Care Home: Birchwood

What the care home does well Activities suitable to meet the needs of people with dementia happen regularly. Staff are trained to care for people with dementia in person-centred ways that put them, their wishes and choices at the heart of their care plans. Because of this people are treated with dignity and respect and get care that is given in their best interests. The home is purpose built to meet the needs of older, disabled people. It’s kept very clean and hygienic and people are able to move about freely using the space as they wish. What has improved since the last inspection? BirchwoodDS0000036679.V377544.R01.S.docVersion 5.2Two requirements and five out of six good practice recommendations were met. One recommendation didn’t apply at this visit and one was partly met. We noted improvements in the writing of care plans and daily records. Care plans in particular were very person-centred and written from the person’s own view. This made it easy to understand the person’s needs and wishes. Following recent training in how to write better records, daily records seen were factual and used more respectful language which preserves peoples` dignity. The good practice recommendations adopted covered better use of social history information, making sure staffing is the same for each day of the week, and recording of supervision sessions more regularly. All show that meeting peoples` needs by a well supported staff team gives them a better quality of life in the home. What the care home could do better: One requirement and one good practice recommendation was partly met. Whilst care plans were well written and clear, not all identified needs were recorded or reported in care plans and daily records. This doesn’t show that people get the care they need when they need it. This requirement is moved on with a short timescale. Further, whilst the environment of the home was well decorated and exceptionally clean, attention hadn’t been given to making sure their bedrooms are easy for them to find, in person-centred ways. This could lead to greater confusion in peoples` minds. A further requirement was made to make sure peoples` health and safety is regularly checked, particularly in bathroom areas. This will make sure people with dementia are kept protected from harm. Two new good practice recommendations were made about making sure all concerns and complaints are recorded in the proper manner and personal information is only recorded in care files. This make sure information about people living at the home is kept confidential and their privacy respected. Further, it will give peoples` relatives greater confidence in raising concerns and making sure proper action is taken. Key inspection report CARE HOMES FOR OLDER PEOPLE Birchwood 35 Birchwood Road St Annes Brislington Bristol BS4 4QL Lead Inspector Sandra Garrett Key Unannounced Inspection 09 September 2009 09:00 DS0000036679.V377544.R01.S.do c Version 5.3 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. Birchwood DS0000036679.V377544.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 Birchwood DS0000036679.V377544.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Birchwood Address 35 Birchwood Road St Annes Brislington Bristol BS4 4QL 0117 971 2266 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) Bristol City Council Miss Debra Jane Clifford Care Home 30 Category(ies) of Dementia (30), Dementia - over 65 years of age registration, with number (30) of places Birchwood DS0000036679.V377544.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 30 persons aged 60 years and over. Date of last inspection 13th September 2008 Brief Description of the Service: Bristol City Council runs Birchwood which is a large, purpose built care home. It’s registered with the Care Quality Commission (the Commission) to give personal care to 30 persons with dementia aged sixty years and over. All rooms are single and have been furnished to meet individual needs. The home is secured with a door entry system. There are spacious, bright lounges for people and their relatives to relax in. The dining room is of a good size and layout, with lots of space for moving around. There’s an attractive courtyard with shrubs, plants and sitting areas. Within the home there are aids and adaptations to help with peoples mobility. This also includes hoists in the bathroom. Birchwood is situated in the south of Bristol and is on a major bus route. Fees are £643.59 per week. Extra charges are made for chiropody, hairdressing, toiletries, newspapers and magazines etc. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority fees payable are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk http:/www.oft.gov.uk The last inspection report wasn’t displayed in the home although a notice in the entrance lobby stated that copies were available from the office if people want to read it. Birchwood DS0000036679.V377544.