Care Home: Birch Tree Lodge

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What the care home does well Service Users care needs are assessed and a plan of care produced to enable staff to support people. These documents are periodically updated, which shows the Registered Manager is revising the information available to staff, to ensure the correct care is offered at the correct level to ensure their independence. A contract is produced prior to people moving into the home. This ensures that people know what is expected of them and what they can expect from their stay at the home. A number of these documents are produced in an easy read format using pictures and symbols. This makes sure that the information is available to all who live at the home. Staff continue to have a very thorough system in place to check medicines on a daily basis. The overall medication system is very secure, with no missing information. This ensures that people receive the correct medication at the correct time. Decisions that the Service Users make are recorded in the daily notes. Service Users time during the week is taken up by college courses and social care both within and out of the home. Though a programme of entertainment is in place, Service Users have the flexibility to choose what they want to do at any given time. Similarly there is a planned menu, though again Service Users have a number of alternative choices of food. This was confirmed both by staff and is entered in the minutes of meetings at the home. Staff have access to a mobile phone and can safely support residents whilst out of the home. Meals are varied and times served are flexible, and residents have access to fresh fruit. Complaints information is displayed in the home, and is also available in an easy read format using pictures and symbols. Staff are aware of safeguarding, and how the whistleblowing procedure works. This ensures staff could act appropriately if the situation demanded, and protect people in the home. The home is comfortable and clean, and staff were aware of cross contamination and cross infection issues. Staff do a number of health and safety checks to help keep the home a safe place to live in. Staff employed in the home have a number of checks before they were allowed to work at the home. Supervision, which is a meeting between the manager and staff on a one to one basis, are continuing, as are the staff meetings. These are minuted and staff have access to those, and are able to add items for discussion. This shows the registered manager enables staff to join in the development of the home. What has improved since the last inspection? The Registered Person visits the home and records the outcome of each visit. This ensures that the progress of the home is monitored, and development of staff is ongoing. The nameplate to the front door of the home has been replaced. This should be less confusing for people those visiting the home. What the care home could do better: The Control of Substances Hazardous to Health (COSHH) data sheets need reviewing as a small number are missing. This leads to a shortfall in the information available to enable staff to deal effectively in case of an emergency. CARE HOME ADULTS 18-65 Birch Tree Lodge 11 Toller Road Quorn Loughborough Leicestershire LE12 8AH Lead Inspector Keith Williamson Unannounced Inspection 26 November 2008 09:00 th Birch Tree Lodge DS0000001758.V373401.R01.S.doc Version 5.2 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 Tree Lodge DS0000001758.V373401.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 Adults 18-65. 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 Tree Lodge DS0000001758.V373401.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Birch Tree Lodge Address 11 Toller Road Quorn Loughborough Leicestershire LE12 8AH 01509 415665 01509 415842 manager.birchtree@aermid.com 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) Aspire Lifestyle Limited Cheryl Ann Palmer Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Birch Tree Lodge DS0000001758.V373401.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No additional conditions of registration. Date of last inspection 7th April 2008 Brief Description of the Service: Birch Tree Lodge is a residential home for 4 adults with learning disabilities with three resident at the time of the visit. Residents all have complex needs including autistic spectrum disorder and some physical health needs. The home is situated in a quite residential part of Quorn village and is close to local amenities such as shops and public transport links. The home is an adapted property, with a lounge, games room, conservatory and bedroom to the ground floor. All other residents’ bedrooms and office are on the first floor. To the rear of the home is a secluded garden. The fees charged range between £916.82 and £1476.16 per week. A copy of Service Users Guide and Statement of Purpose were available, and seen on this occasion. A copy of the last Commission For Social Care Inspection (CSCI) inspection report is displayed in the kitchen of the home, and copies of this report are available from the acting manager. Birch Tree Lodge DS0000001758.V373401.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of the inspections is on outcomes for Service Users and their views of the service provided. The main method of Inspection used was ‘case tracking’ which involves selecting a sample number of clients and tracking the care they received through talking with them where possible, and looking at their records and accommodation, in this case one Service User was chosen. This visit took place over one day, commencing at 9.30am and took six hours to complete. An opportunity was taken to speak with Service Users and staff, look around the home, view records, policies and care plans. Information was gathered prior to the site visit from sources such as the Annual Quality Assurance Assessment (AQAA), which gives information on the home, and is filled in by the manager. All three of Service Users were seen and two Service Users were spoken with. One staff member and the registered manager were also spoken with. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. What the service does well: Service Users care needs are assessed and a plan of care produced to enable staff to support people. These documents are periodically updated, which shows the Registered Manager is revising the information available to staff, to ensure the correct care is offered at the correct level to ensure their independence. A contract is produced prior to people moving into the home. This ensures that people know what is expected of them and what they can expect from their stay at the home. A number of these documents are produced in an easy read format using pictures and symbols. This makes sure that the information is available to all who live at the home. Staff continue to have a very thorough system in place to check medicines on a daily basis. The overall medication system is very secure, with no missing information. This ensures that people receive the correct medication at the correct time. Decisions that the Service Users make are recorded in the daily notes. Service Users time during the week is taken up by college courses and social care both Birch Tree Lodge DS0000001758.V373401.R01.S.doc Version 5.2 Page 6 within and out of the home. Though a programme of entertainment is in place, Service Users have the flexibility to choose what they want to do at any given time. Similarly there is a planned menu, though again Service Users have a number of alternative choices of food. This was confirmed both by staff and is entered in the minutes of meetings at the home. Staff have access to a mobile phone and can safely support residents whilst out of the home. Meals are varied and times served are flexible, and residents have access to fresh fruit. Complaints information is displayed in the home, and is also available in an easy read format using pictures and symbols. Staff are aware of safeguarding, and how the whistleblowing procedure works. This ensures staff could act appropriately if the situation demanded, and protect people in the home. The home is comfortable and clean, and staff were aware of cross contamination and cross infection issues. Staff do a number of health and safety checks to help keep the home a safe place to live in. Staff employed in the home have a number of checks before they were allowed to work at the home. Supervision, which is a meeting between the manager and staff on a one to one basis, are continuing, as are the staff meetings. These are minuted and staff have access to those, and are able to add items for discussion. This shows the registered manager enables staff to join in the development of the home. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Birch Tree Lodge DS0000001758.V373401.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Birch Tree Lodge DS0000001758.V373401.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2&5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The assessment process is detailed and effective resulting in accurate information for prospective Service Users and staff. EVIDENCE: The Service Users assessment information was well detailed and contained information relating to their needs and abilities. This is important as this information forms the basis for any care plan. All Service User assesments have been recently updated, these were held together with the original assessment documents from the Service Users placing authority. A contract was also in place. These documents are important to signify the terms and conditions of their stay. Birch Tree Lodge DS0000001758.V373401.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service Users continue to be looked after well in respect of their personal care needs and choices. Areas of risk are assessed appropriately. EVIDENCE: The Service Users support plan was examined: this like the assessment was well detailed and covered aspects of their daily life. The plan was written in a person centred way, and reflected the assessment information. This is important and shows the staff developing the information needed to care for people. None of the current Service Users are involved in the composition of their care plan nor have a personal copy of their plan. This is down to an ability issue as some Service Users are unable to sign their plan to confirm their agreement with the content. However good practice would indicate that a pictorial or easy read version of the plan would be of benefit to some of the Service Users in the Birch Tree Lodge DS0000001758.V373401.R01.S.doc Version 5.2 Page 10 home. Staff responsibilities for meeting various aspects of the plan were clearly identified and there was evidence that the information was regularly reviewed. The care plans were backed up by risk assessments; these giving staff instruction on how to care for people safely. This is important as it shows staff have the means o deliver care in a safe way to Service Users. Staff displayed a good understanding of the details in the plan of care. Detailed notes cover the activities that Service Users do throughout the day. Birch Tree Lodge DS0000001758.V373401.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15, 16 & 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service Users are supported in maintaining a good choice of lifestyle. EVIDENCE: Service Users individual development is detailed in care plans. Some Service Users attend college though none of the current Service User group are looking toward continuing paid employment. Service Users continue to take part in leisure activities both within and out the home. There is a programme of planned activities in place for each Service User. These are not rigidly enforced, as Service Users have the ability to make choices as to their preferred activities. Staff confirmed the Service Users options when being spoken with. Birch Tree Lodge DS0000001758.V373401.R01.S.doc Version 5.2 Page 12 Menus are made up in advance, again these are not strictly enforced, as some flexibility within the purchasing of groceries allows changes to the menu if Service Users require. Any changes are recorded, and agreed that menu changes happen quite often. This is also backed up in the minutes of the staff meetings, where the Manager is indicating this is good practice. Birch Tree Lodge DS0000001758.V373401.