Care Home: Berwood Court Care Home

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What the care home does well The registered manager has implemented the majority of the improvements required at the previous inspection in June 2007. There are many examples of excellent practices for prospective people enquiring about the services offered and how their needs will be met at Berwood Court. This information is readily made available in written formats and a DVD which provides people with a visual guide of the home. The home uses a number of ways to establish peoples care needs and good attention is paid to specialist health care assessments together with a person`s social history to ensure people needs are met on all levels. The ethos of the home is its knowledge and skills in delivering care to people in a dignified manner. The home uses this principle to guide them in providing people with flexibility in choices they make in their everyday lives at Berwood Court. The home has become part of the palliative pathways enabling staff to provide `end of days` care to people. This means working closely with the primary care trust, doctors and families to ensure end of life care is met sensitively and in a way that is most appropriate to individuals. The registered manager and staff continue to make sure that relatives and friends are involved in the plan of how care is to be provided. The home has also built up good relationships with local doctors and social workers. One professional visiting the home made this comment, "Lovely staff and manager, always helpful towards visitors and clients, clients who always look happy, lovely environment". People, family members and friends are encouraged to make their own views heard together with any suggestions they wish to make so that the lives of people can be further enhanced ensuring good outcomes are sought. Berwood Court has strived to have a stable staff group who are caring, committed and flexible, often working extra hours to support people. The induction process has been developed for new members of staff to make sure that people can be confident that their needs and aspirations will be met. There have been lots of examples of friendly interaction between the staff, people who live in the home and their relatives/friends throughout the day. During the visit staff have demonstrated a dedicated approach to their work and they clearly know peoples likes and dislikes together with how to meet their needs. There has been some good examples of quality assurance systems which includes introducing surveys, suggestion book together with taking the opportunity of inviting the local community to the homes events where views and opinions can be shared in a more relaxed atmosphere. The home is clean, tidy, homely and comfortable. There is a programme for further improvements to the homes interior and exterior so that people live in a home that meets there needs. People commented that they are impressed with the standards of cleanliness in the home and it has been rewarded for their efforts with a five star rating which is the highest that can be given from the Environmental Health Officer. What has improved since the last inspection? What the care home could do better: A small numbers of areas needing attention to ensure safeguards for the medication system have been identified at this visit. Medication checking needs to be consistently maintained. For example, staff must remember to sign the medication administration record, (MAR), after giving people their medication. Also staff must ensure that prescribing labels are in place with the persons name and dosages clearly documented on the medication when it is received from the pharmacist. To make sure that meals offered at teatime are varied and suit peoples differing tastes. For example, a variety of hot snacks need to be considered for people to choose as an alternative to sandwiches and soup. To give some consideration to re checking staff members Criminal Records Bureau (CRB) checks every three years in line with good practice so people are fully safeguarded. To make sure that staffing levels remain consistent with peoples individual needs so that staff do have time to interact with people and are not always too busy with practical tasks to converse with people. To continue to improve the homes environment in respect of diversion visual displays so that people who experience dementia can be stimulated by walking around their home. The home has already made a good start on this but it needs to continue. New visitors to the home should be reminded to sign in and out to safeguard the people living in the home against unwanted visitors. The home has placed signs in the lift which is a good start but staff need to verbally and physically request that new visitors to the home sign in and out. There have been some requirements and recommendations made at the end of this report if the reader wishes to read these. CARE HOMES FOR OLDER PEOPLE Berwood Court Care Home Cadbury Drive Castle Vale Birmingham West Midlands B35 7EW Lead Inspector Sally Seel Key Unannounced Inspection 24th September 2008 09:15 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 Berwood Court Care Home DS0000024824.V372074.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. Berwood Court Care Home DS0000024824.V372074.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Berwood Court Care Home Address Cadbury Drive Castle Vale Birmingham West Midlands B35 7EW 0121 749 7887 0121 749 7997 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) Dukeries Healthcare Ms Karen Cooper Care Home 39 Category(ies) of Dementia - over 65 years of age (39), Old age, registration, with number not falling within any other category (39) of places Berwood Court Care Home DS0000024824.V372074.