Care Home: Birchwood

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What the care home does well The environment created for people is well designed and equipped to a high standard to provide comfortable accommodation. People have personalised their rooms and have full en-suite facilities, so that they have a choice of bath or shower as they wish. Accommodation is divided into three groups to promote small group living. Care plans are in place for each person with their needs outlined and input from speech and language therapists to help meet these requirements. Staffing levels are being maintained to make sure that people`s needs can be safely met. What the care home could do better: Some attention is needed to reviewing of risk assessments, to make sure that these are up to date for each person`s personal circumstances. All care plan files need to contain a photograph of the person. Accurate records need to be maintained of medication administered to people, to ensure there is a proper audit trail in place. It is also advisable for a second member of staff to verify hand written entries on record sheets, to ensure that no errors have been made in transcribing information from pharmacy labels onto the medication records. Gaps in people`s employment histories need to be explained to make sure that people can account for what they have been doing since leaving full time education, and photographs of staff added to their files to complete the full range of documents that are needed. Random inspection report Care homes for adults (18-65 years) Name: Address: Birchwood Fullers Close Chesham Bucks HP5 1DP three star excellent service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Chris Schwarz Date: 2 2 0 4 2 0 1 0 Information about the care home Name of care home: Address: Birchwood Fullers Close Chesham Bucks HP5 1DP 01494794112 01494794115 jon.inker@scope.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Jon Inker Type of registration: Number of places registered: Conditions of registration: Category(ies) : SCOPE care home 15 Number of places (if applicable): Under 65 Over 65 0 0 learning disability physical disability Conditions of registration: 15 15 The maximum number of service users who can be accommodated is: 15 The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability (LD) Physical disability (PD) Date of last inspection Brief description of the care home Birchwood is situated on the outskirts of Chesham with a variety of shops, a theatre, various restaurants, good transport links and other local amenities nearby. Care Homes for Adults (18-65 years) Page 2 of 11 Brief description of the care home The service has been purpose built to provide accommodation for 15 service users with physical or learning disabilities. It is fitted with the latest in disability aids. All service users rooms are on the ground floor, with staff accommodation, office and storage space situated on the first floor. There are thirteen single rooms with en-suite shower and/or bath and one shared apartment with lounge, bedroom, kitchen and bathroom. Extensive tracking hoist systems are present in all rooms. A covered car parking space is adjacent to the apartment. The service is divided into three self-contained units. The staff team includes care staff, physiotherapists, activities organisers and speech and language therapists. Access to allied healthcare professionals is possible through direct contact or referral by the service users general practitioner. Care Homes for Adults (18-65 years) Page 3 of 11 What we found: This random inspection took place on 22 April 2010. It was an opportunity to spend a short time at the service monitoring performance and included looking at a sample of care plans, checking medication practice, looking at standards of accommodation and sampling some of the required records such as staff rotas and reports of monitoring visits by the provider. The inspection was facilitated by the duty senior and the services administrator. There was a calm and relaxed atmosphere throughout the service, with service users free to move around the building. Prior to this visit, the manager was sent an Annual Quality Assurance Assessment for completion, which was returned in good time. Surveys were sent out to a selection of staff and people using the service which provided us with useful feedback about how the service is run. The last key inspection of Birchwood was carried out on 18 June 2007. A sample of care plans from one of the three groups were viewed. These followed the same format and contained essential information about people, such as their name, preferred form of address, current and previous addresses, date of admission, date of birth, marital status, next of kin, doctor details and other significant people involved. A couple of the files did not contain a photograph of the service user, which we would advise the manager to address. Peoples needs were outlined such as moving and handling requirements, bathing/showering needs, dietary needs, hearing and eyesight, allergies, social needs, emotional needs, independent living skills, arrangements for carrying out domestic tasks, interests and hobbies, any agreed limitations on choice or freedom, cultural and faith needs and mental health needs. Involvement of speech and language therapists was evident from communication summaries and outlines of peoples dietary needs. Each care plan had been signed and dated. Review sheets were at the beginning of each file. Risk assessments had been completed for moving and handling and areas such as eating, drinking, using the hoist, falling, using transport, and likelihood of developing pressure damage. In one care plan file, the risk assessments had been written in 2006 with a note to say they had then been reviewed in 2008, with nothing more recent indicated. In two files, the assessments to determine likelihood of developing pressure damage had not been updated since March 2008. We would expect risk assessments to be reviewed at least annually and have set a requirement to make sure this is done. Medication practice in all of the groups was checked. Each group had its own medication cabinets, which were secure and the keys held safely. Medication administration records were up to date with signatures alongside prescribed dose times. Some medicines had been hand written onto the printed sheets by staff. Where this is necessary, a second member of staff should check that the information matches that on the pharmacy instructions, and sign the record sheet to verify. This reduces the likelihood of error in transcribing information onto the medication