Care Home: Birch Green Care Centre

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What the care home does well The needs of people had been assessed before they were offered a placement at the home, to ensure that the staff team were able to provide the care and support required by each individual. Information about the needs of people had been gathered from a range of sources, so that the home could develop a clear picture of everyone admitted to Birch Green Care Centre and therefore provide care and support as appropriate. Some plans of care had been generated from the information gathered before people were admitted to the home. They were well written, person centered documents, providing staff with clear guidance about the needs of people and how these needs were to be best met. The health care needs of people living at the home were being consistently met by the involvement of a wide range of external professionals and the provision of specialised equipment, in accordance with people`s assessed needs. Medications were managed well to ensure that the possibility of any errors or drug misuse was minimised. A wide range of assessments were in place to ensure that any potential risks were identified and strategies implemented within a risk management framework. The privacy and dignity of people living at the home was very well promoted to ensure that they were constantly respected and protected from embarrassing situations, particularly during the provision of personal care. One person living at the home told us, "I am very happy here. I am well looked after. I wouldn`t want to be anywhere else`. This individual introduced us to her key worker who was going to assist her with a shower. The key worker said, "We get loads of training. I am very happy working at the home". These are some of the things people living at the home told us during our visit, "The staff are great. They look after us. I feel that they do everything I need them to do"; "The staff get me up in a morning about 07:40 am, which is about when I would like to get up. They help me to get washed and dressed and then take me for breakfast". People living at the home were provided with a range of activities, which on the day of our visit they appeared to be enjoying and detailed social care assessments had been conducted for everyone living at the home, so that staff had a clear picture of each individual`s history, what they were interested in and what they liked to do. Information was widely available within the home about the local advocacy services, so that if anyone wished to have an independent person to act on their behalf they could easily access relevant details. The arrangements for visiting the home were good and relatives or friends were made to feel welcome to Birch Green Care Centre. They were able to visit people within the privacy of their relative`s bedroom or within the communal areas of the home, dependent on the resident`s preferences. The management of meals was good. People living at the home were provided with a choice of well balanced, nutritious meals and special diets were catered for, as was required to ensure that people`s dietary needs were being met. Systems were in place to enable complaints to be handled appropriately and the policies, procedures and practices of the home protected people living there from abusive situations. The environment was warm, clean and tidy, with friendly staff going about their daily duties. The home was tastefully decorated and well maintained with good quality furnishings, providing people with a very comfortable and homely place in which to live. At the time of our visit we found that the needs of people were being met by the number and skill mix of people on duty. There was a wide range of regular training provided for those working at the home, so that they were able to do the job expected of them and so that they were kept up to date with new ways of working. A high percentage of care staff had achieved a recognised qualification in care, to aid in their personal development and so that they were competent to deliver the care and support needed by the people living at Birch Green Care Centre. The home was being managed in the best interests of the people living there and their health, welfare and safety was promoted by the policies, procedures and practices adopted by Birch Green. The quality of service provided was being monitored very well, so that any areas of good practice were recognised and built upon and any areas in need of improvement were identified and promptly addressed. When asked what the service does well two people living at the home simply wrote on their comment cards, `Everything`. When asked what the home does well comments from staff included, `Residents are given a choice and receive good care. We are given equipment and supplies whenever we need them to assist our residents. We provide a good, relaxed atmosphere`; `I have worked here a long time and I have seen a lot of changes. The home at present is the best it has ever been`; `Staff training is good. The overall cleanliness of the home is good. Refurbishment and maintenance of the home is of a good standard`; When asked what the home does well, those who returned comment cards and who lived at the home wrote, `It is very clean and tidy. Going on trips are a nice break away from the home. There is plenty of entertainment. The staff are very considerate`; `Cleanliness and attention to detail. Support and accessibility to talk to staff and if there is a problem they act straight away. Any medical issues are dealt with immediately`; `I think everything is done well. I like it here as it is, as no-one is pushing me`. What has improved since the last inspection? It was pleasing to see that the two requirements and