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. Before the visit, all information the Commission had received about the service since the last inspection was looked at. This included: The recent Annual Quality Assurance Assessment (AQAA). This is a selfassessment tool that the manager filled in and returned to us, notices of incidents affecting people living at the home and: records of team manager monthly visits to the home. All Bristol local authority homes have independent yearly quality assurance survey reports done. This is due to happen shortly for 2009. All the above helped us prepare for this inspection. At the visit we also looked at a wide range of records and spoke with members of the management team and staff. Because people with dementia aren’t always able to tell us about their lives, we used a formal way of watching people, to help us understand better. We call it the: ‘Short Observational Framework for Inspection’ (SOFI) tool. This means using a methodical and structured way of watching people living at the home. We did this for 1 hour each in both the entrance sitting area and the dining room. We recorded peoples experiences very often throughout the two hours. This included looking at their wellbeing and how they get on with other people living at the home, staff members and their environment. Information from the observation is included throughout this report. What the service does well: Activities suitable to meet the needs of people with dementia happen regularly. Staff are trained to care for people with dementia in person-centred ways that put them, their wishes and choices at the heart of their care plans. Because of this people are treated with dignity and respect and get care that is given in their best interests. The home is purpose built to meet the needs of older, disabled people. It’s kept very clean and hygienic and people are able to move about freely using the space as they wish. What has improved since the last inspection? Birchwood DS0000036679.V377544.R01.S.doc Version 5.2 Page 6 Two requirements and five out of six good practice recommendations were met. One recommendation didn’t apply at this visit and one was partly met. We noted improvements in the writing of care plans and daily records. Care plans in particular were very person-centred and written from the person’s own view. This made it easy to understand the person’s needs and wishes. Following recent training in how to write better records, daily records seen were factual and used more respectful language which preserves peoples dignity. The good practice recommendations adopted covered better use of social history information, making sure staffing is the same for each day of the week, and recording of supervision sessions more regularly. All show that meeting peoples needs by a well supported staff team gives them a better quality of life in the home. 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. Birchwood DS0000036679.V377544.R01.S.doc Version 5.2 Page 7 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 Birchwood DS0000036679.V377544.R01.S.doc Version 5.3 Page 8 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&4 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. Proper use of pre-admission assessments makes sure that the centre is the right place for people with dementia and that staff are able to meet their needs. Staff that are trained and experienced in meeting peoples’ specialist needs make sure they’re looked after with dignity and respect. EVIDENCE: The manager told us that a new way of gaining information about people before they come into the home, has been put in place. This now means that relatives are asked to come in before admission to fill out likes and dislikes forms, and give more background information on peoples lives before they got Birchwood DS0000036679.V377544.R01.S.doc Version 5.3 Page 9 dementia. This gives staff better knowledge of the person admitted and helps them settle in well. We saw the sheets in peoples files. Further background history is also gained from relatives over time when they visit. We saw social work assessments done before people are admitted. These were clear about peoples needs for care. Assessments also give personal histories of people that help staff understand their needs and behaviour. Assessments are also done by the management team before admission and following a stay in hospital. This makes sure the home is the best place for a person with dementia and that staff can meet or continue to meet their needs. We saw lots of information about assessment visits in the home’s message book that showed managers are clear about when peoples needs can be met and whether the home is right for them. Care plans showed signatures from staff to confirm that they can meet a person’s needs. Staff get regular training in supporting people with dementia, managing behaviour that challenges and mental health issues. The manager said she had recently done training with St Peter’s Hospice on end of life care and was using what she had learned to support staff with caring for a terminally ill person with dementia. She said that other staff members would shortly be doing this training. It was clear from observing the person and looking at records, that the manager and staff work closely with her/him and her/his relatives as well as with hospice staff to make sure s/he gets the best possible care. (Please also see Standard 11 for more about this). Birchwood DS0000036679.V377544.R01.S.doc Version 5.3 Page 10 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 & 11 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 documentation of care plans that includes regular checks, makes sure staff are given the information they need to care for people living at the home. However, failure to record all needs and care given in respect of them, may put people at risk. People living at the home are looked after well in respect of their healthcare and medication needs. Secure management of medication ensures people living at the home are kept safe from potential errors. Being