Care Home: Birch Abbey

What the care home does well The manager or senior staff member carry out assessments prior to anybody being admitted to the home so that the home can be sure their individual needs can be met. Each of the residents has a written plan of care and records were easy to access and follow. The care plans provide an appropriate amount of detail as to how to meet the needs of the residents. Resident`s relatives have the opportunity to contribute to the care plans in writing. As part of the feedback in the surveys completed relatives spoke about the six monthly reviews of care and how this was a good way of formalising input by relatives. Care plan documentation made reference to medical input by GP`s and on one, for example the regular care reviews with psychiatric support services were clearly recorded. Residents were observed to be appropriately dressed and to be clean so that dignity is maintained. A visitor spoken with said that residents are always appearing well groomed with good attention paid by staff to ensure standards are consistent. Overall the care of residents was summed up by an entry in the care notes form a social work review. A social work professional had written of one resident: `Looks a different person. they have lost the stressed look they used to have. Looks extremely relaxed and happy. They clearly has a good rapport with staff who sing and dance with them`. We observed the care and interaction of residents and staff and this indicated that residents are generally very well engaged with their surroundings, which have been developed with good practice principals in dementia care. For example in the day area chairs are placed so that socialisation is easier and there are orientation aids on the walls and surroundings such as information boards so that residents can feel more secure in their environment and stimulated to explore and interact. The main development from the last inspection has been the garden area at the front, which is now accessible to residents, so that the front door can be left open and provides a focus for activity. A visitor from the advocacy service was spoken with and said that it was nice to see that residents are free to move about the home without being confined to certain areas. Relatives reported that there is a relaxed feeling the day areas and that care staff are always on hand. Some commented on the survey`s returned: `I`m always well informed and staff are very friendly to all. I`m very satisfied with attention needed and staff seem to have the skills required` `The service meets my mothers needs in a sensitive and discreet way with attention to diverse needs. The service users views and needs always come first` `The care home crates a positive, safe and relaxed environment and promotes health and well-being. I`ve no doubt that the home will continue to improve`. The level of attention paid to individuals also extends to other areas of the home such as bedrooms, which were noted to be highly personalised with Birch Abbey DS0000060016.V363732.R01.S.doc Version 5.2 Page 7residents` personal belongings and mementoes. There are `memory boxes` outside each room which also help with reinforcing feelings of self identity as well as assisting residents to identify their bedrooms. There is an understanding of how to develop the home so that the barriers to residents disability [in this case dementia and mobility needs] can be addressed positively so that residents life can be enhanced and they can have more autonomy and independence as well as feeling better about themselves. The AQAA for the service tells us that: `Staff training is encouraged and supported beyond the minimum requirements, as evidenced by the registered manager now enrolled on a Degree course in Dementia Care and one of the Senior Carers completing Dementia Care Activity training from the NAPA organisation`. Staff interviews and also training records on individual staff files supported this. Two members of the senior staff have attended Bradford University Dementia care mapping course and are now qualified. Over 55% of staff have NVQ qualifications and this supports the view that they are well equipped to carry out care for residents. Staff were observed to be warm and respectful with the residents throughout the course of the inspection. What has improved since the last inspection? CARE HOMES FOR OLDER PEOPLE Birch Abbey 55 Alexandra Road Southport Merseyside PR9 9HD Lead Inspector Mike Perry Unannounced Inspection 26th June 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Birch Abbey DS0000060016.V363732.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. Birch Abbey DS0000060016.V363732.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Birch Abbey Address 55 Alexandra Road Southport Merseyside PR9 9HD 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) 01704 532 788 01704 885 050 birchabbey@btinternet.com Melton Health Care Limited Mrs Janet Dean Care Home 18 Category(ies) of Dementia (18) registration, with number of places Birch Abbey DS0000060016.V363732.