five recommendations made at the last inspection had been appropriately addressed. The management of medications had improved since the last key inspection, which was supported by a random inspection from our pharmacy inspector. Medications were now being managed well to ensure that the possibility of any drug errors or misuse were minimised. The management of meals had improved since the last key inspection and on the day of our visit the menu co-incided with the lunch time meal being served, so that people received the food they had ordered. We were told that those living at the home who needed clothes protection at meal times actually preferred the plastic aprons, rather than a cloth type protector as we had suggested, in order to promote dignity at meal times. The repair work recommended to the ground floor bathroom ceiling had been completed so that the standard of environment was excellent throughout for the people living at Birch Green Care Centre. Since our last key inspection the manager of the home has been registered with the Care Quality Commission to demonstrate her fitness to manage the service on a day to day basis. What the care home could do better: One care plan examined could have been more detailed and could have incorporated all the assessed needs of the individual. Evidence could have been available to show that people living at the home or their relative had been given the opportunity to be involved in the care planning process, so that they could make some decisions about how they wished care and support to be delivered. The plans of care could have been reviewed at least every month, to ensure that current information was available to those working at the home, so that they were able to provide the care needed, in accordance with people`s wishes. It is recommended that the complaints procedure be updated to include the current details for the Care Quality Commission, so that if anyone wishes to contact the inspection unit then they are easily able to do so. All Criminal Record Bureau (CRB) disclosures could have been obtained before people started working at the home, to show that all relevant checks had been conducted before employment commenced. The reason for employing one member of staff before receipt of their CRB could have been recorded and a written record be maintained to demonstrate constant supervision for this individual until their CRB had been received. When asked what the home could do better comments from staff members included,`Employ more staff`; `I feel the staffing levels are not adequate for the people we support. Some people living at the home are very highly dependent and the staffing levels do not reflect this. Meal times and mornings are particularly busy with so many people needing assistance`; `Some areas need improved lighting`; Key inspection report Care homes for older people Name: Address: Birch Green Care Centre Birch Green Birch Green Care Centre Skelmersdale Lancashire WN8 6RS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Vivienne Morris     Date: 1 1 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Birch Green Care Centre Birch Green Birch Green Care Centre Skelmersdale Lancashire WN8 6RS 0169550916 0169551301 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Springhill Care Group Name of registered manager (if applicable) Mrs Catherine Shawarby Type of registration: Number of places registered: care home 74 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 74 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 No. 36). Dementia - Code DE (Maximum No. 38). Physical disability - Code PD (Maximum No. 6). Date of last inspection Brief description of the care home Birch Green Care Centre is a purpose built establishment, providing both nursing and personal care for up to 74 elderly people, including those who have care needs Care Homes for Older People Page 4 of 33 Over 65 0 36 0 38 0 6 Brief description of the care home associated with a dementia related illness. The home is set in pleasant, well maintained grounds. A patio area with garden furniture is available for those wishing to spend some time outdoors. Private accommodation is located on two levels, the first floor being accessible by a passenger lift or stairs. All bedrooms provide single accommodation. A number of pleasant lounges, quiet rooms and dining areas are available throughout the home, where a variety of activities may take place. At the time of this key inspection the fees ranged from £396.50 to £602.00 per week. The fees for the provision of continuing care were arranged on an individual basis. Additional charges were being incurred for hairdressing, toiletries, private chiropody, magazines and newspapers. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection of Birch Green Care Centre took place on 22nd July 2009. The quality rating for this service is two star. This means that people who use this service experience good quality outcomes. The site visit to Birch Green formed part of the inspection process and was conducted over one day in May 2010. It was unannounced, which means that the managers, staff and people living at the home did not know it was going to take place. During the course of the site visit, discussions took place with those living at the home, staff and managers. Relevant records and documents were examined and a tour of the premises took place, when a random selection of private accommodation and all communal areas were seen. We received comment cards back from three people who worked at the home and ten people living at Birch Green. Some comments made by the people involved in our Care Homes for Older People Page 6 of 33 survey are incorporated in to this report. Every year the provider completes a self assessment, known as an AQAA, which gives