Inspection on 15/02/07 for The Birches Nursing Home

This inspection was carried out on 15th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Birches Nursing Home 19/10/05

The Birches Nursing Home 28/04/05

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Birches Nursing Home 239 Water Lane Totton Southampton Hampshire SO40 3GE Lead Inspector Gina Pickering Unannounced Inspection 10:00 15 February 2007 th 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 Nursing Home DS0000062660.V326182.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 Nursing Home DS0000062660.V326182.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Birches Nursing Home Address 239 Water Lane Totton Southampton Hampshire SO40 3GE 023 8066 7141 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) Harcare Ltd Mrs Lesley Kay Head Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21), Physical disability (25), Terminally ill (25) of places The Birches Nursing Home DS0000062660.V326182.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th October 2005 Brief Description of the Service: The Birches is a care home providing accommodation and nursing care for twenty-one residents who are sixty-five years of age or over, physically disabled, terminally ill or frail. A maximum of four residents may be accommodated at any one time who are physically disabled or terminally ill between fifty and sixty-five years of age. Accommodation is provided on two floors in nine single bedrooms and six shared rooms. The home has a lounge and dining area and a small garden. The top floor of the home has an office and a staff training/rest room. The Birches opened in 1991 and is privately owned by Mr Peter Harrison and Mr Paul Harrison. The home is situated in a residential area of Totton, Southampton and is close to all local amenities. Fees for residency at the home range from £513.50 to £640 per week The Birches Nursing Home DS0000062660.V326182.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection process consisted of a visit to the home on 15th February 2007 during which time the inspector spoke with the nurse in charge, one of the home owners, four care staff, the cook, six clients and two visitors. A tour of the environment was made and documentation looked at. Part of the inspection process also included information received by the Commission about the home. This included the pre inspection questionnaire, and staff survey forms. No service user or visitors survey forms were returned to the Commission. Clients comments about the home to the inspector included “staff are friendly and helpful, they will do anything to help”, “staff are lovely and caring”, “I can do what I want to do, stay in my own room reading and watching television” and “if anyone complains about the home they do not know what they are talking about” What the service does well: The pre admission process ensures that new clients are aware of the running of the home and they are confident that the service can meet their needs. Care planning provides detailed information about the person as an individual, what their needs are and how they can be met. Daily life at the home is very much influenced by the wishes and needs of those living there. The importance of clients retaining contact with their family and friends is recognised; visitors are welcome into the home at any time. Clients enjoy the meals provided, they said that the “food is excellent”. Responding to complaints and concerns is considered an important part of quality auditing to improve the service provided. Clients are confident to express concerns and complaints. Clients live in a home that is well maintained. The homeowners and manager continually seek ways to improve the environment to improve outcomes for those living at the home. Imaginative staff rostering results in the home being well staffed with attention being paid to peak periods of activity. Commitment to staff training provides clients with a staff team that have the skills and knowledge to support and care for them. Robust recruitment procedures protect the well being of the clients. The Birches Nursing Home DS0000062660.V326182.R01.S.doc Version 5.2 Page 6 Good health and safety practices and a good history of meeting health and safety requirements and legislation protect all those at the home. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Birches Nursing Home DS0000062660.V326182.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 Nursing Home DS0000062660.V326182.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The good practice of assessment and the provision of information to prospective clients ensure that clients have an understanding of the service and are confident their needs can be met by the service. The home does not provide intermediate care. EVIDENCE: The matron or a nurse from the home visits the prospective client to assess whether the service has the skills and a suitable environment to meet the needs of the individual. The prospective client and their representative are informed about the running of the service by written information and by conversation with he assessing nurse. The pre assessment information is held in the client’s documents. Clients and their relatives told the inspector that The Birches Nursing Home DS0000062660.V326182.R01.S.doc Version 5.2 Page 9 they had received information about the running of the home giving them an idea of what to expect when they moved into the home. The Birches Nursing Home DS0000062660.V326182.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Client’s health and welfare is promoted by the use of informative care planning and risk assessment processes. Safe medication administration practices contribute to protecting the health of clients. Care practices at the home support the ethos of treating persons with respect and dignity. EVIDENCE: Care plan documents contain detailed assessments of all needs of the client such as mobility, equipment needed to support them, sleeping and their feelings about moving into a nursing home. The care plan details action needed to meet the individual needs; the plan is based on the client making the most out of their life. Assessments are made for moving and handling, skin integrity, nutrition/malnutrition and a plan of care made accordingly. Risk assessments and consent from representatives for the use of bedside rails are The Birches Nursing Home DS0000062660.V326182.R01.S.doc Version 5.2 Page 11 in place for those clients assessed as needing them. The plan of care is reviewed monthly; clients and their representatives are invited to attend an annual review of the clients care at the home. A nurse is on duty at all times to attend to the health