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia - Code DE The maximum number of service users who can be accommodated is: 18 Date of last inspection 17th July 2007 Brief Description of the Service: Birch Abbey is registered to care for up to 18 people under the category of dementia care. The home has been in operation since 1989 but has come under new ownership since May 2004. The owners are Melton Health Care Ltd and the Responsible Person is Mr George Daniel Lingard. The Registered Manager is Janet Dean. The service now conducts an assessment on behalf of Sefton Social Services with whom a bed is contracted (reserved) for respite and assessment purposes. The building is a large detached property situated reasonable close to Southport Town Centre. The home currently has no passenger lift (has a stair lift). The home has 14 single rooms and 2 double none of which have en-suite facilities. The day area is on the ground floor and includes a conservatory extension that overlooks the garden at the rear of the building. There is a small patio/garden area to the side of the building, which is accessible and continues on to the rear garden, which has been landscaped. The current fees for the service are £479 weekly. Birch Abbey DS0000060016.V363732.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 2 stars. This means the people who use this service experience good quality outcomes. The inspection was a ‘key’ inspection for the service and covered the core Standards the home is expected to achieve. The inspection took place over a period of one day [6 hours]. We met with the majority of residents and spoke with a number of residents and a visitor to the home at the time. We also spoke with members of care staff on a one to one basis and the registered manager. Prior to the inspection the manager returned an information document about the home called an Annual Quality Assurance Assessment [AQAA]. This is completed every year and gives us a lot of information about the home and the progress that has been made since the last inspection. Resident surveys were also given out and 10 of these were returned. They were mainly filled in by relatives or by staff assisting residents as necessary due the level of communication of some residents. Comments are used in the report. A tour of the premises was carried out and this covered all areas of the home including the resident’s rooms [not all bedrooms were seen]. Records were examined and these included three of the resident’s care plans, staff files, staff training records and health and safety records. What the service does well: The manager or senior staff member carry out assessments prior to anybody being admitted to the home so that the home can be sure their individual needs can be met. Each of the residents has a written plan of care and records were easy to access and follow. The care plans provide an appropriate amount of detail as to Birch Abbey DS0000060016.V363732.R01.S.doc Version 5.2 Page 6 how to meet the needs of the residents. Resident’s relatives have the opportunity to contribute to the care plans in writing. As part of the feedback in the surveys completed relatives spoke about the six monthly reviews of care and how this was a good way of formalising input by relatives. Care plan documentation made reference to medical input by GP’s and on one, for example the regular care reviews with psychiatric support services were clearly recorded. Residents were observed to be appropriately dressed and to be clean so that dignity is maintained. A visitor spoken with said that residents are always appearing well groomed with good attention paid by staff to ensure standards are consistent. Overall the care of residents was summed up by an entry in the care notes form a social work review. A social work professional had written of one resident: ‘Looks a different person. they have lost the stressed look they used to have. Looks extremely relaxed and happy. They clearly has a good rapport with staff who sing and dance with them’. We observed the care and interaction of residents and staff and this indicated that residents are generally very well engaged with their surroundings, which have been developed with good practice principals in dementia care. For example in the day area chairs are placed so that socialisation is easier and there are orientation aids on the walls and surroundings such as information boards so that residents can feel more secure in their environment and stimulated to explore and interact. The main development from the last inspection has been the garden area at the front, which is now accessible to residents, so that the front door can be left open and provides a focus for activity. A visitor from the advocacy service was spoken with and said that it was nice to see that residents are free to move about the home without being confined to certain areas. Relatives reported that there is a relaxed feeling the day areas and that care staff are always on hand. Some commented on the survey’s returned: ‘I’m always well informed and staff are very friendly to all. I’m very satisfied with attention needed and staff seem to have the skills required’ ‘The service meets my mothers needs in a sensitive and discreet way with attention to diverse needs. The service users views and needs always come first’ ‘The care home crates a positive, safe and relaxed environment and promotes health and well-being. I’ve no doubt that the home will continue to improve’. The level of attention paid to individuals also extends to other areas of the home such as bedrooms, which were noted to be highly personalised with Birch Abbey DS0000060016.V363732.R01.S.doc Version 5.2 Page 7 residents’ personal belongings