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places 39). Dementia - Code DE(E) (maximum number of places 39) The maximum number of service users to be accommodated is 39 2. Date of last inspection 6th June 2007 Brief Description of the Service: Berwood Court is a 39 bedded purpose built nursing and residential home, which accommodates people of 65 years of age or above who may experience dementia. The premises are situated in a residential area of Castle Vale in Birmingham. The care home is located on the first floor of the building and is divided into two units, residential and nursing care. All bedrooms are for single occupancy with an en suite facility consisting of toilet and wash hand basin. All bedrooms are furnished as standard with a bed, bedside drawers, (lockable), chest of drawers and wardrobe. People are encouraged to bring in items of their own furniture, pictures and other items that may have some sentimental value. There are communal lounge and dining rooms available for residents within each unit with an additional smaller lounge in the nursing unit which is used as a quiet lounge. There are drinks facilities on both units and relatives are encouraged to help themselves to tea, coffee or juice. Assisted bathing facilities are provided in convenient locations within easy reach of resident’s bedrooms. There is a good supply of specialist equipment to assist people who have restricted mobility. A call system is in all rooms. There is ample off road parking provided. A rehabilitation unit, managed by the Primary Care Trust is located on the ground floor, which is not inspected by The Commission for Social Care Inspection. A shaft lift provides assisted access to both floors and an electronic key pad is in operation to safeguard people who live in the home. The fees charged by the home are £338.00 for residential and £584.00 for nursing care. However, it would be wise to contact the homes registered manager, Karen Cooper to establish the correct fee at any current time. Berwood Court Care Home DS0000024824.V372074.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 stars. This means the people who use this service experience excellent quality outcomes. The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and on aspects of service provisions that need further development. One inspector undertook this fieldwork visit to the home during the hours of 09:15 to 17:45. The registered manager and staff members assisted us throughout. The home did not know that we were visiting on that day. There were thirty-eight people living at the home on the day of the visit with the home having one vacancy. Information was gathered from speaking to and observing people who lived at the home. Seven people were “case tracked” and this involved discovering their experiences of living at the home. This was achieved by meeting people or observing them, looking at medication and care records and reviewing areas of the home relevant to these people, in order to focus upon outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files, training records and health and safety records were also reviewed. Prior to the inspection the registered manager had completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This gave us a wealth of information with good examples about the home, staff and people who live there. Improvements and plans for further improvements have been taken into consideration. Regulation 37 reports about accidents and incidents in the home were reviewed in the planning of this visit. One completed survey from a person’s family member and thirteen completed staff surveys were returned to Commission for Social Care Inspection, (CSCI). Information from all of these sources was used when forming judgements on the quality of service provided at the home. The people who live at this home have a variety of needs. We took this into consideration when case tracking seven individual peoples care provided at the home. For example, the people chosen consisted of both male and female and have differing levels of care needs for both the residential and nursing units in the home. The atmosphere within Berwood Court is inviting and warm and we would like to thank everyone for his or her assistance and co-operation throughout the day we visited. Berwood Court Care Home DS0000024824.V372074.R01.S.doc Version 5.2 Page 6 What the service does well: The registered manager has implemented the majority of the improvements required at the previous inspection in June 2007. There are many examples of excellent practices for prospective people enquiring about the services offered and how their needs will be met at Berwood Court. This information is readily made available in written formats and a DVD which provides people with a visual guide of the home. The home uses a number of ways to establish peoples care needs and good attention is paid to specialist health care assessments together with a person’s social history to ensure people needs are met on all levels. The ethos of the home is its knowledge and skills in delivering care to people in a dignified manner. The home uses this principle to guide them in providing people with flexibility in choices they make in their everyday lives at Berwood Court. The home has become part of the palliative pathways enabling staff to provide ‘end of days’ care to people. This means working closely with the primary care trust, doctors and families to ensure end of life care is met sensitively and in a way that is most appropriate to individuals. The registered manager and staff continue to make sure that relatives and friends are involved in the plan of how care is to be provided. The home has also built up good relationships with local doctors and social workers. One professional visiting the home made this comment, “Lovely staff and manager, always helpful towards visitors and clients, clients who always look happy, lovely environment”. People, family members and friends are encouraged to make their own views heard together with any suggestions they wish to make so that the lives of people can be further enhanced ensuring good outcomes are sought. Berwood Court has strived to have a stable staff group who are caring, committed and flexible, often working extra hours to support people. The induction process has been developed for new members of staff to make sure that people can be confident that their needs and aspirations will be met. There have been lots of examples of friendly interaction between the staff, people who live in the home and their relatives/friends throughout the day. During the visit staff have demonstrated a dedicated approach to their work and they clearly know peoples likes and dislikes together with how to meet their needs. There has been some good examples of quality assurance systems which includes introducing surveys, suggestion book together with