CARE HOMES FOR OLDER PEOPLE
The Birches Nursing Home 239 Water Lane Totton Southampton Hampshire SO40 3GE Lead Inspector
Marilyn Lewis Unannounced Inspection 19th October 2005 09:30 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 Nursing Home DS0000062660.V253621.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 Nursing Home DS0000062660.V253621.R01.S.doc Version 5.0 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.V253621.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 28th April 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, staff training/rest room, a sleep over room and bathroom facilities. 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. The Birches Nursing Home DS0000062660.V253621.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over five hours on the 19th October 2005. The inspector toured the home and met with six residents, two staff members, a visitor and the two proprietors. Care plans were sampled for four residents and records were seen for medicines, complaints, fire safety and fire drills. On the day of the inspection the registered manager was unavailable and a registered nurse and the proprietors assisted the inspector with the inspection process. What the service does well: What has improved since the last inspection?
The Birches Nursing Home DS0000062660.V253621.R01.S.doc Version 5.0 Page 6 Refurbishment of the first and second floors of the home is almost complete. Residents who are accommodated in the new bedrooms provided on the first floor like their rooms. Refurbishment of the ground floor to enlarge the communal lounge and dining room is also almost complete and new flooring is due to be laid in the next few weeks. The complaints procedures and records have been improved to provided clear documentation of any concerns raised. 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 Nursing Home DS0000062660.V253621.R01.S.doc Version 5.0 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.V253621.R01.S.doc Version 5.0 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): 3 A full needs assessment is undertaken for each resident prior to admission to ensure the home can meet their needs. EVIDENCE: A full needs assessment is completed for each resident before a place at the home is confirmed. Assessments were seen for two residents, one of whom had recently been admitted to the home. The assessments covered all aspects of care needs including personal and social care. The registered manager of the home had undertaken the assessments at the residents’ homes. The Birches Nursing Home DS0000062660.V253621.R01.S.doc Version 5.0 Page 9 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 and 10 Residents are treated with respect and the detailed care plans provide staff with the information required to fully support their needs. However, residents health could be put at risk if staff do not adhere to the home’s procedures for administering medication. EVIDENCE: Individual care plans were seen for four residents. The full assessment completed prior to admission formed the basis for resident care plans. The care plans seen were detailed and contained risk assessments for all daily living activities including mobility, nutrition and pressure area care. The care plans showed evidence of monthly review and the resident or their relatives’ involvement in the development and review of the documents. Visits from GPs and other health professionals such as dentists and opticians were recorded in the residents’ care records. One resident spoke of being visited by her GP when required. A chiropodist visits the home regularly. The home has clear procedures in place for dealing with medicines. Medication charts seen were up to date and had been completed appropriately. Medicines
The Birches Nursing Home DS0000062660.V253621.R01.S.doc Version 5.0 Page 10 kept in the controlled medicines cupboard were checked and the records matched the stock held. Suitable systems are in place for the disposal of medicines. It was noted during the tour of the home that in one room, tablets had been left in a container on a table. This was brought to the attention of the registered nurse on duty, who stated that the resident had asked to take the tablets later. It was agreed that the staff member giving the medicines out would ensure the medication was taken by the resident to avoid any errors. Residents spoken to during the inspection said that staff were very caring and treated them with respect. Staff were seen to knock on doors and wait before entering rooms. Residents are able to receive visitors, including GPs, in the privacy of their own rooms. The Birches Nursing Home DS0000062660.V253621.R01.S.doc Version 5.0 Page 11 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 and 15 The home provides a limited number of social activities and residents enjoy the meals provided. However, some residents would benefit from a wider range of social activities and knowledge of the daily meals on offer would allow them to choose their preferred option. EVIDENCE: The home does not employ an activities co-ordinator but staff members provide a limited number of activities including quizzes and bingo. Some residents take part in wheel chair dancing at a local centre each week. Four residents said that they would like more activities. They said that they had enjoyed a visit to the home by a musician but that had been some time ago. They would also like more daily activities. Ministers from local churches visit the home monthly and hold communion services for those who wish to attend. Staff at the home said that there was no restriction on visiting and this was confirmed by a relative visiting at the time of the inspection, who said that they were able to visit at any time and were always made to feel welcome by staff. The Birches Nursing Home DS0000062660.V253621.R01.S.doc Version 5.0 Page 12 Residents said that they enjoyed the meals provided at the home. On the day of the inspection lunch consisted of Gammon or chicken, potatoes, cauliflower with cheese sauce and peas followed by rice pudding. The meals served were well presented, however pureed meals were not served with food items pureed separately to retain flavour and texture. The cook said that in future food items would be pureed separately. Although residents were asked what they would like from a choice of items for tea they were unaware of the choices of food provided at lunch times. Some residents said that they would like to know what was on the menu for the day. However one resident said that she did not mind not knowing as she always enjoyed the meals provided. The proprietor said that he would arrange for each resident to be made aware of the choices on the daily menu. The Birches Nursing Home DS0000062660.V253621.