and mementoes. There are ‘memory boxes’ outside each room which also help with reinforcing feelings of self identity as well as assisting residents to identify their bedrooms. There is an understanding of how to develop the home so that the barriers to residents disability [in this case dementia and mobility needs] can be addressed positively so that residents life can be enhanced and they can have more autonomy and independence as well as feeling better about themselves. The AQAA for the service tells us that: ‘Staff training is encouraged and supported beyond the minimum requirements, as evidenced by the registered manager now enrolled on a Degree course in Dementia Care and one of the Senior Carers completing Dementia Care Activity training from the NAPA organisation’. Staff interviews and also training records on individual staff files supported this. Two members of the senior staff have attended Bradford University Dementia care mapping course and are now qualified. Over 55 of staff have NVQ qualifications and this supports the view that they are well equipped to carry out care for residents. Staff were observed to be warm and respectful with the residents throughout the course of the inspection. What has improved since the last inspection? The home has made excellent progress since the last inspection in meeting all of the statutory requirements that had been made at the time. This means that: • Medication administration records have been improved and there is now clear and accurate recording. There remain some good practise recommendations but overall the medicines are recorded and administered safely. Fire safety records are maintained. The fire officer has visited and has made some recommendations to upgrade the fire safety practises and is working with the home towards the new build programme which will start later in the year. The garden at the front of the building has been developed in line with good practice guidelines for people with dementia and is now both accessible and safe for residents to enjoy. DS0000060016.V363732.R01.S.doc Version 5.2 Page 8 • • Birch Abbey • • The meals in the home have been improved in that there is now more choice available on a daily basis. The general staffing has benefited from better ancillary cover at weekends and during the evening. The home overall has made good progress in developing all of the systems in the home from the care-planning through to the environment and development of staff skills. The owner and management have been careful to follow all good practice guidance in dementia care and have also been innovative in their own right in developing the home with the needs of the people who use the service. The plans for the ‘new build’ home, on the same site have been communicated to both staff and residents / relatives and the feeling about the future is very positive. 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. Birch Abbey DS0000060016.V363732.R01.S.doc Version 5.2 Page 9 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 Birch Abbey DS0000060016.V363732.R01.S.doc Version 5.2 Page 10 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): Standard 3 [standard 6 not applicable] Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are assessed and admitted to the home appropriately so that their care needs can be met by the staff. EVIDENCE: The manager prior to residents being admitted to the home carries out assessments. Also on the care files seen were referral assessments by both health care professionals and by social workers. The staff are aware of the residents needs and can make effective plans to care for them once admitted. The assessments are detailed and include input from relatives. Relatives confirmed, from the surveys returned, that they are involved in six monthly reviews, which the home carries out. Birch Abbey DS0000060016.V363732.R01.S.doc Version 5.2 Page 11 Birch Abbey DS0000060016.V363732.R01.S.doc Version 5.2 Page 12 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): All key standards. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents in the home receive good support in maintaining their health and personal care so that these needs are consistently met. EVIDENCE: Each of the residents has a care plan. The care planning documentation has been introduced over the past two years and staff are now familiar with the records which were easy to access and follow. The care plans provide an appropriate amount of detail as to how to meet the needs of the residents. Resident’s relatives have the opportunity to contribute to the care plans in writing. The care plans have a section that is for the residents to sign their agreement to their care plan. As part of the feedback in the surveys completed, relatives spoke about the 6 monthly reviews of care and how this was a good way of formalising input by relatives. Birch Abbey DS0000060016.V363732.R01.S.doc Version 5.2 Page 13 Care plan documentation made reference to medical input by GP’s and on one, for example the regular care reviews with psychiatric support services were clearly recorded. Residents weight, mobility, medications and diet are regularly reviewed. The manager reported good communication and working relationships with health professionals. Medication administration practice was reviewed. The home has made improvements to the overall practice since the last inspection and the