care needs of the clients. Continual assessments allow for health care issues to be addressed as they arise. Clients have access to the local multidisciplinary healthcare team through the local GP services. Client’s said that staff at the home call the doctor in when they feel unwell. Visitors said that their relative’s health care needs are well met by the service. Medication policies and procedures are in place that includes the ordering, receiving, storage and disposal of medications. At present no clients administer their own medications, though policies and procedures are in place to support this practice if a client is assessed as able to administer their own medications. Medication administration record sheets were looked at as part of the case tracking process. In some records it was documented that a medication was not given, but the reason for it was not documented. The nurse in charge explained that these were medications that were only given when required, but agreed that the fact that the client did not require that medication would be recorded. Medications were stored in a clean and orderly manner. Throughout the visit to the home staff were observed to be interacting with clients in a respectful and friendly manner. Staff wee observed to knock on bedroom doors before entering; this was confirmed in conversations with clients. Clients said that staff are friendly and helpful. The Birches Nursing Home DS0000062660.V326182.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. 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 service provides opportunities for clients to join in with a variety of activities if they wish to. Clients can enjoy receiving visitors when they wish to. The ethos of care at the home is to support individuals to retain as much control over their lives as possible; this includes supporting them to make choices and decisions about their daily life. Good, nutritional meals are planned around the likes and dislikes of the clients. EVIDENCE: The care planning process includes details of the person’s social relations, personal and spiritual fulfilment needs. The nurse discussed that the information gathered in these documents allows the staff to know clients as individuals. A member of the care staff is allocated to the role of facilitating activities in the morning. One client said that if she did not join in with the The Birches Nursing Home DS0000062660.V326182.R01.S.doc Version 5.2 Page 13 activities she felt life at the home would be boring. She said that staff at the home work hard to encourage clients to join in with activities but many clients decline the offer. Activities offered include quizzes, bingo, and various games. One client said that you have to make the most out of the activities offered otherwise you will not get any benefit or enjoyment out of them. Throughout the visit to he home staff were observe to be interacting and holding discussion on a one to one basis, which the clients appeared to enjoy. Some of the clients go to a local coffee morning once a week, where they can enjoy socialising with other people not living in the care home. Visitors are welcome at all times of the day. This was confirmed in conversations with visitors and clients. Clients said that they could receive their visitors in one of the communal areas or in their individual accommodation. Staff spoke with said that clients can take control of their lives, deciding when to get up, when to go to bed and what personal care they wish to have. The care planning process supports the ethos of clients being able to control their lives. One client told the inspector how she could stay in bed if she wishes to, staff will encourage her to get up but it is her choice whether to or not. Meal times are encouraged to be a social event, though if clients do not wish to take meals in the dining room their wish is respected. Clients said that they have a choice of meals at breakfast and teatime, lunch is generally a set meal, but if they do not wish to have the planned meal they will be offered an alternative. All clients that the inspector had conversations with spoke highly of the quality and quantity of food provided at the home. A mealtime was observed. For those clients that require assisted with taking their meals this is done with sensitivity and dignity. The Birches Nursing Home DS0000062660.V326182.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Clients have confidence to voice concerns and complaints. They are sure that any concerns or complaints will be dealt with promptly and effectively. Individuals are protected form the effects of abuse by a workforce that has a good understanding about abuse and the protection of vulnerable adults. Clients say they feel safe living at the home. EVIDENCE: A complaints procedure is in place that clearly details the process for making and investigating a complaint. A clear records is kept of all complaints, whether written or verbal, made to the home, outlining the processes taken to investigate the complaint and the outcome. The nurse in charge during the visit informed the inspector that the information gathered in these investigations is used to improve the service. Discussion with clients and visitors evidence that they are confident that any concerns or complaints addressed to the home will be dealt within an effective and appropriate manner. However all of them said that they had had no need to make any complaints. Polices and procedures are in place about the protection of vulnerable adults. Discussion with staff ad the nurse in change evidence that staff are aware of The Birches Nursing Home DS0000062660.V326182.R01.S.doc Version 5.2 Page 15 issues about the protection of vulnerable adults and the procedures to take if there is a case of suspected abuse. The Birches Nursing Home DS0000062660.V326182.R01.S.doc Version 5.2 Page 16 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. 