information to the Commission about how the service is meeting outcomes for the people living at the home and how the quality of service provided is monitored. It also gives us some numerical information about the service. Some of this information from the AQAA is incorporated in this report. We observed the activity within the home and tracked the care of three people during the site visit, not to the exclusion of other people living at Birch Green. The total key inspection process focused on the outcomes for people living at the home and involved gathering information about the service over a period of time from a variety of sources. The Care Quality Commission had not received any complaints about this service since the last inspection. Care Homes for Older People Page 7 of 33 What the care home does well: The needs of people had been assessed before they were offered a placement at the home, to ensure that the staff team were able to provide the care and support required by each individual. Information about the needs of people had been gathered from a range of sources, so that the home could develop a clear picture of everyone admitted to Birch Green Care Centre and therefore provide care and support as appropriate. Some plans of care had been generated from the information gathered before people were admitted to the home. They were well written, person centered documents, providing staff with clear guidance about the needs of people and how these needs were to be best met. The health care needs of people living at the home were being consistently met by the involvement of a wide range of external professionals and the provision of specialised equipment, in accordance with peoples assessed needs. Medications were managed well to ensure that the possibility of any errors or drug misuse was minimised. A wide range of assessments were in place to ensure that any potential risks were identified and strategies implemented within a risk management framework. The privacy and dignity of people living at the home was very well promoted to ensure that they were constantly respected and protected from embarrassing situations, particularly during the provision of personal care. One person living at the home told us, I am very happy here. I am well looked after. I wouldnt want to be anywhere else. This individual introduced us to her key worker who was going to assist her with a shower. The key worker said, We get loads of training. I am very happy working at the home. These are some of the things people living at the home told us during our visit, The staff are great. They look after us. I feel that they do everything I need them to do; The staff get me up in a morning about 07:40 am, which is about when I would like to get up. They help me to get washed and dressed and then take me for breakfast. People living at the home were provided with a range of activities, which on the day of our visit they appeared to be enjoying and detailed social care assessments had been conducted for everyone living at the home, so that staff had a clear picture of each individuals history, what they were interested in and what they liked to do. Information was widely available within the home about the local advocacy services, so that if anyone wished to have an independent person to act on their behalf they could easily access relevant details. The arrangements for visiting the home were good and relatives or friends were made to feel welcome to Birch Green Care Centre. They were able to visit people within the privacy of their relatives bedroom or within the communal areas of the home, dependent on the residents preferences. Care Homes for Older People Page 8 of 33 The management of meals was good. People living at the home were provided with a choice of well balanced, nutritious meals and special diets were catered for, as was required to ensure that peoples dietary needs were being met. Systems were in place to enable complaints to be handled appropriately and the policies, procedures and practices of the home protected people living there from abusive situations. The environment was warm, clean and tidy, with friendly staff going about their daily duties. The home was tastefully decorated and well maintained with good quality furnishings, providing people with a very comfortable and homely place in which to live. At the time of our visit we found that the needs of people were being met by the number and skill mix of people on duty. There was a wide range of regular training provided for those working at the home, so that they were able to do the job expected of them and so that they were kept up to date with new ways of working. A high percentage of care staff had achieved a recognised qualification in care, to aid in their personal development and so that they were competent to deliver the care and support needed by the people living at Birch Green Care Centre. The home was being managed in the best interests of the people living there and their health, welfare and safety was promoted by the policies, procedures and practices adopted by Birch Green. The quality of service provided was being monitored very well, so that any areas of good practice were recognised and built upon and any areas in need of improvement were identified and promptly addressed. When asked what the service does well two people living at the home simply wrote on their comment cards, Everything. When asked what the home does well comments from staff included, Residents are given a choice and receive good care. We are given equipment and supplies whenever we need them to assist our residents. We provide a good, relaxed atmosphere; I have worked here a long time and I have seen a lot of changes. The home at present is the best it has ever been; Staff training is