Care Home: Birchdale Nursing & Residential Home

What has improved since the last inspection? Birchdale Nursing & Residential HomeDS0000018168.V375434.R01.S.doc Version 5.2 Page 8Staff have worked hard to make sure the care plans are clear and detailed about the care provided. People and their representatives are now involved in planning their care with staff. Information about people`s past lifestyles and choices are now written down so that staff can continue to support them or help them access help from others. The corridors have been "themed". Pictures, memorabilia, signage and different colour schemes have been provided to help people with memory loss find their own way around the units and keep them stimulated and interested. There are now sluice disinfectors across the units to reduce the risk of infection. Staffing levels on the Fernlea Unit have been increased which means people receive more help when needed. And this has improved the mealtime experience for them. Staff have received specialist training so that they can understand and support people with memory loss. In house maintenance checks are now kept up to date so people can be kept as safe as possible. What the care home could do better: Medicine storage, security and record keeping within the home could be improved. Stocks of medicines should be checked regularly and further supplies ordered in a timely fashion to prevent medication being out of stock. Audit of the medication system could be improved and should include checking stocks of medication against administration records to help confirm that medicines are being given as prescribed. The planned refurbishment of the bathrooms, showers and bedrooms must continue so that the home remains a safe pleasant place to live. Infection control systems must be followed so that people can be protected from infection as far as possible. Key inspection report CARE HOMES FOR OLDER PEOPLE Birchdale Nursing & Residential Home Moore Street Gateshead Tyne & Wear NE8 3PN Lead Inspector Irene Bowater Key Unannounced Inspection 7th May 2009 09:30 DS0000018168.V375434.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Birchdale Nursing & Residential Home DS0000018168.V375434.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Birchdale Nursing & Residential Home DS0000018168.V375434.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Birchdale Nursing & Residential Home Address Moore Street Gateshead Tyne & Wear NE8 3PN 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) 0191 477 6777 0191 477 4241 Birchdale@fsch.co.uk www.fshc.co.uk Four Seasons Healthcare (England) Limited (Wholly owned subsidiary of Four Seasons Health Care Ltd) Mrs Marion Taylor Care Home 63 Category(ies) of Dementia (28), Mental disorder, excluding registration, with number learning disability or dementia (15), Old age, of places not falling within any other category (10) Birchdale Nursing & Residential Home DS0000018168.V375434.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following categories: Old Age, not falling within any other category, Code OP - maximum number of places 10 Dementia - Code DE, maximum number of places 28 Mental Disorder, excluding learning disability or dementia, Code MD maximum number of places 15 The maximum number of service users who can be accommodated is: 63 9th June 2008 2. Date of last inspection Brief Description of the Service: Birchdale Residential and Nursing home is a 63-place purpose built facility. All of the bedrooms are single rooms. The home predominantly provides a service for older people with a dementia type illness. The home has three floors of accommodation. The home has recently had a major refurbishment and there are now four separate units. The top floor unit is called the Gables and has fifteen single bedrooms. This is presently an all male unit. The middle floor has two units. The Oaklands is a ten-bedded unit, which provides general nursing care and the Woodland is a seventeen bedded unit, which provides social and personal care for people with Dementia. Fernlea is the unit located on the lower ground floor and provides nursing care for people who have Dementia and Mental Health care needs. Each unit contains lounges, dining rooms, bathrooms, toilets and bedrooms. There is one main kitchen but each unit has a small kitchenette area where drinks and light snacks can be made. All areas are accessed via a central Birchdale Nursing & Residential Home DS0000018168.V375434.R01.S.doc Version 5.2 Page 5 reception area. There is a passenger lift that serves all 3 floors. The laundry is located on the lower ground floor and services the whole building. Birchdale has easy ramped access into the reception entrance on the middle floor. There is also good access around the homes corridors. The home is close to local bus routes and short walk from a metro station. The home is in a residential area on a steeply sloping street. There is good car parking at the front of the home. The weekly fee ranges between: Minimum £394 to £410 per week plus the free nursing care rate which is set Nationally. Rates for privately funded people vary from £410 to £430 per week. Other costs such as hairdressing (between £6-16), chiropody (£8.50) and toiletries are not included within the current fee level. Birchdale Nursing & Residential Home DS0000018168.V375434.