treated with dignity and respect benefits people living at the home. However, records about death and dying don’t show that all personal wishes of people being cared for at the home are taken into consideration. EVIDENCE: Birchwood DS0000036679.V377544.R01.S.doc Version 5.3 Page 11 We looked at a sample of four peoples care records in depth. This is called case-tracking and helps us get a good picture of the overall care they get. For people with dementia we also use an observation tool which helps us to know that people who may not be able to tell us about themselves, are cared for properly. We found that care plans are now written in person-centred ways and from the viewpoint of people themselves. ‘Person-centred’ means care that looks at a person’s whole life, history and needs. It recognises and values them as individuals with rights and choices, rather than just focussing on meeting basic physical care tasks. The plans we saw were detailed, clear and gave a good picture of the person, their likes and dislikes and the way they want to be cared for. Needs identified from the pre-admission assessments were picked up as well as those developed afterwards. Care files are well organised with checklists for staff to follow when preparing them. Care plan reviews are also well documented in both the monthly updates and more formal reviews involving relatives. All care plans were checked regularly and any changes noted. Relatives were able to comment on the care their loved one gets and review sheets were signed. We followed up a requirement made at the last visit about making sure care plans show all needs picked up are recorded and met regularly. It was disappointing to note that this hadn’t been fully met. From our observation and looking at records we found that individual needs weren’t always recorded although it was clear for one person at least that staff were aware of the risks of a particular need. We also checked care records to see whether footcare, dental or mouth care was being given. However, we could find no evidence of this. The requirement is therefore moved on with a short timescale. One person’s care plan clearly showed her/his need for a vegetarian diet. All details about what food the person would or would not like to eat were recorded. Staff we spoke to were knowledgeable about the person’s dietary choices. We saw that in fact the person did eat chicken or turkey on both days of our visit. However, this had also been recorded as a choice. Staff were also clear about making sure the person’s vegetarianism is respected. We did however see other records that stated the diet was no longer being followed! We advised the manager to make sure that specialist dietary needs are kept up and to make sure all staff know what the person wishes to eat at any time. We saw that people get a high level of healthcare input from GP practices, district nurses, chiropodists, audiologists and specialist professionals such as hospice nurses and members of the community mental health teams. A ‘GP visits’ sheet is kept in each person’s care records. However, we suggest this be expanded to become a healthcare visits sheet as the existing sheet wasn’t being kept up and not all records of healthcare visits were easy to see. We checked medication and found that all was properly signed for with no gaps. One person is on a variety of controlled medication (i.e. covering Birchwood DS0000036679.V377544.R01.S.doc Version 5.3 Page 12 medication such as morphine and heroin that is legally more controlled), and we checked this. All was correctly signed and accounted for with the right quantities kept securely. We saw that this medication is checked regularly by healthcare professionals and staff were very aware of signs to show that the person needed it quickly for relief of pain. This means the person is kept as comfortable and free of pain as possible. From all our observations over the two days of this visit we saw that people were treated with dignity and respect. Some staff at the home have worked there for many years. This enables them to get to know the people they care for very well. Staff were able to tell us about individuals and the information they gave us was also seen in care records. We followed up a requirement about making sure care plans and daily records are written in ways that keep peoples’ dignity and treat them with respect. Records we saw were better, although still more factual (rather than person-centred and reporting on the person’s whole wellbeing and enjoyment of life in the home). We did note a tendency for staff to focus on particular issues that showed they may be more concerned than people themselves. We discussed this with the manager and advised that daily records should be about more than just a single issue, be person-centred and include quality of life recording, not just care given. As recorded above, one person has a terminal illness. We met the person on both days and found that s/he was bright, cheerful and comfortable. Staff showed that they’re very aware of the person’s need to remain as independent as possible and had learned to ‘read’ the person’s body language to make sure s/he’s kept comfortable. We saw a detailed care plan that clearly showed the care to be given. Issues around eating and drinking were being well managed and we saw the person enjoying meals on both days of our visit. A sheet had been added to the care records about the persons’ ‘preferred priorities of care’. This means any additional