Care Home: Birdhurst Gardens

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What the care home does well The home continues to provide people who plan to use the service and their representatives with the information they need so that they can make an informed decision about whether or not to use the service. There are increasingly comprehensive person centred care plans that include information on their unique needs and personal goals. There are individual risk assessments and risk management strategies in place so that they can participate in activities in the home and in the community in a reasonable safe manner. People are able to attend appropriate social activities so that they can continue to be engaged as a part of the local community. Arrangements are made for people to have regular contact with their friends and families and consultation with relatives about day to day matters occurs when this is appropriate. What has improved since the last inspection? There were a total of one requirement and five recommendations made at the previous key standards inspection in May 2007. It is highly positive to note that all of these had been achieved by the time of this inspection. What the care home could do better: The service needs to compile a fire action plan as required by the London Fire Brigade and need to confirm the dates of the most recent fire alarm system and fire extinguisher safety checks with the Commission. It is also recommended that the safeguarding refresher training be completed for any staff who have not had this training within the last two years. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Birdhurst Gardens 15 Birdhurst Gardens South Croydon Surrey CR2 7DT     The quality rating for this care home is:   two star good service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: James Pitts     Date: 3 0 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Birdhurst Gardens 15 Birdhurst Gardens South Croydon Surrey CR2 7DT 02086806876 02086811649 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Surrey and Borders Partnership NHS Trust care home 9 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: Date of last inspection Brief description of the care home 9 Birdhurst Gardens is registered to provide care for up to nine adults with learning disabilities. There are currently seven service users living at the home. The home also provides respite care to four service users. Birdhurst Gardens is situated in a quite residential street of similar properties in south Croydon. The home is a large detached property built over three floors. Each of the service users has a single bedroom; there is also a communal lounge/dining room as well as, bathrooms, an office and kitchen. To the rear of the premises is a pleasant garden, which is well used in the summer months. The home has an outside laundry facility and parking to the front. All service users are charged a fee of #57, 898, 09 per annum. Care Homes for Adults (18-65 years) Page 4 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The people who use this service can expect to achieve GOOD Quality Outcomes. Birdhurst Gardens is registered to provide care for up to nine adults with learning disabilities. There are currently eight people using this. The home also provides respite care. Birdhurst Gardens is situated in a quite residential street of similar style domestic properties in south Croydon. The home is a large detached house built over three floors. Each of the service users has a single bedroom; there is also a communal lounge/dining room as well as, bathrooms, an office and kitchen. To the rear of the premises is a pleasant garden, which is well used in the summer months. The home has an outside laundry facility and parking to the front. All service users are charged a fee of £58, 621, 82p per annum. Care Homes for Adults (18-65 years) Page 5 of 27 The site visits took place on two days, the first visit being at a time when all of the people who use the service were out for the day attending activities. The second visit took place earlier in the morning when everyone was still at home before going out. Two of the people who use the service made specific comments, one saying how much they like the staff, and one staff member in particular. The other person made comments about their excitement in respect of a holiday that is currently being planned. Six of the people who live here also sent us questionnaires that they had completed with the help of staff. These indicated that those who replied are either usually or always satisfied with the service and many also highlighted that they have lived here for quite a long time. Methods of inspection included a tour of the premises, observation of contact between staff and people who use the service and discussion with Ms Sowambur, the registered manager. Records that we examined included person centred plans, risk assessments, complaints, adult protection, staffing training records, Statement of Purpose, Service Users Guide, medication, and health and safety records. Requirements and recommendations from the previous inspection were also discussed with the registered manager. What the care home does well: What has improved since the last inspection? 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 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and health care support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides people who plan to use the service and their representatives with the information they need so that they can make an informed choice about whether or not to use the service. The homes admission procedure ensures that anyone who wishes to live here have a thorough assessment of their needs and aspirations before they move in. Evidence: The home has a Statement of Purpose and Service Users Guide. The Information included in these documents provides the necessary detail that potential users of the service would wish to know. We looked at the assessment of need and the admission process for the one person who has come to live at the home in the last year. This person transferred from another Surrey and Borders care home that was closing down. The assessment and planning procedures that were used demonstrate that proper consideration was given Care Homes for Adults (18-65 years) Page 9 of 27 Evidence: to whether the service can meet their needs, before a decision was made for this person to move in. Care Homes for Adults (18-65 years) Page 10 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service can continue to feel confident that staff know what they need. They can also be assured that the staff will make sure that each person who lives at the home is allowed to live the sort of life that they can meaningfully choose to. Evidence: All of