good. The overall cleanliness of the home is good. Refurbishment and maintenance of the home is of a good standard; When asked what the home does well, those who returned comment cards and who lived at the home wrote, It is very clean and tidy. Going on trips are a nice break away from the home. There is plenty of entertainment. The staff are very considerate; Cleanliness and attention to detail. Support and accessibility to talk to staff and if there is a problem they act straight away. Any medical issues are dealt with Care Homes for Older People Page 9 of 33 immediately; I think everything is done well. I like it here as it is, as no-one is pushing me. What has improved since the last inspection? What they could do better: One care plan examined could have been more detailed and could have incorporated all the assessed needs of the individual. Evidence could have been available to show that people living at the home or their relative had been given the opportunity to be involved in the care planning process, so that they could make some decisions about how they wished care and support to be delivered. The plans of care could have been reviewed at least every month, to ensure that current information was available to those working at the home, so that they were able to provide the care needed, in accordance with peoples wishes. It is recommended that the complaints procedure be updated to include the current details for the Care Quality Commission, so that if anyone wishes to contact the inspection unit then they are easily able to do so. All Criminal Record Bureau (CRB) disclosures could have been obtained before people started working at the home, to show that all relevant checks had been conducted before employment commenced. The reason for employing one member of staff before receipt of their CRB could have been recorded and a written record be maintained to demonstrate constant supervision for this individual until their CRB had been received. When asked what the home could do better comments from staff members included, Care Homes for Older People Page 10 of 33 Employ more staff; I feel the staffing levels are not adequate for the people we support. Some people living at the home are very highly dependent and the staffing levels do not reflect this. Meal times and mornings are particularly busy with so many people needing assistance; Some areas need improved lighting; If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 11 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 12 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Birch Green Care Centre has a good system in place to assess the needs of people before they are admitted to the home, so that the staff team are confident that they can deliver the care and support required. Evidence: Good information was available for people thinking about moving in to Birch Green, so that they were well informed about what life was like at the home. The statement of purpose, service users guide and welcome pack together provided details about the facilities and services available at Birch Green Care Centre. We tracked the care of three people living at the home and found that sufficient information had been gathered about the needs of these people before they moved in, to ensure that the staff team could provide the care and support required by each individual. Care Homes for Older People Page 13 of 33 Evidence: When asked how the home had improved within the last twelve months the registered manager wrote on the homes self assessment, Our Statement of Purpose and Service User Guide have been updated as part of our personalisation project. We have also introduced our much more user friendly Welcome Pack for new residents. Care Homes for Older People Page 14 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The privacy and dignity of people living at the home is well respected and they are fully supported to meet their health and personal care needs. Evidence: Two of the three plans of care seen had been generated from the information gathered about peoples assessed needs before they were admitted to Birch Green. They were well written, person centered documents, providing staff with clear guidance about how the needs of people were to be best met. The third care plan examined was less detailed and could have included all the assessed needs of this individual, to ensure that staff were fully aware of how to provide the care and support they required. There was little evidence available to show that the plans of care had been developed with the involvement of the service user or their relative, so that they were able to make some decisions about how their care was to be delivered. The plans of care had not been reviewed every month to ensure that information provided was current and Care Homes for Older People Page 15 of 33 Evidence: up to date. People who sent us comment cards said that, in general, they received the care and support they needed, including medical care. One person wrote, The new review process was good because my niece was involved and it was about what I wanted. One relative wrote on the comment card, Mum, Dad and I are very pleased with the care and support Dad is receiving. Birch Green is a smashing home and we all feel listened to. The care records as a whole showed that a variety of external professionals were involved with the care of people living at Birch Green to ensure that their health care needs were being met. A wide range of assessments had been conducted, so that any potential health or personal care risk was identified and strategies implemented in order to minimise the element of risk. We noted that a range of specialised equipment was provided for individual people in accordance with their assessed needs in order to promote