taking the Berwood Court Care Home DS0000024824.V372074.R01.S.doc Version 5.2 Page 7 opportunity of inviting the local community to the homes events where views and opinions can be shared in a more relaxed atmosphere. The home is clean, tidy, homely and comfortable. There is a programme for further improvements to the homes interior and exterior so that people live in a home that meets there needs. People commented that they are impressed with the standards of cleanliness in the home and it has been rewarded for their efforts with a five star rating which is the highest that can be given from the Environmental Health Officer. What has improved since the last inspection? The home has now employed two activity co-ordinators to make sure that people have the opportunity of social stimulation on a daily basis including weekends. Staff have commented that all people regardless of their abilities and mental health are encouraged to take part with support as needed. The home has generally good systems in place for ordering, receipt and administration of people’s medication. Improvements have been made since the last inspection visit. For example, there is a list of individual’s medication alongside possible side effects for staff to refer to as needed so that any signs of illness and/or reactions links can be sought in the first instance. Also the registered manager has introduced her own audit checks which makes sure that staff are keeping up good medication practices in line with protecting peoples health and wellbeing. The home has been given an excellent rating by the pharmacist at the local pharmacy. Meals are thoughtfully and well prepared and menus offer a range of options for breakfast and lunchtime. The registered manager has sought advice from the local dietician to make sure people are offered a healthier well-balanced diet. The registered manager has ensured that the practice of keeping food warm whilst serving it up has been put in place. People can choose to have their meals in their own rooms or join other people in the dining area of the home. Members of staff sensitively offer people assistance and encouragement as they need it. The nurses door now remains closed and everything that might be hazardous to people has been locked in cupboards so that people are able to walk around the home and into rooms with safety in mind together with a sense of freedom. Control of Substances Hazardous to Health, (COSSH), items are now securely stored to prevent accidental ingestion by people who live at the home. Berwood Court Care Home DS0000024824.V372074.R01.S.doc Version 5.2 Page 8 The home has an ongoing plan of further improvements to the homes décor and furniture both inside the home and its garden area. The new furniture has been chosen by the people who live in the home. The home demonstrates a strong commitment to training; now having achieved a further increase in its staff who have or are undertaking the National Vocational Qualification, (NVQ), Level 2. Also the registered manager has completed her National Vocational Qualification, (NVQ), Level 4 and RMA award. What they could do better: A small numbers of areas needing attention to ensure safeguards for the medication system have been identified at this visit. Medication checking needs to be consistently maintained. For example, staff must remember to sign the medication administration record, (MAR), after giving people their medication. Also staff must ensure that prescribing labels are in place with the persons name and dosages clearly documented on the medication when it is received from the pharmacist. To make sure that meals offered at teatime are varied and suit peoples differing tastes. For example, a variety of hot snacks need to be considered for people to choose as an alternative to sandwiches and soup. To give some consideration to re checking staff members Criminal Records Bureau (CRB) checks every three years in line with good practice so people are fully safeguarded. To make sure that staffing levels remain consistent with peoples individual needs so that staff do have time to interact with people and are not always too busy with practical tasks to converse with people. To continue to improve the homes environment in respect of diversion visual displays so that people who experience dementia can be stimulated by walking around their home. The home has already made a good start on this but it needs to continue. New visitors to the home should be reminded to sign in and out to safeguard the people living in the home against unwanted visitors. The home has placed signs in the lift which is a good start but staff need to verbally and physically request that new visitors to the home sign in and out. There have been some requirements and recommendations made at the end of this report if the reader wishes to read these. Berwood Court Care Home DS0000024824.V372074.R01.S.doc Version 5.2 Page 9 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. Berwood Court Care Home DS0000024824.V372074.R01.S.doc Version 5.2 Page 10 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 Berwood Court Care Home DS0000024824.V372074.R01.S.doc Version 5.2 Page 11 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): 1,2,3,4 & 5. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home provides comprehensive information about the home together with a visit generally from the registered manager who completes a pre-admission assessment. Prospective people and their relatives and/or friends can also visit the home for lunch if they wish so that people can make an informed decision in the knowledge that their needs will be met. EVIDENCE: The home has produced a Statement of Purpose and service user’s guide which is very comprehensive in respect of its contents. For example, it has the homes philosophy, services offered in the home, how to complain, menus, and the homes last report and so on. In addition to this the home has produced a smaller version of this document which the registered manager and/or staff members can send to prospective people and/or their friends/relatives. The Berwood Court Care Home DS0000024824.V372074.R01.S.doc Version 5.2 Page 12 information supplied within the document provides people with an overall picture of what Berwood Court is all about, what it can provide, how it provides this. For