The home had also got a new deputy. The atmosphere in the home had started to improve. The staff’s trust grew from day to day. The communication became more professional and impacted on the quality of work. The measures introduced to stabilise the team had started to show results and proved to be correct. The certificate of insurance was in the office and the manager took on board to display it in a more prominent place straight after the inspection.
The Birches DS0000014883.V265054.R01.S.doc Version 5.0 Page 18 Service users’ money was not held on the premises, but BUPA offered an account where the service users’ money could be safely kept and protected. The manager explained a new plan for formal supervision that would bring this process up to date. Two staff spoken to commented that they were well supported and that supervision met their needs. Staff mandatory training was up to date and included all mandatory courses. Accidents/incidents were recorded and the management team analysed them to reduce reoccurrence. COSHH sheets in the laundry were reviewed and were up to date. Fire risk assessment was up dated. The Birches DS0000014883.V265054.R01.S.doc Version 5.0 Page 19 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 X X 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 3 X X X X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 X X 3 2 X 3 The Birches DS0000014883.V265054.R01.S.doc Version 5.0 Page 20 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 OP15 Regulation 8 Requirement Timescale for action 30/12/05 2. OP14 Schedule 4 The home must have a registered manager, as required on the previous inspection. The home did not have permanent manager, but the experienced manager on secondment had satisfactorily moved the home forward. The responsible individual must, now, review the manager’s position and plan and inform the CSCI of these plans to have a registered manager in post. The new time scale relates to this plan. The home must keep dated and 30/12/05 signed records of service users’ personal valuable possessions brought into the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Birches DS0000014883.V265054.R01.S.doc Version 5.0 Page 21 1 OP15 2 OP36 A sheet from individual care plans related to food preferences and special dietary needs should be copied and given to the catering manager to allow kitchen staff to plan, organise and provide appropriate food for the users as identified in care plans. This gesture would also encourage better communication within the home among all staff. All senior staff should ensure that the supervision process is reintroduced and carried out according to the manager’s plan. The Birches DS0000014883.V265054.R01.S.doc Version 5.0 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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