administration record, and the manager is advised to address this. One persons controlled medicines were checked and recorded quantities were found to tally with amounts in stock. One of the recent provider Care Homes for Adults (18-65 years) Page 4 of 11 monitoring reports mentioned that attention was needed to how staff signed medication administration records, such as using correct codes for as required medicines. It was noticed during this visit that in several cases the final tablet in blister packets had been pushed through, ahead of time, with no explanation on the medication record to explain why. It is important that accurate records are maintained of medicines, to provide a proper audit trail, and a requirement is made to address this. The environment was being well maintained. Birchwood is located a short distance from Chesham town centre and is a purpose built property, with accommodation for service users on the ground floor. Accommodation is divided into three groups, Chess, Avon and Isis. Each is self contained with single, en-suite bedrooms and one shared flat for two people. Those rooms that were seen were spacious and personalised, with the necessary adaptations to assist people with daily living tasks. En-suites had both bath and shower, facilitating choice. Doorways and corridors were wide throughout to allow easy access by people who use wheelchairs. Standards of cleanliness were good and there was good odour control. Staff rotas were being maintained which were colour coded for each group. The senior on duty advised that more carers were about to be added to each morning to meet current care needs. A bank of relief staff was available to fill gaps in the rota; there was no agency usage at the time of this visit. Recruitment files for four staff were looked at. The application form now asks for a full employment history for applicants, although in three of the files there were gaps to peoples backgrounds which they had not explained and had not been pursued at interview according to the notes that were taken. Criminal Records Bureau clearance had been received before people started working at the service and there were written references and proof of identity in each case. Files did not contain a recent photograph of the staff member, which need to be added. A requirement is made to improve recruitment practice. Surveys were returned from five people using the service and seven members of staff. People using the service told us that they had received enough information about the service to help them decide if it was the right place for them to move into. They said they had been given written information about the services terms and conditions. Most people said they receive the care and support that they need and that there were staff available when they need them. People said that staff listen and act on what they say and that they receive the medical support they need. People told us that activities are arranged which they can take part in, if they wish, and that they liked the meals. People knew how to make a complaint and said there was someone they could speak with informally if they were not happy. People using the service said that the building is kept fresh and clean. Under what does the home do well? people said look after me very well, everybody makes it enjoyable - everyone does their best to be friendly, I like living here, the food is good and the speech and language team are excellent - they are working to improve communication and my own skills all the time. Under what could the home do better? people commented even more activities (more shows), emotional needs support using more input from psychiatric nurses, more physio, covered walkway between the buildings and more staff. Staff said in surveys that they are given up to date information about the needs of the people they support. They said their employer had carried out checks, such as Criminal Records Bureau clearance and references, before they started working and that their induction covered the areas they needed to know about. Staff told us that they receive Care Homes for Adults (18-65 years) Page 5 of 11 training which is relevant to their role, helps them understand and meet the individual needs of people, keeps them up to date with new ways of working and gives them enough knowledge about health care and medication. Staff said they are supported by their manager and meet to discuss how they are working. They said they knew what to do if someone raised any concerns and that the ways in which information is shared worked well. They said there were usually enough staff to meet the individual needs of people and that they felt they had enough support, experience and knowledge to meet the different needs of people who live at Birchwood. Additional comments included Birchwood gives a high quality of care and support to all its clients. All the clients are treated as individuals and all their physical and emotional needs are met. Birchwood offers a wide choice of activities and classes enabling the clients to go out into the community. The staff at Birchwood work very well as a team, the staff work well within a team together and are caring, supportive and patient, I believe all the needs of the clients are well managed with choices of lifestyle wholly respected. The atmosphere is excellent, and I think, in my opinion, that Birchwood is the most up to date care home for people with cerebral palsy. Areas where staff felt the service could improve were more open and constructive conversations and communication between care staff team, sometimes there is a lack of communication about things we should all know and perhaps more outings. What the care home does well: 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 set out on page 2. Care Homes for Adults (18-65 years) Page 6 of 11 Care Homes for Adults (18-65 years) Page 7 of 11 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 8 of 11 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Individual risk assessments are to be reviewed at least annually. This is to ensure that each persons needs are kept up to date. 30/06/2010 2 20 13 Accurate records are to be maintained of medication administered to people. This is to ensure there is a proper audit trail in place. 31/05/2010 3 34 19 Gaps to peoples working 31/05/2010 backgrounds are to be investigated and a photograph of them added to their staff file. This is to ensure that all appropriate checks have been carried out. Care Homes for Adults (18-65 years) Page 9 of 11 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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