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. Before the visit: We looked at: • Information we have received since the last visit on the 9 June 2008. • How the service dealt with any complaints and concerns since the last visit. • Any changes to how the home is run. • The provider’s view of how well they care for people. • The views of people who use the service and their relatives, staff and other professionals. • We have reviewed our practice when making requirements, to improve national consistency. • Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. • In future, if a requirement is repeated, it is likely that enforcement action will be taken. The Visit: An unannounced visit was made on the 7 May 2009.This visit was carried out by two inspectors and started at 09:30 and was completed at 16:30.A medication inspection was completed separately by the pharmacist. During the visit we: • Talked with people who use the service, relatives, staff, the manager and visitors. • Looked at information about the people who use the service and how well their needs are met. • Looked at other records, which must be kept. • Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. • Looked around the building to make sure it was clean, safe and comfortable. • Checked what improvements had been made since the last visit. • We told the Registered Manager and Regional Manager what we found. Birchdale Nursing & Residential Home DS0000018168.V375434.R01.S.doc Version 5.2 Page 7 What the service does well: The staff collect information together about the person before anyone moves into the home to make sure they can meet their needs. The administration of medicines is generally well managed and the personal wishes of service users are considered when agreeing when and where to administer medication. Visitors are always welcomed and there are links with the local community. Staff are respectful and sensitive with people when helping them or when speaking to them. The menus offer a variety of well-cooked nutritious meals. People can enjoy a healthy, well-balanced and interesting diet. Clear information is available should anyone have a concern or complaint about the care or service they are receiving. The registered manager makes sure that all checks and clearances are received before staff are employed. Staff receive on going training so that they can care for the different needs of people living in the home. They have completed safeguarding training and feel confident that they can recognise signs of abuse would be able to raise an ‘alert’ and protect those at risk. There are good arrangements for supporting people to keep their personal monies in a safe place if they want. The Registered Manager makes sure that quality assurance systems are followed so that people receive consistent quality of care and their views are taken into account. Comments from surveys included: “Staff are always on hand and have encouraged A to walk with help.” “Any concerns have been listened to and I have been very happy with the outcome.” “Very attentive staff, nothing is a bother and all management and staff are approachable and are able to deal with any situation that may happen.” “I am very happy that mam is there.” What has improved since the last inspection? Birchdale Nursing & Residential Home DS0000018168.V375434.R01.S.doc Version 5.2 Page 8 Staff have worked hard to make sure the care plans are clear and detailed about the care provided. People and their representatives are now involved in planning their care with staff. Information about people’s past lifestyles and choices are now written down so that staff can continue to support them or help them access help from others. The corridors have been “themed”. Pictures, memorabilia, signage and different colour schemes have been provided to help people with memory loss find their own way around the units and keep them stimulated and interested. There are now sluice disinfectors across the units to reduce the risk of infection. Staffing levels on the Fernlea Unit have been increased which means people receive more help when needed. And this has improved the mealtime experience for them. Staff have received specialist training so that they can understand and support people with memory loss. In house maintenance checks are now kept up to date so people can be kept as safe as possible. What they could do better: 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. Birchdale Nursing & Residential Home DS0000018168.V375434.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 Birchdale Nursing & Residential Home DS0000018168.V375434.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 is not applicable to this service. People using the 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 receive clear information about the service and good assessments of need before admission. This helps them make the right decision about using the service. EVIDENCE: Everyone admitted to the home has an assessment of all care needs, which is completed by care managers, nurse assessors and the home manager. The Company have an assessment document that included areas specifically about the needs of people who have a dementia or mental health related illness. Birchdale Nursing & Residential Home DS0000018168.V375434.R01.S.doc Version 5.2 Page 11 Staff are also able to record what people’s assessed needs are and how they should meet these needs based on a “person centred approach to care”. The preadmission assessments are used as the basis of the care planning process for each person. Birchdale Nursing & Residential Home DS0000018168.V375434.