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. Clients benefit from a well maintained home that has the aids and equipment to meet their needs. Good hygiene and infection control practices promote the health and wellbeing of those living at the home. EVIDENCE: The home is located in an adapted building in a residential area of Southampton. Much work has been done over the past 24 months to improve the environment for the clients. This has included the addition of a shower room, enlargement of the lounge area and alterations to some of the client’s bedrooms. One of the homeowners discussed the plans for further improvement; at present this includes the continual maintenance and redecoration of the home. The Birches Nursing Home DS0000062660.V326182.R01.S.doc Version 5.2 Page 17 A shaft lift enables clients to access all areas of the home. Client’s bedrooms are of varying sizes. Many of the bedrooms seen were personalised with the client’s own possessions. Many of the bedrooms have toilet facilities that are screened off from the main room by curtains. The service provides sufficient assisted bathing facilities and moving and handling equipment. All areas of the home were clean and tidy during the visit. Clients and visitors said that the home is clean and tidy at all times. There is a member of the cleaning staff on duty each day. Infection control procedures are in place, and staff receive training about the control of infection. All staff that handle food items have training about food hygiene. All laundry is done in the service’s own laundry by the care staff. The laundry room was clean and tidy during the visit to he home. The Birches Nursing Home DS0000062660.V326182.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Rota’s show well thought out and creative ways of making sure the home is staffed efficiently, with attention being given to busiest times of the day. Training of all staff is considered highly important. Clients are cared for by a work force that has received training that is based on improving their outcomes. Robust recruitment practices protect the welfare of clients. EVIDENCE: Staffing rotas supplied with the pre inspection questionnaire indicate that there are five care staff on duty during the morning and five during the afternoon/evening. The shift times are staggered during the morning and afternoon/evening shift so that there are extra members of staff on duty at peak activity times. There is a nurse on duty at all times of the day and night and one member of care staff on duty with the nurse at night. Discussion with staff members, clients and visitors said that there are sufficient numbers of staff on duty at all times. Call bells were noted to be answered promptly indicating sufficient numbers of staff to meet the needs of the clients. The service is highly committed to providing a well qualified staff team to care and support the clients. 69 of the care staff have NVQ level 2 or above qualification in care. All newly appointed care staff follow an induction The Birches Nursing Home DS0000062660.V326182.R01.S.doc Version 5.2 Page 19 programme that conforms to Skills for Care guidance. Discussion with staff, information provided by the service in the pre inspection questionnaire and inspection of a sample of staff records indicate that staff receive good amounts of training. Staff said that in the past twelve months as well as receiving mandatory training they have received training such as diet and nutrition, dementia and infection control to able them to meet the needs of those living at the home. A student nurse on placement at the home said that the home had included her within their staff training programme. She had attended courses about moving and handling and dementia. The nurse in charge explained how the home supports student nurse to develop their nursing and management skills as well as developing their own staff member’s skills. Looking at sample of staff records indicated that recruitment policies and procedures are followed correctly protecting all clients at the home. This includes having two satisfactory references and suitable CRB and POVA clearance prior to the person commencing employment at the home. The Birches Nursing Home DS0000062660.V326182.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 26 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has the required qualifications and is competent to run the home. She is client focused and leads a staff team who have been recruited and trained to a good standard. Good financial practices protect client’s monies. The service has a good record of meeting health and safety requirements and legislation. EVIDENCE: The registered manager, Lesley Head, has been in position for several years and has obtained the registered managers award as well as other courses that The Birches Nursing Home DS0000062660.V326182.R01.S.doc Version 5.2 Page 21 support her managerial and practical nursing skills. At the time of the visit to the home the manager was not on duty, her deputy was in charge of the home. The home was being managed effectively on the day of the visit, all documentation needed was available. It is concluded that the manager has created a working environment that ensures the running of the home is seamless whether she is there or not. All staff, clients and visitors spoken with spoke highly of the manager, expressing that they can approach her with any concerns. Various quality-auditing processes are in place. These include the monthly reviewing of care plans, day to day chats with the clients, Reg 26 visits to assess the running of the service as well as environmental audits. The service will look after small amounts of client’s money. Accurate records are kept of all money kept and spent; clients and their representatives can inspect these records whenever they wish. Staff records seen at the home and staff surveys returned to Commission evidence that staff receive regular supervision. This practice will support them to develop their skills and understanding about how to improve outcomes for those living at the some. Health and safety policies and procedures are in place and staff receive training about health and safety matters. The fire logbook indicates that all fire safety checks and staff training are carried out inline with requirements and recommendations of the Fire and Rescue services. Risk assessments for the environment are incorporated in each client’s care planning documentation, making risks associated with the environment personal to their needs. A sample of service records were viewed evidencing that all facilities and equipment are serviced at the manufacturers recommended intervals. The Birches Nursing Home DS0000062660.V326182.R01.S.doc Version 5.2 Page 22 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X 3 X X X X X X 3 STAFFING Standard No Score 27 4 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 12 13 14 15 Score 3 3 3 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X 3 3 X 3 The Birches Nursing Home DS0000062660.V326182.R01.S.doc Version 5.2 Page 23 No 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. Standard Regulation Requirement Timescale for action 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 Nursing Home DS0000062660.V326182.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 The Birches Nursing Home DS0000062660.V326182.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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