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service Users health, personal care and medication needs are well met. EVIDENCE: Service Users personal care and support needs are clearly detailed in their care plan. These include information such as individual likes and dislikes. Service Users also have information in their plan of care, about their health management and have regular access to dental and optical services, as well as an annual health check from their General Practitioner. Contact from other professionals such as consultant psychiatrists, psychologists and speech and language therapy staff also have individual input. This is important as it shows the home cares for peoples greater health needs on an individual basis. Medication continues to be well managed, with a substantive system in place ensuring the accurate administration to people in the home. Birch Tree Lodge DS0000001758.V373401.R01.S.doc Version 5.2 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users are protected by policies, procedures and a well informed staff group. EVIDENCE: There have been no complaints forwarded to the Commission for Social Care Inspection about the home. There have been no complaints recorded by staff at the home since the last visit. Complaints information is clearly displayed in the Service User Guide, and is available in a pictorial version, which would help the current Service Users in making a complaint. Staff told the Inspector what they knew about complaints, adult protection and whistleblowing procedures. Adult Protection training has been re-arranged since the last visit and staff are continuing a programme of training to ensure they are aware of the latest information to protect Service Users in the home. There have been no protection issues forwarded to the Commission for Social Care Inspection. Birch Tree Lodge DS0000001758.V373401.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service Users live in an environment that is homely, comfortable and clean. However the lack of progress on decorating and replacement of furniture detracts from the overall Service Users comfort. EVIDENCE: There is a plan of refurbishment in place; this has been redated with delayed dates from those seen at the last visit. This is unreasonable, as the décor of the home urgently needs to be brought up to a good standard. The home is registered for four Service Users, and one room is still being used to provide a “sleep in” room for staff. The Registered Manager stated that the future plans for this bedroom had yet to be decided. The nameplate to the front door of the home has now been changed. This should be less confusing for people visiting the home. Birch Tree Lodge DS0000001758.V373401.R01.S.doc Version 5.2 Page 16 The “star” type deadlocks on the toilet doors, have been removed which reduces the potential risk to Service Users. Staff were aware of cross contamination and cross infection issues. Birch Tree Lodge DS0000001758.V373401.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service Users are supported and protected by trained staff and effective recruitment practices. EVIDENCE: Staffing levels reflect the Service Users level of need and enable individual support throughout the day and night. A programme of training is in place, though some of the courses are quite dated and refresher training is necessary to keep staffs knowledge and practices up to date. Staff spoke positively about the training opportunities they had taken up recently. Staff recruitment records were examined; these were up to date and in order. These contained a written application form, written references and evidence of identity. This is important as it shows the Manager is ensuring the safety of the Service Users at the home. Staff supervision is planned in advance and undertaken regularly. This assists Birch Tree Lodge DS0000001758.V373401.R01.S.doc Version 5.2 Page 18 in planning the appropriate staff training courses. This is important as it means staff are viewed on an individual basis, and the appropriate training planned accordingly. Birch Tree Lodge DS0000001758.V373401.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40 & 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Improvements in health and safety now provide a safer environment for Service Users. EVIDENCE: The permanent manager has now completed the registration process to become the Registered Manager of the home. Quality Assurance, which is the way the staff ask the Service Users and other interested people, how well the home cares for people live there, has now been started. Questionnaires have been received back from Service Users relatives, and the manager is in the process of adding those to the Service User Guide. Birch Tree Lodge DS0000001758.V373401.R01.S.doc Version 5.2 Page 20 On this being completed, this shall inform new Service Users to the home, what it is like to live there. Health and safety has improved with staff continuing to test the fire system, hot water and fridge temperatures on a regular basis. The fire risk assessment and escape plan are up to date and the testing of the electrical system has now been completed. A small number of Control of Substances Hazardous to Health (COSHH) data sheets, which provides vital information on cleaning and other dangerous substances used in the home, are missing from the list of products compiled for staff. This poses a risk to people in the home, and these need to be updated. The registered person has now commenced his visits to the home, and completes a written record of these visits. These are required to ensure the ongoing development and improvement of the home. Birch Tree Lodge DS0000001758.V373401.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 3 X 3 X Birch Tree Lodge DS0000001758.V373401.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA12 Regulation 42 Requirement The Registered Manager shall take appropriate steps to reduce the risks of health and safety in the home. This is to ensure the safety of people in the home. Timescale for action 17/12/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations The resident or a relative could be asked to sign the care plan when they are being reviewed. Adult protection training should be re-arranged as soon as possible, to ensure all staff are aware of protection issues and how to act if those become apparent. 2. YA18 Birch Tree Lodge DS0000001758.V373401.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Tree Lodge DS0000001758.V373401.R01.S.doc Version 5.2 Page 24 - 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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