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care is now being planned and delivered in a respectful and person centred way. This enables people to fully access healthcare and other services and ensures their needs are supported. EVIDENCE: Each person has a plan of care based on the admission information which was carried out by care managers, the home manager and where necessary nurse assessors. Staff complete pressure ulcer risk using the Waterlow scoring system, dependency, moving and handling, nutritional assessments, using the Malnutrition Universal Screening Tool (MUST), continence and fall risk Birchdale Nursing & Residential Home DS0000018168.V375434.R01.S.doc Version 5.2 Page 13 assessment. These tools help the staff understand the level of risk and helps them complete a care plan for each person. The staff have worked hard to improve the care plans since the last visit to the home. There is evidence that staff are working with the person and their relatives to find out about their previous lifestyles and histories. This information is then used to show how show how they are promoting people’s independence and choices about daily living. Information is available about a person preferring to spend most of the time in their room watching DVD’s and listening to music. There are agreements in place when this person will have the room cleaned and how personal care will be supported by male staff. Other information shows how staff support someone’s knitting hobby, watching the “soaps” on television and maintaining links with family members. Most of the people living in the home and their relatives have been involved in writing “Life Histories”. These give a good insight into people’s lives and help the staff provide care based on current wishes. Advice has been sought from the psychiatrist and challenging behaviour team should anyone become anxious, verbally or physically disruptive. Staff have completed risk assessments, updated care plans and have behaviour monitoring charts in place. This means that staff are all following the same guidance and care so that support is given in a structured way and people feel supported and protected. The moving and assisting information is now detailed and includes in formation about which hoist, sling and number of staff needed to support the person. Many people have food and fluid charts to record their daily nutritional intake. This are now being completed properly and can be cross referenced to the care plans. People who do have poor appetites or weight loss have their weight regularly checked and staff contact the dietician should there be any concern. There are plenty nursing profiling beds and equipment is in use to maintain people’s skin integrity. Currently no one in the home has any pressure damage. Everyone has access to all NHS facilities to ensure their healthcare needs are met. There are regular visits from GP’s and other health professionals including, dentists, opticians and chiropody services. A visiting general practitioner was spoken to during the visit and suggested that the home was “the best he had ever seen it” and that he was happy with the way the staff assisted him on his visits to the home. Birchdale Nursing & Residential Home DS0000018168.V375434.R01.S.doc Version 5.2 Page 14 Advice is also sought from speech and language therapists, dieticians, occupation therapists, psychiatrists and continence advisors. Morning medicine administration was observed on the ground and middle floors and was well managed and followed good practice guidance. Staff were not disturbed by colleagues during the process and offered support and encouragement to people taking medicines. People who preferred to take their medicines in their room or later in the morning were accommodated. Medicine administration record (MAR) charts were looked at on each floor. There were a number of gaps in the administration records and the quantity of medication recorded on some MAR charts did not always reflect any medication carried over form the previous month. This makes it difficult to maintain a complete record of medication in the home and to check if medicines are being given as prescribed. One person did not receive a night time dose of quetiapine liquid for 8 days and was recorded as out of stock, despite a full unused bottle located in the trolley and recorded as received into the home and available for at least four of these days. On another person’s MAR chart salbutamol tablets were recorded as being out of stock for 5 days earlier in the monthly cycle. A number of handwritten entries on MAR charts had not been countersigned by a second person to confirm their accuracy Most medicines, including controlled drugs, were stored appropriately in locked cupboards within locked treatment rooms. Some medicines no longer in use were on windowsills or bench tops and not locked away. One storage unit was being used to store ointments alongside dressings and syringes and had no lock fitted. The treatment room on the ground floor was warm at the time of the inspection and the room temperature