their safety, comfort and well being. We found that medications were being managed well to reduce the possibility of errors or drug misuse. The Medication Administration Records were maintained appropriately and medicines were being stored safely. Care staff had received relevant training and had undergone competence assessments before they were able to administer medications to ensure that the safety of people was maintained. When asked how the service has improved within the last twelve months the manager told us, We have revised the medication policies and procedures. The General Manager has worked closely with GPs, Medications Co-ordinators and the PCT Pharmacist and local pharmacy to improve communication, routines and procedures in relation to medications. This has included visiting each practice as well as attending the Medication Coordinators training to outline how important getting the prescriptions right is for people resident in a Care Home. The Service Users Guide outlined the importance of privacy, dignity, independence and choice for people living at Birch Green, to ensure they were able to decided how they wanted care to be delivered and how they wished to be treated. Induction records showed that staff were instructed about respecting people who lived at Birch Green and this was confirmed by staff we spoke to. The plans of care showed that privacy and dignity was an important aspect of the care provided at Birch Green and Care Homes for Older People Page 16 of 33 Evidence: relevant policies and procedures were in place to support this information. We saw staff regularly throughout the day speaking to people with great respect, making sure that their privacy and dignity was consistently promoted, which was pleasing to see. We spoke at length with one relative who told us that she was very happy with the care and support her husband received at the home, she said, The staff are very kind and caring. We received comment cards from three people working at the home. One of these people told us that they are always given up to date information about the needs of people living at the home and two people said that they are sometimes given this information. Care Homes for Older People Page 17 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home experience a lifestyle that satisfies their social and recreational interests and needs. People are encouraged to keep in regular contact with family and friends in order to maintain close links with loved ones. Evidence: There were two activity co-ordinators employed a Birch Green, who were responsible for ensuring appropriate social activities were provided for the people living at the home. It was pleasing to see that activity meetings were held each month with an action plan agreed for future events, in accordance with peoples preferences, which was considered to be good practice. Very detailed social care assessments had been conducted, which provided a clear picture of peoples lives, including what they liked to do. A comprehensive activity log was then developed, which showed individual participation in social activity, which was commendable. At the time of our visit we observed a quiz taking place in the morning, followed by an Care Homes for Older People Page 18 of 33 Evidence: afternoon of Beatle mania with tea dance, which people living at Birch Green were thoroughly enjoying. Records showed that there was a fun packed programme of activities available for those living at Birch Green and people spoken to told us that there was always something going on. Although no-one living at the home at the time of our visit was using an advocate to act on their behalf, we were told that the advocacy service had been previously utilised and we noted that there was plenty information telling them how to access an advocate, if they so wished. The arrangements for people visiting the home were explained in the Service Users Guide, showing that visitors were made welcome to Birch Green and that they were able to visit their relative or friend within the privacy of their own bedroom or in the communal areas of the home, in accordance with the service users preferences. We spoke to two visitors, who both told us that they are made to feel welcome to Birch Green Care Centre and that they were regularly offered lunch with their relatives living at the home, which promoted the involvement of family and friends in the activity of daily life at Birch Green. Ten people who lived at the home sent us comment cards, who told us that in general, the home arranges activities that they can take part in if they wish. Their views about the quality of meals varied, but in general people usually liked the food served. When asked what the home does well comments from people living at Birch Green included, Events and parties where family are involved are good fun, like the fun day last summer. Angela the nurse in charge looks after me well and she really cares; The home does everything well. It allows me to maintain my independence by supporting me to go to the bank and do other activities. The home has helped me with my confidence and I now go to visit my family without support to attend family events. This is important to me; The staff are very good, I cannot fault them. We can go out and do our own shopping with Karen. When asked if there was anything the home could do better one person wrote on the comment card, I go out once a week, usually with Karen, but I would like to go out more. Care Homes for Older People Page 19 of 33 Evidence: The homes self assessment gave us some very detailed information about what people enjoy doing whilst living at the home and how families can become involved with the daily activity of Birch Green Care Centre. The record of meals served showed that people