example, it is good to see a four week menu plan and how people can expect their care plans to be reviewed. This information ensures that people are able to make an informed decision about whether they wish to live in the home. The registered manager also takes time to point out to people that they are able to gain access to the homes website and CSCI’s website. Within this smaller version there is a DVD which the registered manager and staff have put together to provide people with further information about the home together with a visual guide around the homes environment. In the AQAA the manager has confirmed that the home wants to develop more pictorial formats in their service user guide to ensure all people can read the information and it is readily accessible. One person’s survey confirmed that they received sufficient information to make an informed choice about whether they would like to live at Berwood Court and they received a contract. Case tracking confirmed good practice in the area of pre-admission assessments of prospective people who are considering living in the home. This is generally undertaken by the homes registered manager and then people are asked whether they would like to visit the home. The registered manager in her completed AQAA states, “The relatives are then asked if the potential service user would like to join us for a lunch visit, where both the service user and relatives can dine with us, on a day of their choice”. There is good evidence that staff are qualified and skilled to meet the individual needs of people, all staff receive an induction, basic and specialist training including dementia care. There is evidence from records and discussions that staff are well briefed and knowledgeable about the needs of new people to the home. Each care plan and risk assessment takes into account peoples cultural, religious, social history and preferences together with individual health needs. People told us: “My family knew about the home before I came to live here and I liked it when I came to visit”. “It is a good home and the best one for me”. Staff told us about the home: “Makes residents feel like this Berwood Court is their home”. “Berwood Court is a lovely home for staff and residents. We all feel like one big happy family, it is a pleasure to come to work”. The home does not provide an intermediate care service. Berwood Court Care Home DS0000024824.V372074.R01.S.doc Version 5.2 Page 13 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 & 11. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments promote peoples health, social, psychological and emotional wellbeing. The dignity of people is maintained at all times this includes in times of ‘end of life’ care which enables people to live as full a life as possible until they die. Medication administration and practices are protecting the people who live in the home in maintaining people’s health and wellbeing. EVIDENCE: Each person has a comprehensive care plan. This is an individualised plan about what the person is able to do independently and states what assistance is required from staff in order for the person to maintain their needs. We looked at seven peoples care plans and risk assessments in some detail. Berwood Court Care Home DS0000024824.V372074.R01.S.doc Version 5.2 Page 14 There were good ‘social profiles’ documented which provided staff details about people past lives, likes, dislikes and interests. In each persons care record were good pieces of evidence that was in easy to read styles. For example, ‘My Way Forward’ had a persons basic details, such as name and address contacts, ‘My Past Medical History’, ‘My Personal Life Plan’, Likes/Dislikes together with needs and what the person can do independently. ‘My Life History’ and ‘My Circle of Friends and Family’. This will assist staff to have meaningful conversations with people and people take part in stating the things important to them. A survey received from one person confirms that they always receive the medical support that they need. Another person told us, “Yes I feel I have everything I want and/or need here”. Staff told us:“We meet the needs of all service users and give high quality care, also give them choice, encourage them to promote their independence and maintain their dignity”. “Care levels are good”. “We meet their needs of all service users and promote their dignity and independence; we respect their wishes and treat each person as an individual”. Senior members of staff on both the nursing and residential unit write each individuals care plan and risk assessments. Each person will have their own key worker who will get to know the individuals needs, dislikes and likes together with how each person prefers to receive their care with what places them particularly at risk. For example, in one persons care record it is stated, ‘don’t like to be rushed, don’t like cold and like to be warm’. There is evidence within the care records that were sampled that care plans are reviewed and this is also a source of information that is supplied in the homes service user guide. Where appropriate the home makes sure that family members are included in reviewing and/or updating peoples care plans. This makes sure that people are confident that their needs will be met even if they change. Some people in the home experience a dementia type illness and staff receive specialist training to make sure that individuals receive the most appropriate care in a dignified way. The home is proud to be involved in the ‘Dignity Challenge’ whereby they receive regular updates, changes and can be involved in discussion groups. This makes sure that staff are abe to promote and learn from examples of good practices of care regardless of a persons mental health, social background or religion. The home prides itself in developing good relationships with external professionals, such as, doctors, dieticians, physiotherapists, speech and language therapists and social workers. There is evidence in the care records that we sampled of where dieticians have been advising staff how to meet people’s needs if they are at risk from swallowing difficulties. In one care record a person has declined to have medical intervention but instead prefers Berwood Court Care Home DS0000024824.V372074.R01.S.doc Version 5.2 Page 15 to try swallowing food with