manager now carries out regular auditing to ensure that standards are maintained. Administration records were clear and easy to follow and the good practise guidance around, for example, giving PRN [give when necessary medication] was being followed and was being reviewed through the care plan. Some of the records had handwritten entries for medication received into the home and one member of staff signed these. It is recommended that these entries are checked and signed by two staff so that risk of errors in the copying of the prescription is reduced. All staff have who administer medications have received training so that they have the base knowledge and skill to administer medicines. The manager stated that she then observes staff in-house as a practical assessment. It would be recommended that the manager signs this of as a final ‘competency assessment’ and keeps a record on the individual staff file. Residents were observed to be appropriately dressed and to be clean so that dignity is maintained. Records kept by staff indicate that there is very good attention paid to residents’ personal care. A visitor spoken with said that residents are always appearing well groomed with good attention paid by staff to ensure standards are consistent. Staff interviewed had a clear understanding of the principals of care and how these should be applied and this was reflected in the written care documentation. Over all the care of resident was summed by an entry in the care notes form a social work review. A social work professional had written of one resident: ‘Looks a different person. They have lost the stressed look they used to have. Looks extremely relaxed and happy. They clearly has a good rapport with staff who sing and dance with them’. Birch Abbey DS0000060016.V363732.R01.S.doc Version 5.2 Page 14 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): All key standards Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home environment and staff skills have been developed so that residents are free to move around the home and are also engaged in activity that ensures a good quality of life. EVIDENCE: The AQAA returned by Birch Abbey states: ‘Staff have been given training with activities for those with dementia and Birch Abbey regular keeps up to date with activity ideas through membership of NAPA and attendance by various team members at key industry conferences and seminars. Staff are provided with resources and equipment to provide a wide range of activity from nail care, hair care and other indoor items to outdoor ones such as walks in and outside the grounds (local café, pub and parks) and assisting with ‘life at Birch Abbey’ such as ‘working’ with the gardening team’. Birch Abbey DS0000060016.V363732.R01.S.doc Version 5.2 Page 15 We observed the care and interaction of residents and staff and this indicated that residents are generally very well engaged with their surroundings, which have been developed with good practice principals in dementia care. For example in the day area chairs are placed so that socialisation is easier and there are orientation aids on the walls and surroundings such as information boards so that residents can feel more secure in their environment and stimulated to explore and interact. The main development from the last inspection has been the garden area at the front, which is now accessible to residents and provides a focus for activity. The front door to the home is now left open and residents are free to walk in and out at leisure and enjoy this facility, which includes a patio area and chicken run. One of the residents enjoys maintaining a small greenhouse. A visitor from the advocacy service was spoken with and said that it was nice to see that residents are free to move about the home without being confined to certain areas. Staff monitor residents were about but are able to maintain privacy for residents and enable them to mobilise and wander more freely due to the more ‘high risk’ residents being monitored on the ‘my amego’ system which is an assistive technology that can monitor risk behaviours and alert staff at key times. For example one resident could have a ‘lie in’ bed until mid morning despite being a high risk of falling due to the fact that the system alerted staff when this person was getting out of bed so that staff could then be present. The incidence of falls for this person had been reduced to nil since admission. There is a strong staff presence and staff interactions were noted to be supportive of resident’s feelings of well being. Staff were skilled at interacting appropriately and assisting residents with activities at their own pace. Both care records and surveys evidenced that residents are engaged in various activities and these include both in house daily activity as well as outings with family. Relatives reported that there is a relaxed feeling the day areas and that care staff are always on hand. Some commented on the survey’s returned: ‘I’m always well informed and staff are very friendly to all. I’m very satisfied with attention needed and staff seem to have the skills required’ ‘The service meets my mothers needs in a sensitive and discreet way with attention to diverse needs. The service users views and needs always come first’ ‘The care home creates a positive, safe and relaxed environment and promotes health and well-being. I’ve no doubt that the home will