were offered a choice of meals in accordance with menu of the day, which was clearly displayed in the dining room at lunch time, so that those living at the home were aware of the options available. It was evident that people could have an alternative to the menu, if they so wished. People spoken to at the time of our visit all said that they enjoyed the food served. We sampled a choice from the menu, which was well presented, fresh and tasty. People spoken to told us that they always enjoyed the food served. We spoke with two visitors who both told us that they were able to dine with their relatives when they were at the home at meal times, which was considered to be good practice. The dining room was tastefully furnished and decorated with nicely presented dining tables, creating a pleasant atmosphere in which to eat. It was pleasing to see that people were able to help themselves to condiments and hot beverages during lunch. Cold beverages were also available, if preferred. We observed staff offering a range of choices throughout the meal and saw people being assisted with their food, as was needed, in a discreet manner. Care Homes for Older People Page 20 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints were well managed and people living at the home were safeguarded. Evidence: A detailed complaints procedure was in place at the home, which was prominently displayed and was included in the Service Users Guide, so that people were made aware of how to make a complaint, should they wish to do so. However, the complaints procedure needed to be updated to show the current contact details of the Care Quality Commission. A system was in place so that any complaints received could be recorded and this showed that the procedure was followed through in day to day practice. People living at the home and relatives spoken to told us that they would know how to make a complaint should the need arise. One relative said, Thank goodness my wife is in here and another commented, I have no complaints about the home. It is marvelous. One person living at the home told us, I have never needed to make a proper complaint, but whenever I mention any minor thing, it is dealt with straight away. Detailed policies and procedures were in place in relation to the protection of vulnerable adults, including whistle blowing, so that staff were aware of their responsibilities in reporting any signs of abuse. Care Homes for Older People Page 21 of 33 Evidence: Staff spoken to told us that they had received relevant training about the protection of people living at the home and that they would know what to do should they have concerns about the safety of people in their care. The training matrix showed that staff had been provided with safeguard training and certificates on staff files supported this information. All ten people who sent us comment cards and who lived at the home told us that there was someone they could speak to informally if they were not happy and eight of these people told us that they would know how to make a formal complaint should they need to do so. When asked if the staff listened to them and acted on what they said, responses varied, although half said that they always did. All three staff members who sent us comment cards told us that they would know what to do if someone has concerns about the home. When asked what the service does well an extract from what the registered manager wrote on the homes self assessment was, At Birch Green we view complaints as positive, responding to complaints promptly and with sensitivity to the complainant. Complaints are always investigated and feedback given to complainants, however small the issue may appear to be. Lessons learned from complaints are reviewed and practices changed to improve what we do. There are never recriminations for those who complain. Care Homes for Older People Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment within Birch Green Care Centre is excellent, providing people with safe, comfortable and homely surroundings, in which to live. Evidence: At the time of our visit to Birch Green Care Centre, the environment was found to be clean, tidy and in general pleasant smelling, providing comfortable surroundings for people to live in. The home was very well maintained, tastefully decorated and furnished to a high standard, making it a homely place for those living at Birch Green. Parts of the building had been upgraded since our last inspection, such as many of the bathrooms and toilets. A new assisted bath had been installed as well as a second hairdressing salon and many corridors had been repainted. It was pleasing to see staff working at the home eager to show us the environmental improvements, which together enhance the environment for the people living at Birch Green Care Centre. The laundry department had been significantly extended and upgraded to incorporate additional industrial laundry equipment, so that the needs of the home and the people living there were being consistently met. Detailed infection control policies and procedures were in place, clinical waste was being disposed of in the correct way and records showed that staff had received training in the control of infection, so that they were aware of measures to take in order to prevent cross infection or contamination. Care Homes for Older People Page 23 of 33 Evidence: When asked if the home was fresh and clean, the majority of people who sent us comment cards and who lived at Birch Green said it always was. When asked what the home could do better one person told us, Ive been promised a while ago that my room would be repainted and new curtains hung, but I am still waiting. I spend a lot of time in my room. I would like a bigger bedroom. The homes self assessment told us that