care and that to be given at the end of the person’s life. The manager said she had found the training she had attended very helpful in understanding end of life care and she had been talking with staff about this. We also saw ‘last wishes’ sheets in other care files we looked at. However these were brief and didn’t fully show what the person’s wishes are about the end of their lives and how they wish to be cared for. We suggest that the sheets be expanded to include favourite music, flowers and what people would like at their funerals. This will show that peoples wishes and desires are respected even at the end of their lives. Birchwood DS0000036679.V377544.R01.S.doc Version 5.3 Page 13 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. People with dementia benefit from a range of social and leisure activities that meet their specialist needs. Our observation showed they have a good level of engagement with their surroundings, each other and all staff. Encouragement of contact with the community helps people stay in touch with what is happening outside the home. Few restrictions placed on people living at the home gives them lots of choice in a relaxed atmosphere. Meals at the home are well prepared and managed, provide daily variation, good nutrition and social contact for people. EVIDENCE: We did our observation for a total period of two hours. We watched peoples day unfold in two separate areas: the entrance hall sitting area and the dining Birchwood DS0000036679.V377544.R01.S.doc Version 5.3 Page 14 room at lunchtime. From our observation overall people’s well being is good. We scored peoples engagement in their surroundings with staff and in tasks (such as activities or eating). From these people scored 70 out of a 100 engagement with tasks. We chose to watch people that were less able to join in or engage with others. It was good to see that staff made a point of including these people in all activities and giving a lot of eye contact and praise when they did. When we started our observation CD’s of music from bygone eras were being played. Some people sang along while others tapped their fingers or toes along with the music. It was particularly moving when one person sang along to ‘I’ll be seeing you’ and knew almost all of the words. Staff came and started activities whilst we were watching. Ball throwing was a fun game most people enjoyed, even the most passive or withdrawn. We all joined in and people became animated as the game went on. This was also a good game for peoples co-ordination and there were very few dropped catches. After this a large version of Connect 4 was brought out. Some people played this with staff whilst others watched. Staff then asked people about playing musical instruments, but by this time it was clear people were getting tired and didn’t want to do anymore. Tea and coffee was a welcome break for them. We suggest that any activity should be done in short bursts of ten minutes at most followed by a rest, as people with dementia may find it tiring and hard to concentrate for any longer. We saw in each person’s records, activity and key time sheets. These showed what people like to do and whether they join in. Activities happen daily either in groups or individually. People clearly love listening to music and others like to knit. Some people just like to walk around purposefully and don’t want to join in with activity but will watch for a while. Key time records showed the individual time staff spend with each person. We saw quite a lot of records about tidying of rooms and drawers and suggest discussing with staff more person-focussed key activities. We saw in the dining room lots of photos of various outings that showed people having a good time. We noted that entertainers come into the home and events are held –some for fundraising that people can join in with. Our overall assessment of Birchwood is that it’s a lively place with lots of people with dementia that are able to enjoy life and have good levels of well being. As far as possible people are able to exercise choice in what they want to do or not do. As above, some people have a need to simply walk about and this is respected. People can choose when to get up and when to go to bed. They’re able to stay in bed for a lie-in if they wish. They can choose what to wear, what to eat and whether to join in with activities or entertainment. Whilst the home is secure to make sure people are kept safe, if they wish to go for a walk this choice is respected and a staff member goes with them. Birchwood DS0000036679.V377544.R01.S.doc Version 5.3 Page 15 Contact with the community is also kept up in this way. People can go to the nearby shops with staff and are encouraged outside to watch the wildlife that comes into the grounds. People are not deprived of their liberty unnecessarily and we didn’t see anyone anxious to leave or go out alone. We saw from the AQAA that a non-denominational religious group comes in to hold services and priests and vicars come in on request. Peoples cultural needs are met wherever they have them. We did the second part of our observation in the dining room at lunchtime. It was good to see that tables are now all laid with tablecloths, serviettes, placemats, cutlery and condiments. Lots of tables had small flower arrangements that made them look attractive and homely. People who need them now have patterned cotton tabards to wear rather than plastic aprons as we saw at our last visit. The tabards are of different colours