the people who live at Birdhurst Gardens continue to have a detailed service user plan. We looked at three of these during this inspection and they tell the staff in detail about the best ways to support each person. It also tells the staff about what each service user likes to do each day, the things that they like and how the staff should do the best things to help in the right way. Each service user has an allocated key worker. This is a member of staff who especially makes sure that each individual is being supported in the right way. It was recommended at the previous key standards inspection that more details should be included in each care plan about the support required to undertake personal care tasks, and about their unique cultural and Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: religious heritage. This is now happening and the care plans are currently being updated for this year, using a newer version of the personal care plan format that has been introduced. The staff team evidently remain committed to making sure that all the people who live here are allowed to make meaningful choices about how to live their life. The people who use this service are asked about the things that they like, what they want and how they want things to happen. They also all take part as far as is practicable in helping to run the home and do the things about the house that need doing. Staff are there to help whenever they need to. Risk assessments are written for each of the people who use this service. A risk assessment tells the staff how to make sure that each of the people living here is kept safe from anything that might harm them. The staff are still very good at doing this and they make sure that the risk assessments are looked at regularly to make sure that these are changed if they need to be. There are also risk assessments written about anything in the house or garden that might hurt anyone if it is not taken care of. Care Homes for Adults (18-65 years) Page 12 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service can continue to feel confident that they will be supported and encouraged to attend appropriate social activities so that they can be a part of the local community. Appropriate arrangements are also made for people to have regular contact with their friends and families. Dietary needs are well catered for and well-balanced, nutritional meals, based on personal preferences continue to be provided. Evidence: Each of the people who use this service continues to have a varied programme of social activities with an emphasis on using resources in the community. Each person attends day services at Geoffrey Harris House on four days per week. The manager said that people go on different days and have an individual activity timetables, Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: including household and recreational activities. Holidays are also planned and staffing resources are made available to facilitate these. One example is that three people who use this service have decided to go together on a cruise in early summer and the planning for this is well underway. The manager said that some people have regular visits to and from family and some keep in contact with relatives and friends by letters or telephone. Relatives continue to be invited to care plan reviews, Christmas and birthday parties and barbeques in the summer. Food menus are based on a four-week rota and show that consultation occurs with each person about their likes and dislikes. Menus are seasonally varied and include meals that reflect individual cultural preferences. The menu is presented with pictures as well as words in order to make these as accessible as possible for all of those who use this service. People continue to be offered an alternative to the main meal if they prefer. The trusts dietician checks the menus for nutrition and balance. Weekly activity records also show that people can be, and are, supported to prepare and cook meals for themselves and others in the home. Care Homes for Adults (18-65 years) Page 14 of 27 Personal and health care support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service can be assured that they receive the proper support in the way they prefer and require and are now protected by the policies and procedures for responding to health care needs and handling medicines. Evidence: It was noted at the previous key standards inspection that one persons centred plan stated that the person needed support with brushing their teeth but the plan did not indicate how this support should be offered. It was recommended that where people need support with personal care tasks such as bathing, brushing teeth and shaving that more detail and instruction should be recorded so that unfamiliar staff are aware of exactly how that person should be supported. It is positive to note that the recommended improvement has been achieved and this is reflected in the sample of person centred care plans that we looked at during this inspection. All of the people who use the service continue to have a health action plan and all have health screening checks. There is continuing evidence that people have good access to health care professionals including Opticians, Dentists and Psychologists. An Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: example is that one person was referred for a check to see if the suffer from dysphagia. This is a condition where swallowing difficulties can place someone at severe risk of choking. Fortunately no serious problem was identified and updated checks were also carried out for some others to ensure that they too are not at risk. This is evidence of good practise in responding speedily where a heath care concern may arise. It was recommended at the previous key standards inspection that all staff should receive updated training about managing diabetes and ensure that they are competent to administer insulin. This occurred in September 2007. Medication is stored in a locked cabinet in a small room under the stairs. Medication administration records were examined. Due to a couple of medication errors that were identified at the previous key standards inspection it was recommended that all staff be reminded of the policies and procedures for handling medicines. It was also recommended that the registered manager carry out weekly medication checks to make sure that people are receiving their prescribed medication. Both of these issues subsequently received the necessary attention and no further concerns were identified at this inspection. Care Homes for Adults (18-65 years) Page 16 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service can continue to feel confident that the staff team at the home know what to do if there are complaints or concerns