a lot of work had been done to the environment since our last visit to this service ti improve the surroundings for those living at Birch Green Care Centre. Care Homes for Older People Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People working at the home were well trained and in sufficient numbers to meet changing needs of residents and the recruitment procedures, in general, safeguarded those living at Birch Green Care Centre. Evidence: We examined the duty rota and found that staff working at the home had a wide range of skills and qualifications in order to provide the care and support required by those living at Birch Green Care Centre. At the time of our visit we found that peoples needs were being met by the staffing levels provided. We were told that the home was working hard to achieve skills across the board. Records showed that a wide range of specific training was provided as mandatory courses, so that staff were able to meet the different needs of people living at the home. We established that audits were conducted in relation to accidents occurring in the home and that staffing levels were calculated in accordance with these audits to ensure enough staff were deployed to maintain peoples safety. One of the three staff members who sent us comment cards said that there were always enough staff to meet the individual needs of all the people who use the Care Homes for Older People Page 25 of 33 Evidence: service, but the other two felt that there were never enough staff on duty. The majority of people who sent us comment cards and who lived at the home said that, in general, staff were available when they were needed. When asked what the home could do better one person wrote on the comment card, The older night staff could be more helpful. We were told that the percentage of care staff having completed a recognised qualification in care was 86.6 , which is commendable. We examined the staff records of four people recently appointed by Birch Green care centre in order to assess the recruitment practices adopted by the home. We found that, in general, all relevant checks had been conducted before people commenced employment. However, a Criminal Record Bureau (CRB) disclosure had not been received for one person until after they had started working at the home. We were told that this individual had been constantly supervised until their CRB had been obtained. However, there were no written records available to support this information. All three staff members who sent us comment cards said that their employer carried out checks, such as a Criminal Records Bureau disclosure and references before they started working at the home and that they were provided with training that was relevant to their role. Induction records of new staff were examined, which consisted of a very comprehensive workbook, covering a variety of topics to ensure those employed by the home received sufficient information and guidance to enable them to do the job expected of them. The staff training matrix showed that people working at Birch Green were provided with a wide range of training and certificates on staff records confirmed this information. Staff spoken to told us that they received plenty training to enable them to do their jobs well. When asked about their induction period all three staff responded differently. One person said it covered everything they needed to know very well, a second said it partly did and a third felt their induction did not cover what they needed to know at all. When asked what the home could do better the registered manager told us, We have Care Homes for Older People Page 26 of 33 Evidence: not yet devised an appropriate tool for measuring staff ratios according to dependency levels. As part of our Personalisation Plan, the Springhill Care Group are looking at this with a view to developing a tool which can measure not just Activities of Daily Living, but take account of the wider needs, demands and wishes of residents and how these impact on staffing levels. When asked if there was anything else they would like to tell us one staff member wrote on the comment card, The ratio of Dementia care residents to staff is not right. Care Homes for Older People Page 27 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed in the best interest of the people living there and their health and safety is well protected by the policies, procedures and practices adopted by Birch Green Care Centre. Evidence: Surveys: stakeholders - due to be done, relatives, service users, staff. Remarks acted upon. Example: Surveys from residents showed they did not want cooked breakfast menu changed in accordance with their wishes. Meetings: management, residents (17/03/10), kitchen meeting, general staff meeting. Reg 26 visits done by Steve Newton. COSHH data sheets available. Committees: Health and safety, management. Meetings generate action plans. Internal checks of water temps and bed rails done regular. Service certificates: Duty of care contract expires 31/01/11. Gas safety cert: 12/10/2009 Fire fighting equipment: 01/06/2009 Fire alarm: 19/04/2010. PAT: March 2010. Fire safety log book in place. Fire training - Good attendance 19/11/2009 Fire drill: 15/10/2009 - Staff in attendance recorded. Accident records audited - completed satisfactorily. Care Homes for Older People Page 28 of 33 Evidence: We were told that the home was in the process of implementing a personalisation project in order to promote a person centered approach. This was outlined in the document Expression of Interest, which explored how providers could further the work in offering people living at the home more personalised support, which was considered to be good practice. The registered manager was evidently working hard to improve general standards