that people can choose. The meals themselves are well-prepared and tasty. On the day we observed, people had a choice of roast turkey with stuffing or roast beef with Yorkshire puddings. Staff showed people plates of either dish that they could choose from. We didn’t see anyone being helped to eat although were aware that one person chooses to eat away from the dining room and a staff member is allocated to help her/him. The atmosphere in the dining room at mealtimes was animated and people clearly enjoy the meals they choose. Birchwood DS0000036679.V377544.R01.S.doc Version 5.3 Page 16 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. Lack of proper attention to recording complaints fails to meet peoples needs for action to be taken over them and could lead to a ‘gate keeping’ culture. Good management of potential abuse issues keeps people with dementia protected from risk of harm or abuse happening to them. EVIDENCE: From the Annual Quality Assurance Assessment – the document home managers have to fill in once a year to tell us how the home is working, the manager had stated no complaints had been received since the last inspection. Copies of the complaints leaflet and how to complain were seen pinned up on notice boards in clear sight for relatives or visitors to see. We looked at the Complaints file and also the management team message book. There were no formal complaints recorded in the file. However we picked up at least three concerns/complaints from the message book. These were from relatives who were unhappy about issues such as admission to hospital and staff care practice. As they were recorded in the message book it was difficult to see what action had been taken and what outcome the relatives could expect. Birchwood DS0000036679.V377544.R01.S.doc Version 5.3 Page 17 The way the complaints had been recorded could also show a ‘gate keeping’ culture by members of the management team. This means that managers decide what is serious or important to treat as a valid complaint rather than accepting all concerns as complaints and taking each one seriously, however minor. We therefore made a good practice recommendation to improve complaints record keeping. This will show that all concerns or complaints are taken seriously and also investigation, actions and outcomes happen within the recognised 28 day timescale. We were made aware of a safeguarding adult from abuse issue during our visit and attended a protection planning meeting on the second day. Information on the allegation had been sent to us. We had also received clear information about other safeguarding issues that showed how staff manage serious concerns and possible abuse. Quick action is taken to protect people and keep them safe and all incidents however minor, are properly investigated. We looked at staff training files and saw that a large number of staff had attended training in safeguarding adults from abuse between 2007 and 2009. Staff are aware of how to recognise whether abuse may have taken place and are vigilant in making sure people are protected. There is a clear whistle blowing policy in place and new staff are given training during their induction, on how to ‘blow the whistle’ on abusive colleagues and report any abuse they may witness. Birchwood DS0000036679.V377544.R01.S.doc Version 5.3 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 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. Whilst the home is in a good state of décor and repair, the physical environment doesn’t always meet the specialist needs of people with dementia and may not keep them safe. Good, proper cleaning and hygiene makes sure people are protected from risk of infection as far as possible. EVIDENCE: The home was very clean and hygienic at this visit. The whole home smelled fresh and when we arrived all was very tidy. We remarked on this to the manager as in fact the home looked too tidy. From the AQAA the manager had stated rummage boxes were in place, filled with things that people might like to look at and touch. The boxes are also an aid to reminding people of their Birchwood DS0000036679.V377544.R01.S.doc Version 5.3 Page 19 past. However at first we didn’t see any rummage boxes. After a while we did find small boxes that were either empty or had very few things in them. Further, the boxes were placed on high shelves that people couldn’t reach. We discussed the boxes with the manager who said that people do use them but tend to take things out of them to hoard in other places. We suggest that keeping rummage boxes going is a continuing activity and should be kept up so that people have lots to look at and touch. The home would also benefit from items of different textures that people can touch. At first we didn’t see any books or magazines around and the environment although homely, looked ‘sterile’. A person living at the home was looking for that day’s newspaper and at first staff were inclined to give her/him one that was several days old. However, after a search that day’s paper was found. However copies of magazines from bygone eras had been loaned to the home and the administrator had copied and framed lots of old adverts. These sparked a lively discussion in the office with some of us so the reminiscence value is good! We followed up a good practice recommendation made at the last visit to make sure changes within the home are done in the best interests of people living there. From the inspection visit that we did in September 2008 we wrote: ‘Some bedroom