about abuse. The home has clear guidance for staff about the procedures to be followed in either of these circumstances. Evidence: At the time of writing this report there had been six comment cards had been returned to the Commission from people who use the service. No comments from relatives had been received. Because of the communication difficulties that some people experience both the manager a members of staff had supported people to complete the comment cards. The feedback that was given was positive and examples of comments that people made can be seen in the summary at the beginning of this report. The homes complaints procedure is completed in text and picture format in order to make this as accessible as possible for the people who use the service. Two complaints had been made in the last year. Each of these was minor in nature and was properly resolved by the service. The previous key standards inspection recommended that all members of staff attend refresher training on adult protection. Since that time a further four staff have done so. It is now recommended that those who have not updated this training and are not new staff who receive the training as a part of their induction now be sent on an Care Homes for Adults (18-65 years) Page 17 of 27 Evidence: update course. It is very positively noted that the service has quickly implemented the new national requirements under the Mental Capacity Act. This is evident in the way in which a very diligent process was undertaken in respect of an important decision for one of the people who lives here. This person would not have been in a position to knowingly make the decision independently without the involvement of others. Assessment and meetings were held to ensure that this person had their best interests considered and that all viewpoints, including those of their family, were given due regard. The service is congratulated for the way in which this process was managed. Care Homes for Adults (18-65 years) Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service can continue to feel confident that they are living in a well maintained, clean and pleasant home. Evidence: The home has a toilet and bathrooms on each floor plus two separate toilets. Bedrooms are of good size and sufficient to meet individual needs and lifestyles. Bedrooms have been decorated to their own personal choices. Furniture remains of good quality. During day 2 of this inspection it was seen that decorators are just starting redecoration of communal areas, and this will extend to bedrooms now that each person has had the opportunity to select their own colour scheme. Care Homes for Adults (18-65 years) Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service can continue to feel confident that the home carries out the proper pre-employment background checks and that staff are properly supported and managed to do their work. Evidence: There have been further staff changes since the previous inspection in May 2007. These staff changes resulted in 2 staff being redeployed from another service within the trust that had closed. These staff would previously have been subject to the recruitment procedures in operation and it was therefore unnecessary to repeat that process. Over 50 percent of the staff team are qualified at NVQ level 2 or higher. This means that the service currently complies with the percentage of staff that are required to hold this qualification. The home keeps records that say what training courses staff have done, and when they did them. This is a part of the annual appraisal process that continues to be undertaken each year for all employees. Care Homes for Adults (18-65 years) Page 20 of 27 Care Homes for Adults (18-65 years) Page 21 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The overall impression when visiting the service is that it is well managed. There have been a number of further improvements made benefiting people who use the service and staff since the last key inspection. Evidence: Ms Sowambur, the registered manager, is qualified RMN registered nurse and has attended the Registered Managers Award qualification course equivalent to NVQ Level 4. She has managed the home for some time and is able to continually demonstrate that she has the necessary skills and qualities to do so. It should be noted that this service is included in Surrey and Borders social care change programme, which will result in services being transferred to other providers. Given the understandable uncertainty that this process can create it is positive to note that the service continues to seek improvements and does not allow this situation to impair that. A requirement was set at the key inspection that the registered manager ensures that weekly fire alarm checks are carried out and that all staff are aware of the location of Care Homes for Adults (18-65 years) Page 22 of 27 Evidence: the weekly record. This is now occurring. The homes fire records indicate that regular weekly fire alarm checks are carried out. On 9th July 2008 the London Fire Brigade visited the home and required that the service have an emergency plan. This has not been achieved and will result in a requirement to compile a plan, or to send a copy to the Commission if this has already been compiled by the trust. Additionally the trust must forward a copy of the most recent fire alarm system and fire extinguisher maintenance check certificates. Monthly visits that are required under regulation 26 are occurring and evidence for the previous 12 months of the reports of these visits was seen. Ms Sowambur stated that the annual development plan for this current financial year is being written at the moment. Ms Sowambur produced up to date certificates for Gas Safety, Portable Appliance Testing and a half yearly water treatment test. The public and employers liability insurance was also within date at the time of this inspection. Care Homes for Adults (18-65 years) Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 42 23 The registered person, as required by the London Fire Brigade at their visit of 9th July 2009, must compile an emergency and a copy be sent Commission. To ensure the safety and wellbeing of those who live and work at the service. 26/06/2009 2 42 23 The registered person must 26/06/2009 forward a copy of the most recent fire alarm system and fire extinguisher maintenance check certificates. To ensure the safety and wellbeing of those who live and work at the service. 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 25 of 27 1 23 It is recommended that any members of staff who has not attended refresher training on adult protection since prior to 2007 be sent on this training. Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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