staff having knowledge of the consistency required and assistance if needed. This evidences that this persons wishes have been respected and followed. There was information in respect of dental, optical and doctors visits, with outcomes. A social worker who visited the home commented in the suggestion book, “Lovely staff and manager, always helpful towards visitors and clients, clients who always look happy, lovely environment”. There were some good care plans and risk assessments in place for people who were at risk of falling and people had moving and handling plans so that staff knew what equipment to use to prevent any injuries occurring. Monthly reviews were undertaken for moving and handling, nutrition and skin soreness. There were some good audits in place to monitor pressure sores with outcomes of how pressure sores heal. The home has a comprehensive medication policy, procedure and medication system for the administration of people’s medication which is provided by the local pharmacy. The registered manager undertakes regular monthly audits of medication on both the nursing and residential unit to make sure that people are safeguarded from any bad practice errors that could affect people’s health and wellbeing. Also the local pharmacist has completed an audit of the homes medication administration and handling. The outcome was that the homes administering and handling of medication is excellent. The management of medication was reviewed on both the residential and nursing units of the home with the registered manager. One person’s medication that was checked on the residential unit was correct in the amount of prescribed medication to be given but the staff member had forgotten to sign the medication administration record, (MAR), when they had given the person their medication on that day. The registered manager confirmed that she would now be discussing the importance of staff doing this to make sure all people’s health and wellbeing are safeguarded. All other medication sampled on the residential unit were correct with signatures of the members of staff who have given people their medication. On the nursing unit one person’s medication had its prescribing label missing. The registered manager discussed this with the nurse on the unit who promptly contacted the pharmacist who confirmed that they would rectify this immediately. All other medication sampled on the nursing unit was in order. It was good to see that all creams/lotions had prescribing labels and that the description of where the cream/lotion should be applied. This makes sure that staff are applying medication in a safe way. Both the nursing and residential unit medications were being stored cleanly as per manufacturer’s guidelines. The management of controlled medication was robust. Medication is signed in upon receipt. The registered manager has developed a plan of each persons medication alongside any potential side effects of medication given which staff are able to refer to if people become ill and/or develop an adverse reaction to Berwood Court Care Home DS0000024824.V372074.R01.S.doc Version 5.2 Page 16 their medication. All staff that are trained in medication administration and handling and are audited by the registered manager to make sure good practice is maintained and peoples health and wellbeing are protected. People appeared well supported by staff to choose clothing appropriate for the time of year which reflected individual cultural, gender and person preferences. There is evidence that the registered manager routinely observes staff attitudes and practice relating to privacy and respect together with peoples views and experiences. The home has become part of the palliative care pathways which means that people are provided with a sensitive and good quality of ‘end of life’ care. There is evidence that the home gathers information from people and family members and/or friends so that the person receives individualised care that meets their needs and in the way they want. The registered manager in her completed AQAA states, ‘Both I and the residential team leader are palliative care co-ordinators and attend courses within the community to enable us to promote all changes and new legislation, to ensure we provide up to date care’. Berwood Court Care Home DS0000024824.V372074.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including a visit to this service. Activities and social stimulation is promoted within the home and individuals are encouraged and supported to take part irrespective of their general health, physical or mental health needs. The home welcomes families, friends and people living in the community to promote peoples sense of belonging. The meals provided are wholesome and satisfying but the home needs to be mindful of providing more variety of choices to suit peoples differing tastes at teatime meals. EVIDENCE: The home has two dedicated activities coordinators to support people with their interests. The home has internal activity plans which include carpet bowls, quizzes, manicures, and board games, armchair exercises, shopping and going for walks. Time is set aside for one to one, which means that people can have time on their own with the activity coordinators to ensure that they receive stimulation and continue any chosen interests. This may be for people Berwood Court Care Home DS0000024824.V372074.R01.S.doc Version 5.2 Page 18 who have to stay in their rooms or people who prefer not to join in larger group activities People told us:“I like to do word searches and take part in the quizzes”. “I like to be with other people” However, some staff feel that they would like more opportunities to spend time interacting with people as opposed to being only focused on meeting people practical needs. Staff told us:‘Gives residents a good quality of life 24 hour care’. ‘Good range of activities’. ‘Encourages families to be involved with residents care’. ‘More staff to ratio of residents to give even better care’. ‘Sometimes you want to spend more time but you have not enough staff to do it and you are busy meeting their needs but you don’t have time to sit with them’. The registered manager and members of staff showed us the display of photographs in relation to the homes fete which people and staff alike are very proud to show visitors. These evidenced activities