doors had no photo or any picture to help a person find their room. Some had photos of people as they are now – that they may not recognise. Staff we spoke to admitted that people do deny themselves in these photos and we discussed other pictures such as family ones, pets or people when they were younger that might help them. Staff said that photos of people as they are now are needed to help agency staff find rooms. We suggest that the use of pictures should be about helping the person whose room it is to find it rather than for the benefit of staff’. It was disappointing to find that since then nothing had changed. We saw photos of people as they are now that a) could be somewhat unflattering to them and not what they would choose and b) not what they might recognise. We found lots of evidence in both peoples records and in their rooms to suggest interest in things such as pets, family, wildlife, hobbies or royalty that they might recognise. We discussed the matter with the manager who said a member of the Mental Health In-Reach team (that supports care homes to manage mental health issues) would be visiting to give advice on activities. We suggest that this person (an occupational therapist) be asked for advice on person-centred ways of helping people find their rooms. Corridors and some bedrooms had been redecorated. Lounges were cosy and ‘themed’ e.g. one is a wildlife lounge with lots of framed pictures of squirrels, deer, rabbits etc. Another is a reminiscence lounge that has pictures and items that reflect Victorian, Edwardian, and Second World War eras. The courtyard is very popular with people who were seen enjoying the space and sitting with Birchwood DS0000036679.V377544.R01.S.doc Version 5.3 Page 20 each other and staff. If people wish to smoke they can do so in the courtyard although there is also a smoking lounge. However, the most popular space by far is the area around the front door. The entrance area has been returned to a sitting area for people – which they clearly and naturally want to go to after meals. This gives people a focal point and they enjoy watching visitors come and go. From all the above we concluded that the recommendation we made last time had only been partly adopted. It was pleasing to find that bedroom and other doors were unlocked and people are free to go where they want. Bathrooms are also unlocked and there are clear risk assessments in place to make sure people are kept safe from harm if they go into them. We looked at the bathrooms and in one found a large number of solutions such as bath essence, shaving foam, shampoo and conditioner etc that should have been locked away in the cupboards available. As some people will be at risk we suggest that bathroom doors be painted the same colour as the corridor walls to deter people from recognising them. This will keep them protected from risk of harm. Birchwood DS0000036679.V377544.R01.S.doc Version 5.3 Page 21 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 & 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. Low numbers of permanent staff and reliance on agency staff could affect the quality of life for people living in the home but the situation is well-managed so that all care and social needs are properly met. Satisfactory progress with National Vocational Qualification in Care training makes sure people are looked after well. People living at the home benefit from a well trained and experienced staff group that is able to meet their needs. EVIDENCE: Birchwood is a care home run by the local authority and is subject to its ‘Residential Futures’ programme. This means the home is, among others, likely to close in the not too distant future. People and staff will be relocated into a newly refurbished home in a nearby suburb that will cater for 40 older people with dementia. We discussed this with the manager as the uncertainty has had an impact on staffing. Staffing levels are still low and only supported by frequent use of agency staff. However, wherever possible the same staff are used regularly to give people a sense of continuity and familiar faces. We saw Birchwood DS0000036679.V377544.R01.S.doc Version 5.3 Page 22 agency staff on duty as carers during our visit and they worked well with people and their permanent colleagues. We followed up a good practice recommendation about making sure staffing levels are the same both during the week and at weekends. We looked at rotas that at first made this difficult to see but the manager discussed them with us and showed that the same number of staff now cover each day. From our observation there was clearly enough staff during both days to meet peoples different and complex needs. No new staff have been recruited since the last visit. We also followed up a good practice recommendation about staff training and team building. In particular we found that staff have had training in how to write care records properly and effectively. As above we found that daily records had improved following this training and respectful language is used. However we urged managers to make sure staff accurately record events such as abuse incidents, as such evidence is vital to making sure people are kept safe and protected. Other training done by staff over the last year included: moving and handling updates, person-centred care and supporting people with dementia. Formal team building sessions hadn’t been held following the low morale we picked up at our last visit. However the manager said that staff had