is not being recorded. In addition, temperature monitoring of the fridge in this room is poor. The date of opening of medicines with limited use once opened is not always recorded. This means that there is a risk that the medication may be used beyond the date recommended by the manufacturer and may not be safe to administer. There were no discrepancies between the entries in the controlled drug register, entries on the MAR charts and the quantities of controlled drug held in the home. There was no evidence of any regular controlled drug stock checks. Although audit of the medication system is carried out this is not regular, nor detailed enough to help identify and medication problems promptly or to confirm that staff are closely following the home’s medicine policy. Birchdale Nursing & Residential Home DS0000018168.V375434.R01.S.doc Version 5.2 Page 15 Medication no longer required on the nursing unit is removed by a waste contractor but surplus medication from the residential unit is returned to the supplying pharmacy. Current waste management legislation requires all medicines waste from this home to be disposed of via a registered waste contractor. Birchdale Nursing & Residential Home DS0000018168.V375434.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opportunities to take part in meaningful activities and keep control of everyday decisions are good and mealtimes well organised. This means people can lead full and active lives. EVIDENCE: The home employs an activities organiser. She was not on duty but staff on all units were encouraging and supporting people to take part in daily activities that they choose. For example, some were watching a DVD in the lounge, staff were supporting others play a floor game of snakes and ladders, some enjoyed a spontaneous sing song and some preferred to stay in their rooms watching television or listening to music. Birchdale Nursing & Residential Home DS0000018168.V375434.R01.S.doc Version 5.2 Page 17 The additional carer on the Fernlea unit has made a difference in delivering a better quality of care with staff having more time and people being able to have individual attention. A couple of ladies sat knitting and chatting and chatting and three men were playing pool. An activities programme displayed in the entrance hall informs everyone what is planned for the week ahead. There is a vast range of activities including pamper days, board games, reminiscence, music, food tasting ,memory jogger cards and local history. There are also theme nights with May having an Italian night. Information is provided in a monthly newsletter and there is a display of photographs of recent social events. Each unit has a different theme such as scenes of the beach, railways, sailing and musical instruments and music scores. Stimulating objects and pictures decorate the home. Pictures of old film stars and entertainers decorate the walls and murals made out of materials that can stimulate the mind when touched are available for people to stop, look at and feel. The sensory room has been repaired and is a quiet place where individuals can go with a carer to relax. Many people have brought small items with them making their rooms homely and reflective of their previous lifestyles, religious beliefs or cultural backgrounds. The cook is very knowledgeable about making sure everyone receives nutritious and well-balanced meals. Menus are being reviewed in line with the guidance “Food for Thought”. And, the manager has provided the menus in picture styles so that people can make proper choices about what they would like to eat. There are small kitchens on each unit .The cook regularly checks that there are plenty supplies of milk, juices, sandwich fillers, bread, fruit, yogurts and biscuits available to make sure people receive a nutritious and fortified diet. There are dining rooms on each unit and people can choose have meals in their own rooms. All main meals are prepared in the central kitchen and sent to each unit in a “hot trolley” and the food is then served by the care staff. People are asked for Birchdale Nursing & Residential Home DS0000018168.V375434.R01.S.doc Version 5.2 Page 18 preferences the day before but are able to choose something else at the point of service. The dining tables in all units were appropriately set with table cloths, serviettes, cutlery and crockery. Choices for the lunch time meal included liver and onions with mashed potatoes and swede or chicken nuggets, chips and beans followed by rice pudding, fruit, or yoghurt. Hot and cold drinks were given throughout the meal. The meal time experience on all units was an unhurried and social time and staff were aware of people’s needs and gave support in a sensitive way. Comments included: “lovely dinner” “canny food” “always too much but its good”. Birchdale Nursing & Residential Home DS0000018168.V375434.