and eating at the fete with visitors from the community, relatives and friends joining in the day. The registered manager confirmed that there is another fete planned for later this year. The registered manager is a firm believer in the home maintaining good links with the community and showing respect to the homes immediate neighbours. For example, ensuring visitors do not park their vehicles outside of peoples own homes. People who live in the home and staff alike who were spoken with on the day of our visit confirmed that the home provides a range of activities. People who have a mental health difficulty are encouraged and supported to participate in all activities to ensure that the home is appropriately equipped to ensure all people regardless of their health and/or mental health experience social stimulation. A hairdresser visits the home twice weekly and people can choose to have their hair attended to in the homes own salon. A dentist visits every two months and chiropodist visits every six weeks with people having a choice of whether they would like to have any dental treatment and/or feet attended to. People may attend religious services as they wish but transport will need to be arranged for this and/or people may want their religious service in the home in a quiet room. Berwood Court Care Home DS0000024824.V372074.R01.S.doc Version 5.2 Page 19 The home makes sure that it celebrates people’s birthdays including staff members where everyone is supported to join in the day. Also special holidays are promoted and entertainment planned for all and families are invited. The registered manager in her completed AQAA states, ‘we do not have schedules, we ensure that the service user has the kind of day that they wish, such as where they have breakfast, whether it is taken in the privacy of their own rooms or shared in the communal dining area.’ Dignity in care philosophy is displayed on the walls in the home. On the day of our visit staff were seen to check with people what meal they would prefer and people were seen to sit freely where they would like to be. The lunchtime and teatime meals were observed and the atmosphere was calm and unhurried. Tables were nicely presented and staff were observed to assist people whilst maintaining their dignity. The menus are on display in the home and if a person needs a pictorial style menu these can be made available. This is so people are not disadvantaged when choosing their preferred meal option. The home produces a rotating four week menu and this consists of two options for lunchtime plus side dishes of vegetables for people to choose, a desert and teatime meal. Continental breakfast is offered and people are provided with fresh fruit at all meal times. The home has also introduced fresh fish so that people are offered healthy and nutritional meals. An example of one day’s options:Lunch - Fricassee Chicken in tarragon sauce or mixed bean goulash. Side vegetable dishes – garden peas, cauliflower and garlic and herb potatoes. Desert – rhubarb and apple crumble. Teatime – Soup, exotic fruit salad with clotted cream. People spoken with told us that the meals were always hot and generally very appetising. Staff told us:‘Food menus to a high standard’ ‘Offer more variety in meals especially at teatimes, too much tea and sandwiches’. There is an open visiting policy, which means that people can see their visitors as they choose and maintain relationships that are important to them. People were seen to visit throughout the day and could choose how they wished to entertain their visitors. One visitor said, ‘You are made to feel very welcome here”. Berwood Court Care Home DS0000024824.V372074.R01.S.doc Version 5.2 Page 20 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 excellent. This judgement has been made using available evidence including a visit to this service. The home has robust policies and procedures in place so that people are comfortable and supported in expressing their concerns, reporting abuse to ensure that people are protected and have their rights upheld. Visitors’ to the home have the opportunity of expressing their viewpoints and suggestions in a book, with the registered manager documenting her response with a definitive action plan to enable the people living in the home to gain quality of life in how the home is managed. EVIDENCE: The home has received one complaint in the last twelve months which has been resolved in the appropriate timescales satisfactorily. The complaints procedure is displayed in the home, is included in staff members handbooks and in the homes service user guide so that people know how to make a complaint. There is also a Whistle Blowing policy on display to encourage people to act appropriately without fear of discrimination. The home has a comments and suggestions book which it keeps by its signing in and out book for everybody to voice any concerns, complaints and/or possible improvements. Evidence within this book was positive as the registered manager always records the date with a full response including action taken. For example, ‘Took over 10 minutes to be let inside. Another Berwood Court Care Home DS0000024824.V372074.R01.S.doc Version 5.2 Page 21 relative let me in. Reply from manager – ‘Apologise will speak with staff and put new controls in place’. Staff told us:‘Yes see the manager who will meet the peoples concerns to sort any problems’. ‘My manager is always there to address any concerns’ I may have. She is also very supportive’. The home also sends out questionnaires People spoken with on the day of our visit confirmed that they were aware of how to make a complaint or voice their concerns with the registered manager, team leader or senior carer. The home has a copy of the local authority multi-agency protection of vulnerable adult’s policy together with one from a neighbouring local authority. There is also research in relation to safeguarding people from the risk of abuse for staff to refer to. There was evidence that staff have received training relating to issues of abuse. Berwood Court Care Home DS0000024824.V372074.R01.S.doc Version 5.2 Page 22 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, 21, 22, 24 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that is appropriate to the specific needs of the people who live there. The well-maintained