worked hard and well as a team to boost fundraising and that this had had a good effect on their morale – as well as dramatically improving funds. This is commended during a period of uncertainty about the future. Birchwood DS0000036679.V377544.R01.S.doc Version 5.3 Page 23 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): 31,33,36 37 & 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. People benefit from living in a home that’s run by a trained and experienced manager who is registered with the Commission for Social Care Inspection. Proper mechanisms for checking quality of care for people keep them safe and protected. However the way records are kept could be improved to maintain peoples confidentiality. Improvement in staff supervision means people get consistent care from a staff team that are able to regularly talk about their working practices. Peoples health and safety is promoted by clear policies, procedures and records that show they’re kept safe. Birchwood DS0000036679.V377544.R01.S.doc Version 5.3 Page 24 EVIDENCE: The manager Debbie Clifford is trained and experienced in working with older people. She holds a National Vocational Qualification at Level 4 in management and the Registered Managers Award. Ms Clifford was welcoming and open to the inspection process and showed enthusiasm for improving the lives of people with dementia in more person-centred ways. We had been unable to send out surveys before this visit due to unforeseen circumstances. Further, the home hasn’t yet had its yearly independent quality assurance survey done. We’ve been made aware however that the surveys will be done between September and November ’09. For homes for people with dementia surveys are sent to relatives and other stakeholders. We also use our observation tool to measure quality of care at each visit. We had been sent regular copies of the team manager’s visits to the home that’s another way of checking quality within the service. The team manager was also present during the inspection for the safeguarding meeting and our feedback to the manager. We followed up a requirement made at the last visit about improving the frequency and recording of staff supervision. Despite a temporary reduction in the management team, it was pleasing to note that the majority of staff supervisions had exceeded the number as laid down in the local authority’s own policy. We checked a sample of records. Some were still brief although the whole way supervision is done had improved. It’s clear that staff get enough opportunities to discuss their work. Whilst daily records written by care staff had improved, we were concerned about the way other records are kept. As detailed above we looked at the management team’s communication or message book. We found that too much detailed, personal information was written in the book that isn’t kept confidential. Where information needs to be passed on about individuals this should be recorded in their care records with a brief note written in the message book for staff to look at these. This will make sure information about people is treated with confidentiality and respect. We saw that frequent, regular fire drills are done and staff sign to say they have taken part. We also saw records of fire training in all staff training files. Staff do training in health and safety and control of substances hazardous to health as well as food hygiene and first aid. Equipment, water, fire doors and alarms are checked regularly and properly recorded. Thermostatic valves on all water taps make sure that people are protected from scalding. Birchwood DS0000036679.V377544.R01.S.doc Version 5.3 Page 25 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 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 Score X X 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 2 3 Birchwood DS0000036679.V377544.R01.S.doc Version 5.3 Page 26 Are there any outstanding requirements from the last inspection? YES 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 OP7 Regulation 15(1) Requirement Care plans must record all relevant, identified needs and records must show that all such needs are met regularly. This will make sure people get the care they need, when they need it. Timescale for action 10/11/09 Timescale not met from September 2008 inspection 2. OP19 13(4) (c) Regular checks of bathroom areas should be made to protect people from accidents. 31/10/09 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 OP16 Good Practice Recommendations All complaints should be recorded properly in the file kept for the purpose and clear evidence of investigation and outcome easy to see. This will make sure people’s concerns are all taken DS0000036679.V377544.R01.S.doc Version 5.3 Page 27 Birchwood 2. OP19 3. OP37 seriously. and people with dementia are kept protected from risk of harm. Advice should be sought about making sure people can use the home’s environment in person-centred ways. This will make sure they aren’t disadvantaged or confused about where to go and what to do. All personal information about each person living at the home should be kept in their own confidential records and not in a general message book. This will make sure records about individuals will be kept confidential and their privacy respected. Birchwood DS0000036679.V377544.R01.S.doc Version 5.3 Page 28 Care Quality Commission Care Quality Commission SouthWest Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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