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good complaints and protection procedures are in place and effectively followed to ensure that people and their relatives are listened to and protected from abuse. EVIDENCE: The Company has a comprehensive complaints procedure, which is displayed in all areas of the home. It is also available in the Service User Guide, which is available in reception. There is a complaints book which shows that all complaints and concerns are taken seriously and there is written evidence of investigations and outcomes. The Company have clear Safeguarding policies and procedures. Training is initially completed during induction and then through workbooks. The manager has completed a two-day “Alerter” training course which links into the Local Authority framework. Birchdale Nursing & Residential Home DS0000018168.V375434.R01.S.doc Version 5.2 Page 20 Staff were very clear about what they would do should they have any suspicions or receive any allegation of abuse. There have been no safeguarding alerts or complaints since the last visit. Birchdale Nursing & Residential Home DS0000018168.V375434.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,24,26. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The ongoing investment is providing a more comfortable, pleasant place for people to live. EVIDENCE: There have been many environmental improvements following best practice guidance for homes caring for people with memory loss. Corridors have been redecorated and have individual themes such as painting of the seaside, sailing, railways and music. There are lots of items to see and keep people’s interest. Birchdale Nursing & Residential Home DS0000018168.V375434.R01.S.doc Version 5.2 Page 22 All of the communal areas have been decorated and furnished to a good standard. New furniture has been bought and communal areas have been redecorated and wall mounted televisions have been provided for lounges. The conservatory was very warm but the blinds were in use and the windows were open. There are plans to provide an air conditioning system in the near future. Refurbishment to bathrooms and toilets are a work in progress. The four en suite bedrooms are being refurbished to provide walk in shower facilities. The shower room on the Gables has a problem with drainage of water after someone has had a shower (pooling of water) and some wall tiles are missing. The shower room on the Fernlea unit needs to be refurbished as there is damage to tiles, mould and grim around the tiles and the shower unit is broken. A trolley used for linen has seen better days and the practice of storing clean and tying a clinical waste bag to the side is a possible infection control risk. Also some clinical waste bags just being stored on floor and not an appropriate bin with lid so there was some odour. Bedrooms on some units have been refurbished to good standard with nursing beds, new carpets and furniture. Some bedrooms need new fitting as wardrobes, chest of drawers are not in good condition (original) and the original sink units are damaged through wear and tear. The sluice on the nursing unit has a disinfector but the area was messy and the hopper needs cleaning. Some tiles need to be replaced and staff need to make sure that the key is not left in the door. Also the storage of equipment should be looked at so the risk of cross infection is minimised. The laundry is on the lower ground floor. It has a separate clean and soiled area and was generally clean and tidy. The increase in domestic staff has been beneficial with staff on each unit to keep areas clean, tidy with no odours. Birchdale Nursing & Residential Home DS0000018168.V375434.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels and systems around recruitment, selection and training of staff are good and meet the range of needs of the people using the service and protect them from harm. EVIDENCE: Since the last visit to the home there has been an increase in domestic, activities and care staff. This has been really noticeable throughout regarding the cleanliness in the home and the increase in activities for people. The additional carer on the Fernlea Unit is making sure staff have time to deliver a “person centred care” and people are receiving a better quality care. The records for recruitment were satisfactory. There was evidence of Criminal Record Bureau checks, Protection of Vulnerable Adult checks, two written Birchdale Nursing & Residential Home DS0000018168.V375434.R01.S.doc Version 5.2 Page 24 references, proof of identity and professional identity numbers for registered nurses. New staff have an induction period, which is over twelve weeks and follows the “Common Induction Standards” from Skills for Care. They are given a “Staff Handbook” which covers all aspects of employment matters and care practice. It also covers equality and diversity and valuing that everyone has a contribution to bring to the home. There is training programme in place. All mandatory training is up to date. Other training includes, Dementia Care Mapping, Mental Capacity Act, Infection Control, Assertiveness training, dealing with death and dying, bereavement and loss, End of Life Pathways, End of Life care for people with Dementia, subcutaneous fluids, catheter care, venapuncture and customer care. Birchdale Nursing & Residential Home DS0000018168.V375434.R01.S.doc Version 5.2 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38. People using the 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 run by a competent manager who makes sure that good quality assurance and safety systems are in place. This makes sure that people receive a good quality of care. EVIDENCE: The manager has been registered with the Commission. She has many years experience as a manager and holds the Registered