environment is continually being improved to ensure that it meets the needs of the people who live there. EVIDENCE: A partial tour of the home was undertaken; we looked at communal areas and some bedrooms on the invitation of the person themselves. The atmosphere was calm, relaxed and friendly, there were no unpleasant odours. Berwood Court Care Home DS0000024824.V372074.R01.S.doc Version 5.2 Page 23 The residential and nursing units have separate lounges and dining areas, which are pleasantly decorated. There have been a number of improvements to the décor of the home making it a comfortable and pleasing environment for people to live in. People were supported to choose furniture for these rooms so that it created a sense of belonging for people and inclusion. Corridors are wide and people were seen moving around the home as they chose to. There is also another small lounge area which is quieter. Within the wide hallways there are strategic seats with a book case situated by some of the seats, where people can choose to be quiet and read or watch the world go by as they wish. Chairs have been arranged to promote social interaction as far as possible. Throughout the home some corridors have paintings, pictures and photographs’ hanging on the walls to make the home more meaningful to people who may have dementia. Bedrooms seen were personalised and reflected individual tastes, gender and cultural preferences. People are encouraged to bring in their own possessions in order to have familiar items around them to make their rooms as homely as possible. The home has a range of assisted bathing facilities including baths and showers to enable people to make choices about the mode of bathing they prefer. All bedrooms have en-suite facilities consisting of toilet and wash hand basin. People told us:“Everything is clean here”. “It is lovely and does not smell”. The garden area is pleasantly landscaped and gardeners attend to these monthly. The gardens are clean and tidy to create a pleasing place for people, families and friends to walk around and sit in. There are plans to put more raised flower beds in the garden area and to purchase some new garden furniture. The environmental health officer has undertaken a recent visit and awarded the home five stars for cleanliness and hygiene, this is the highest rating that can be given. This means that the home should have good hygiene procedures in relation to food handling and this will minimise the risk of any cross contamination occurring. The home refers to the Department of Health’s guidance, ‘Essential Steps’ and there are some good measures in place so people are protected from the risk of becoming ill due to unhygienic standards in the home. For example, the carpets are steam cleaned every two weeks and the home has plans within its programme of continual improvements to renew all carpets later this year. Berwood Court Care Home DS0000024824.V372074.R01.S.doc Version 5.2 Page 24 The temperature in the home did not seem too warm for the people living there on the day of our visit but some staff stated that it does get rather warm during the summer months. One person stated that the home could, “Install air conditioning unit especially in the lounges as it is very hot during the summer months”. This was mentioned at the homes last inspection. The door to the nurse room is now kept closed and locks have been fitted on all cupboards in there to protect people living in the home from any hazardous items. Berwood Court Care Home DS0000024824.V372074.R01.S.doc Version 5.2 Page 25 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 excellent. This judgement has been made using available evidence including a visit to this service. People have confidence in the staff who care for them as recruitment practices are robust and there is evidence of proactive training for staff members to ensure that staff are skilled to be able to meet the needs of people. Staff are sensitive to peoples individual needs and actively listen to peoples wishes even at the busier times in the day. EVIDENCE: There are currently thirty eight people living in the home, all with a variety of dependency levels and diverse needs. Assessment of staffing rotas demonstrates that the home continue to maintain satisfactory staffing levels. The registered manager regularly reviews the staffing levels making sure the home complies with the Department of Health guidelines taking into account of the occupancy and dependency levels of people living at the home which is seen as very good practice. The registered manager told us that she very seldom uses agency staff but if there is a need to then she tries to use the same agency staff to ensure consistency for the people living at the home. In addition to care and nursing staff the home also employs kitchen, domestic, Berwood Court Care Home DS0000024824.V372074.R01.S.doc Version 5.2 Page 26 laundry, maintenance and administrative staff to ensure that all aspects of peoples needs are met whilst living in the home. The home demonstrates a strong commitment to staff training and development. 92 of staff have completed a National Vocational Qualification, (NVQ), Level 2. This exceeds the recommendaed standards. The home is also working alongside their doctor to help nurses get the practical experience with things such as taking bloods, specific monitoring and health promotion. This should ensure that a knowledgeable and skilled workforce can meet people’s needs individually and collectively. Four staff records were reviewed and were found to contain all of the relevant information including two written references, POVA first checks (Protection of Vulnerable Adults), CRB checks (Criminal Records Bureau). Records were well organised and information easy to retrieve. Staff have been provided with job descriptions and there was evidence that people receive a comprehensive induction into the home so that they are aware of their responsibilities. Review of peoples training indicated that staff have received mandatory training together with more specialist training. For example, COSHH, (Control of Substances Hazradous to Health), food hygiene, health and safety, emergency first aid, infection control, moving and handling, fire training, medication training, knowledge of dementia, adult protection, nutrition care, bed rail safety, pressure area care and so on. The home provides in-house training whereby people are supported to undertake relevant training in a timely fashion. This should ensure that staff have up to date training in order to care for people living in the home. Staff spoken with were knowledgeable about the people who were living in the home and what care was required. Staff were seen to interact well with people living at the home and the atmosphere was calm, friendly and relaxed. Staff told us:‘Staff are fully trained and experienced’. ‘More incentives for staff’. ‘It is a very good working environment. Staff always find time to interact with service users – take out for walks when weather is good’. ‘More staff to ratio of residents to give even better quality of care’. Berwood Court Care Home DS0000024824.V372074.R01.S.doc Version 5.2 Page 27 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, 32, 33, 35, 36, 37 & 38. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The manager has a clear understanding of the key principles and focus of the service, based on organisational values and priorities. These work to continuously improve services together with providing an increased quality of life for residents, with a strong focus on equality and diversity and promoting human rights, especially in the areas of dignity, respect and fairness. There is also a focus on person centred thinking, with residents shaping service delivery. Berwood Court Care Home DS0000024824.V372074.R01.S.doc Version 5.2 Page 28 EVIDENCE: Karen Cooper is the registered manager, she has extensive experience and in the time she has been at Berwood Court, Ms Cooper has been the driving force in making sure that improvements happen so that people receive the best possible outcomes. Mrs Cooper believes strongly about dignity in care and has promoted this throughout the home with its staff group. The registered manager has recently undertaken and passed her National Vocational Qualification, (NVQ), Level 4 and RMA (Registered Managers Award. The registered manager is clear about further changes she would like to implement in order to ensure that the home is run in the best interests of the people who live there. The registered manager was seen to have an ‘open door’ policy with staff asking questions, seeking advice or sharing information about people who live at the home. Also the registered manager was seen to greet people as she walked by them and it was clear to see that she has rapport with people on all levels. Staff told us:’The new manager has given this home a good name and the care has gone up to the standards they should be’. ‘The manager always supports staff with all work concerns’. Prior to the inspection the registered manager had completed an Annual Quality Assurance Assessment, (AQAA), and returned it to us. This gave us comprehensive information about the home, staff and people who live there, improvements and plans for further improvements. Throughout this report the reader will find lots of examples of what the registered manager told us. From responses from people who live at the home and staff surveys, observations and discussions throughout this visit there is strong evidence that the ethos of the home is open and transparent with the views of both staff and people listened to, and valued. People, staff and visitors spoken to feel that the management team are approachable, supportive and people are able to air their views in an open manner. Staff meetings are held regularly so that people have the opportunity to voice their concerns and suggestions for improvements. The Responsible Individual visits the home and complete Regulation 26 visit reports on behalf of the registered provider, and reports on the quality of service being offered at the home. The manager and the organisation have a number of audits in place to monitor the service provided. For example, questionnaires are sent out, the manager does monthly medication checks and unannounced visits at night to make sure the staff are following good practices so that people are protected from risks and good outcomes are sought. Berwood Court Care Home DS0000024824.V372074.R01.S.doc Version 5.2 Page 29 The arrangements for the safekeeping and financial transactions of people’s personal monies are good, this prevents financial abuse. Health and safety and maintenance checks had been undertaken in the home to ensure that the equipment was in safe and full working order. Maintenance checks are completed on the fire system and equipment so that people should be safe in the event of a fire occurring. Accident records were reviewed and the manager completes an audit every month in order to monitor trends that are occurring. Also CSCI have received Regulation 37 notifications which tell us about any incidents that happen within the home. Berwood Court Care Home DS0000024824.V372074.R01.S.doc Version 5.2 Page 30 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 4 3 4 4 4 X HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 4 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 3 4 X 3 3 X 4 X 4 STAFFING Standard No Score 27 3 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 X 3 3 4 4 Berwood Court Care Home DS0000024824.V372074.R01.S.doc Version 5.2 Page 31 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 OP9 Regulation 13(2) Requirement Staff must verify by signing the MAR charts that medication once medication has been given so that peoples health and wellbeing are safeguarded. Timescale for action 25/09/08 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 OP9 Good Practice Recommendations Staff must check medication that is received into the home to ensure that it is correctly labelled with persons name, date and dosage. This is needed to evidence that people are administered the correct prescribed medications to promote their health. Staff must ensure that all new visitors to the home are verbally requested to sign in the visitor’s book. This is to safeguard people from unwanted visitors and should emergency evacuation need to take place in the event of a fire. 2 OP38 Berwood Court Care Home DS0000024824.V372074.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Berwood Court Care Home DS0000024824.V372074.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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