continue to improve’. Birch Abbey DS0000060016.V363732.R01.S.doc Version 5.2 Page 16 The level of attention paid to individuals also extends to other areas of the home such as bedrooms, which were observed to be highly personalised with residents’ personal belongings and mementoes. Each bedroom has a ‘memory box’ outside containing photos and personal items from residents past, which aid in resident identifying their room and also their personal identity. The standard of food at the home is generally good. The main meal of the day is served at lunchtime and the cook prepares fresh home cooked food. The meal was nicely presented and appeared appetising. Since the last inspection the menus have been developed to ensure more choice and the staff canvas residents daily for their preferences. Again surveys returned were positive that the food presented to residents was good. Birch Abbey DS0000060016.V363732.R01.S.doc Version 5.2 Page 17 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): All key standards. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good complaints process and the home has responded appropriately to concerns raised so that residents are protected. EVIDENCE: The complaints procedure is clearly displayed and is available in all of the homes literature. The AQAA told us that there has been one complaint since the last inspection. This was about the variety of the meals and this has been addressed by the home and the complainant responded to appropriately. The survey returns gave evidence that relatives and residents are aware of who make a complaint to. Staff have received training around safeguarding issues such as how to identify and report abuse and the staff spoken with were comfortable with the procedures surrounding this. A visitor from an advocacy association was spoken with and had a positive view of the home and felt that issues around protection such as management of resident’s monies were clearly identified and managed appropriately. The home has positive relationships with the advocacy service. Birch Abbey DS0000060016.V363732.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home has been developed along good practice principals which aim to meet the individual care needs of people with dementia and therefore provides a comfortable and stimulating environment. EVIDENCE: The AQAA tells us: ‘We have installed a custom built deck at the front of the building to provide not only ramp access to the building but also a level deck direct from the front door. By installing a new security system and fencing to the front garden we have been able to get rid of the lock on the front door (during the day), allowing people to come and go from the building and the garden, whilst still maintaining ultimate security of the site. Birch Abbey DS0000060016.V363732.R01.S.doc Version 5.2 Page 19 We have installed a ‘Living’ Sensory Garden at the front including our own chicken hut with three lovely chickens, a putting green, a washing line and garden furniture. We have installed our own cinema system with curtains to our conservatory to add to the sense of ‘going to the pictures’. We have installed a new stair lift. We have re carpeted the building 3 times during the last 12 months. We have purchased new chairs, recliners and couches to create different areas within the lounge and the conservatory’. All of the above was evidenced on the inspection visit from observations made and evidences a very good commitment by the home to creating a positive environment for people with dementia. There is an understanding of how to develop the home so that the barriers to residents disability [in this case dementia and mobility needs] can be addressed positively so that residents life can be enhanced and they can have more autonomy and independence as well as feeling better about themselves. We observed a high level of orientation aids, form signage for toilets etc through to use of orientation boards and newspapers. The comments from relatives and visitors elsewhere in the report substantiate this approach. Overall the home was found to be bright and homely with a high degree of personalisation in all areas from resident’s pictures and artwork displayed in day areas to personalised bedrooms. All areas were clean and well maintained. The building is old and not purpose built but the ‘excellent’ rating has been given due to the fact that the existing home has been developed positively; and the good practice principals applied have provided a sound basis for the future purpose built home on the same sight which is planned over the next year. Birch Abbey DS0000060016.V363732.R01.S.doc Version 5.2 Page 20 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): All key standards. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are recruited and trained appropriately so that resident needs can be met. EVIDENCE: At the time of the inspection there were 18 residents at the home and they were being supported by 4 carers (1 of whom was a senior carer). There was also a cook, a domestic and the registered manager on duty. There is no laundry person employed. These numbers are depleted in the afternoon when the cook goes off duty [2pm] and again at 5pm when care staff reduces to 3 as the manager leaves at this time. Care staff duties therefore include some kitchen work and laundry work which, by definition, takes time from care work with residents although this has been addressed to some degree by the increase in weekend domestic cover as well as a kitchen assistant employed in the evening to help in the kitchen. The AQAA tells us that: ‘Staff training is encouraged and supported beyond the minimum requirements, as evidenced by the registered manager now enrolled on a Degree course in Dementia Care and one of the Senior Carers completing Dementia Care Activity training from the NAPA organisation’. Birch Abbey DS0000060016.V363732.R01.S.doc Version 5.2 Page 21 Staff interviews and also training records on individual staff files supported this. Over 55 of staff have NVQ qualifications and this supports the view that they are well equipped to carry out care for residents. Staff spoken to have also completed training around dementia care and this is ongoing. The residents and their relatives gave good feedback about all staff and the manager. Previous comments under health and social care headings in this report also evidence this view. Staff were observed to be warm and respectful with the residents throughout the course of the inspection. Staff were present in the lounge throughout the inspection and were readily available to meet the needs of the residents. Staff files were checked for two new members of staff in order to assess the staff recruitment and selection procedures at the home. The files showed that pre employment checks are being carried out and staff records had the required police and written reference in place so that residents are protected by the home employing suitable staff. Birch Abbey DS0000060016.V363732.R01.S.doc Version 5.2 Page 22 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): Key standards Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are management systems in place so that the home can continue to be developed along good practice guidelines and therefore run in the best interests of the residents. EVIDENCE: Janet Dean is the manager of the home. Janet has completed an NVQ in management [at level 4] and is currently undertaking a course in dementia care at degree level. She was described in very positive terms by both staff and relatives who find her approachable. she was observed to have very good interactive skills with residents and is able to gain their trust. Birch Abbey DS0000060016.V363732.R01.S.doc Version 5.2 Page 23 There are processess in place to monitor and improve on the quality of the service. The home has a quality assurance check which is carried out annually and which accessess residents and relatives views of the service. The results of this are available in the home and show an overall high satisfaction with the care in the home. Part of this process is for the provider [owner] to complete monthly monitoring visits and produce a report which is made available to the manager in terms of feedback about the quality of the service. These were seen and evidence the ongoing support and involvement of the owner. The home does not manage any money for residents. Resident’s relatives are invoiced for any additional costs for activities, hairdressers, chiropody etc. This arrangement is made clear to residents and relatives and is provided in the residents guide to the home. Where a resident does not have a relative or representative to support them with their finances then care managers and advocates are used for this purpose. During the inspection there was a representative of the advocacy service in the home visiting a resident. A policy is available. Health and safety policies, procedures and practices are in place to safeguard the well being of residents, staff and visitors and some of these where reviewed. Following requirments and recommendations made on the last report the records seen were up to date [including fire saftey records]. It would still be a good practice recommendation to have a staff member attend training to act as ‘fire marshall’ for the home and the manager statted that this would be addressed. From the improvments listed in the report it is obvious that the home continues to develeop the serivce by both listening to residents and their representatives and resourcing the right information so that the home can be run in the best interests of the residents. Birch Abbey DS0000060016.V363732.R01.S.doc Version 5.2 Page 24 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 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 X X 3 Birch Abbey DS0000060016.V363732.R01.S.doc Version 5.2 Page 25 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. 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. 1 Refer to Standard OP9 Good Practice Recommendations It is recommended that handwritten medications on the MAR charts are checked and signed by two staff so that risk of errors in the copying of the prescription is reduced. It would be recommended that the manager signs off a final ‘competency assessment’ for staff administering medications and keeps a record on the individual staff file. 2 OP38 A staff trained to act as ‘fire marshal’ would be recommended. Birch Abbey DS0000060016.V363732.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Waterloo, Liverpool L22 OLG 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 Birch Abbey DS0000060016.V363732.R01.S.doc Version 5.2 Page 27 - 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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