Managers Award. She has Birchdale Nursing & Residential Home DS0000018168.V375434.R01.S.doc Version 5.2 Page 26 completed a recognised training course in dementia care. She does not hold a nursing qualification. Audits of all care and other services are carried out with action and outcomes recorded. The regional manager visits on a monthly basis and completes a separate report. These reports are to make sure the quality of the home continually improves. The results from the Company’s customer survey completed in February 2009 were positive with a range from very good to fair. Regular staff meetings are held and the agenda includes, team building, training, customer care and clinical governance. The last relative meeting had to be cancelled but the previous meeting in October showed that relatives were asked about their views and asked to provide life stories so that people’s previous history could be taken into account when planning care. The AQQA was completed and returned when asked for and the information showed what improvements are planned for the next year. The residents personal finances are managed well. The details are kept of all deposits and withdrawals on the computer system and paper records, including receipts that are signed by the individual where possible. Monthly reconciliation checks are carried out of balances and cash. All mandatory training was up to date. Health and safety risk assessments are clear and kept up to date. Accidents are recorded and best practice guidance is used to track trends, which prevents as far as possible the same accidents occurring. Internal maintenance checks are up to date and external service certificates are available and up to date. Birchdale Nursing & Residential Home DS0000018168.V375434.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 2 X X 2 X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Birchdale Nursing & Residential Home DS0000018168.V375434.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 12,13 Requirement The registered persons must ensure: Medication must be given as prescribed and a record made at the time that it is given. A system should be in place to request, obtain and maintain adequate supplies of prescription medicines for service users so that they can be given them as and when prescribed. Best practice guidance and the provider’s medication policy must be followed when recording all medication All medication must be stored safely, securely and at the temperature recommended by the manufacturer This will safeguard the health and welfare of people living in the home. The registered persons must 01/10/09 ensure that the shower flooring on the Gables is repaired and the shower room on the Fernlea unit DS0000018168.V375434.R01.S.doc Version 5.2 Page 29 Timescale for action 07/07/09 2 OP21 23 Birchdale Nursing & Residential Home refurbished. This will ensure people have safe and suitable bathing facilities to use. The registered persons must continue with the refurbishment of the bedrooms. 3 OP24 16,23 01/12/09 4 OP26 13,23 This will ensure that people live in rooms which are safe and equipped to assure comfort and meet individual need. The registered persons must 07/07/09 ensure that staff always follow infection control policy. And make sure sluices are kept clean, tidy, and free from odour and locked when not in use. This will ensure the home remains clean and people are protected from possible infection. 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 1 The temperature of the treatment rooms and all medicine fridges should be regularly monitored to confirm that medicines are being stored within the appropriate range recommended by the manufacturer and so are safe to use. The treatment room on the ground floor is particularly warm. 2 A system should be in place to record all medication kept in the home including any medication carried over from the previous month. 3 Staff should sign and date handwritten entries they Birchdale Nursing & Residential Home DS0000018168.V375434.R01.S.doc Version 5.2 Page 30 make on MAR charts. Each entry should be checked and countersigned by a second person to reduce the risk of error when copying information. 4 When medicines are not administered as prescribed the appropriate code should be recorded on the MAR chart along with an explanation on the reverse side of the chart if necessary. 5 Care plans should be updated to reflect any changes made to medication. 6 The pharmacist should be requested to include additional labelling on the MAR charts to guide staff on any specific administration requirements. 7 When medicines are collected from the home for disposal a member of staff should sign and date the record book to confirm their removal. 8 The date of opening of medicines with a limited use once opened should be recorded to make sure that medicine is not used beyond the date recommended by the manufacturer. It is highly recommended that the refurbishment plan continues throughout the home. It is highly recommended that the current NVQ training continue to ensure that a minimum of 50 of care staff achieve NVQ Level 2 Award. 2 3. OP19 OP28 Birchdale Nursing & Residential Home DS0000018168.V375434.R01.S.doc Version 5.2 Page 31 Care Quality Commission St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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