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): 16 and 18 Residents know that any complaints will be taken seriously and they are protected by staff awareness of the procedures to be followed should abuse be suspected. EVIDENCE: The home has clear complaints procedures in place that indicate who will investigate the complaint. Records seen indicated that all complaints are taken seriously and acted upon. Two residents who were asked if they knew how to make a complaint, did know, but said they had no reason to do so. They said that they felt any concerns raised with the registered manager would be dealt with promptly. Procedures are available for staff to follow should abuse be suspected. Leaflets are also available for residents and visitors to the home. Two staff members spoken to were aware of the procedures to be followed and indicated that they would have no hesitation in reporting any concerns. The Birches Nursing Home DS0000062660.V253621.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, 21, 22, 23, 24, 25 and 26 The provision of a clean, safe home with personalised bedrooms, enlarged communal rooms and specialist equipment as required, gives a pleasant environment for all who live and work there. EVIDENCE: Refurbishment of the home has been taking place throughout the year. Work to provide two new bedrooms on the first floor of the home has been completed and residents are now occupying the rooms. A shower room on that floor is due for completion in the next few weeks. An extension has been built onto the lounge providing a larger and brighter communal space. New carpet is due to be laid in the lounge, dining room and corridors on the ground floor. The exit from the new door in the lounge to the garden had a step. The proprietor said that a patio was to be laid alongside the lounge door and a ramp with a very slight slope was being incorporated in the work to allow residents easy access to the garden. The small garden is also going to be landscaped when the building work has been completed. The Birches Nursing Home DS0000062660.V253621.R01.S.doc Version 5.0 Page 15 Residents in the lounge at the time of the inspection visit said that they had not been disturbed by the building work taking place and looked forward to using the extra space provided. Work is also due to be completed shortly to refurbish a bathroom on the ground floor. On the day of the inspection the home looked clean and welcoming. Residents’ rooms looked cheerful and contained many personal items such as photographs and ornaments. Three residents in their rooms at the time of the visit, said that they liked their rooms. Specialist equipment such as hoists and pressure relieving mattresses are provided for residents assessed as requiring them. The Birches Nursing Home DS0000062660.V253621.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): EVIDENCE: Standards for staffing were assessed in the inspection report dated 28th April 2005. All the standards were met. At the time of this inspection, a sufficient number and skill mix of staff were on duty. The Birches Nursing Home DS0000062660.V253621.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): 33, 35 and 38 Residents benefit from the open approach to management in place at the home, their financial interests are safeguarded by the home’s clear financial procedures and their health, safety and welfare is protected by safe working practices. EVIDENCE: Meetings are not held for residents. However the registered manager of the home spends time with residents on a one to one basis, giving an opportunity for residents to voice their opinions about the quality of care provided at the home. Five residents spoken to during the visit, said that the registered manager was approachable and they found her easy to talk to about any issues. A relative also said that the registered manager and staff were friendly and that communication was good. The Birches Nursing Home DS0000062660.V253621.R01.S.doc Version 5.0 Page 18 Opinions were also gained through questionnaire surveys. The inspector saw a recent survey conducted in September 2005. Ten questionnaires had been completed. All were satisfied with the care provided, although three indicated they felt there was a lack of suitable activities. The home keeps small amounts of residents’ money in a secure place. Records seen for three residents, matched the amount of money held. The home has complied with requirements made by the Fire Service following a visit to the home. Fire records seen indicated that all staff had received training in fire safety and had attended fire drills. On the day of the inspection the kitchen looked clean and food was stored appropriately. The temperature of the fridge and freezer were being monitored and recorded. The Birches Nursing Home DS0000062660.V253621.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 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x 3 3 x 3 x x 3 The Birches Nursing Home DS0000062660.V253621.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? No 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 16(2)(n) Requirement The registered person must develop and put into action a programme of suitable recreational activities. The registered person must ensure residents have access to the daily menu and are offered choice of meals. The registered person must ensure staff adhere to the procedures for administering medicines. Timescale for action 31/01/06 2 OP15.7 12(3) 30/11/05 3 OP9.4 13(2) 20/10/05 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.V253621.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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