for people living at Birch Green. Staff spoken to told us that there were a lot of changes taking place, which was enabling the home to progress, which was pleasing to hear. When asked if their manager gave staff enough support and met with them to discuss how they were working two staff members who returned comment cards said that their manager sometimes did and the third told us that they never did. However, those spoken to on the day of our visit said that they felt well supported by the management team and, in general, all staff members felt that they had the experience and knowledge to meet the different needs of people who live at the home. When asked what improvements have been made in the last twelve months the homes self assessment told us, The General Manager has been in post for 11 months and is now settled into the post and familiar with staff, residents, routines and policies and procedures. She has been formally reviewed and passed her Company probationary period. Audit programmes are in place to audit all aspects of the home, there are records of audits carried out. Meetings are planned for the year and circulated to staff. A business plan was in place, which provided us with a forecast of improvements intended for the home, to ensure a consistent approach to raising standards for the people living there. The service had also been accredited by an external awarding body, showing that the home was periodically audited by a recognised professional organisation. A variety of surveys had been conducted at regular intervals, so that the home could obtain views from a wide range of people unloved with the care and support of those living at Birch Green. We were told that any comments made on the surveys, were acted upon as was appropriate and we obtained information to support this statement. A company representative made unannounced visits every month and subsequently prepared a written report about their findings, so that any shortfalls were identified and addressed in a timely fashion. Care Homes for Older People Page 29 of 33 Evidence: A lot of internal audits had been conducted and the home was developing an Evidence Based Excellence (EBE) quality strategy, which, we were told, would be embedded throughout the service once fully implemented, which demonstrated good progress. A wide range of meetings were regularly held for different disciplines at the home with recorded minutes retained, so that any relevant information could be shared and any topics of interest discussed. A record of any complaints or compliments about the quality of service provided was retained by the home and followed through, so that any positive outcomes were recognised and any areas for improvement were identified and dealt with, as appropriate. The policies and procedures of the home were in the process of being updated, linked in with the Evidence Based Excellence quality strategy, so that people were provided with current and up to date information. The system for retaining any monies or personal allowances on behalf of people living at Birch Green Care Centre was robust, with clear records being maintained and secure storage facilities being available. A range of environmental assessment had been conducted, so that any potential risks were identified and strategies put in place in order to promote the health and safety of anyone on the premises. Several committees had been formed so that any health and safety matters could be discussed and any preventative actions implemented, in accordance with formal action plans, which was considered to be good practice. A fire risk assessment had been drawn up with the involvement of the fire officer and from this an action plan implemented, which incorporated fire safety awareness for all staff, so that those working at the home knew what they should do in the event of a fire breaking out. Some staff members had completed fire Marshall training, who were responsible for ensuring that the fire safety policies and procedures of the home were followed in day - to - day practice. A random selection of service certificates were examined, which showed that outside contractors periodically checked systems and equipment to make sure it was safe for use, in accordance with manufacturers guidelines. The home also conducted regular internal checks, so that any malfunctions could be identified and promptly rectified. Care Homes for Older People Page 30 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 The plans of care should be reviewed every month or more often, if needed, so that current information is provided for staff to ensure they are aware of the care and support required by every individual living at Birch Green. The plans of care should consistently include all assessed needs and should always provide staff with detailed guidance about how these needs can be best met. People living at the home or their relative should be given the opportunity to be involved in the care planning process so that they can make some informed choices about how they would like their care and support to be delivered. Where this offer is declined, then this should be recorded. It is recommended that the complaints procedure be updated to include the current contact details for the Care Quality Commission. Criminal Record Bureau (CRB) disclosures should be obtained before people start work at the home, except in exceptional circumstances, which should be recorded. In such situations a written record should be maintained to demonstrate constant supervision until the CRB is received. Page 32 of 33 2 7 3 7 4 16 5 29 Care Homes for Older People Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 33 of 33 - 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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