Care Home: Birkdale Park

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What the care home does well Prospective residents have a detailed assessment prior to admission. This ensures that staff have identified the individual needs and are then able to use that information to commence a care plan for the prospective resident. Prospective residents and their families are able to visit to view the service and can have periods of respite before accepting a permanent placement. One relative interviewed stated, "I looked at twenty homes and chose this one, I`m happy with it". Birkdale Park is a very well maintained service and residents bedrooms, public rooms and hallways are very well decorated and clean throughout. There are two public rooms. One overlooking the front garden provides residents with a quiet and relaxing environment. The conservatory/dining room overlooks the rear garden and is light and airy. Residents also have easy access to the gardens. The rear garden has plenty of garden furniture that is suitable for residents and their visitors needs. Residents and their relatives were happy with the care that is provided. Residents interviewed stated, "I think it`s very nice. I have been in a couple of places but this is the best place I have been" and "I sleep all night here, I never use to at home". Residents were happy with the staff that care for them. Residents interviewed stated, "Staff are exceptionally nice, very patient", "We are looked after well" and "Staff come straight away at night if they are buzzed". Residents told us they enjoyed their meals. One resident interviewed stated, "I like the food, it`s very good, I look forward to the meals What has improved since the last inspection? Each resident now has a care plan on admission to the service. The care plans viewed were lengthy and covered all of the residents assessed needs. All new residents have had a manual handling assessment and this will also ensure any risk of falls has been identified. Early specialist intervention is now being sought for those residents who are at risk nutritionally. Dietary advice has been sought for residents from the Dietitian and prescribed supplementary meals have been provided. Where residents nutrition is compromised their weight is measured more frequently. Prescribed creams are now administered from the residents own labeled cream. The service has fitted new windows in the kitchen, preparation room and staff room. A new wet room has also fitted to the nursing floor. Staff records show that better pre employment records, up to date police checks and registered nurse permission to practice documentation is up to date. This will ensure residents are protected. What the care home could do better: Care plans and care documentation that is not active needs to be archived so that the up to date care plan and other care documentation are easier to follow. Care plans need to evidence that the resident or their representative agrees the care planned and any changes. The multi disciplinary records need to be more detailed to ensure full information is documented. This will ensure staff are clear about residents needs. A care plan should be in place for each wound that shows the treatment and progress of each area. It is recommended that wound mapping is used to show the progress of residents wounds. Staff will then be able to monitor the effects of treatment more closely. It is strongly recommended that the resident who was identified as being uncomfortable in their chair should be reassessed. This will ensure that the resident is able to be positioned in a more suitable armchair that will provide the required support. It is recommended that the resident who has been refusing to use their dentures has a dental assessment. This will clarify the residents problems with eating their meals. The resident may then be able to have a more enjoyable meal time, without their food getting cold. All registered nurses need to sign the medication administration records so that we know if the resident has had their prescribed medication or not. The service should not order any more paracetamol for the resident identified during the visit until the large amount stored is used up. When creams have been applied to residents skin the name of the cream needs to be identified so that staff know what is being used. It is recommended that staffing levels should be kept under review to enable activities to be in place for residents. Residents should be canvassed for their views on what kind of activities they would like to do. This will prevent them from feeling isolated. Each resident needs to have an activities record that documents what activity they have attended. All staff should have a training and development file, that evidences all on line training and practical training attrended. This will evidence their individual training needs and training record to date. All staff files should evidence that staff have a contract that shows the terms and conditions of employment. The staffing rota should show the full names of staff who who work there. This will make it easier to identify who is on duty. It is strongly recommended that a senior nurse is employed to manage and supervise the nursing needs of the residents. This will ensure that residents care is not compromised. Key inspection report Care homes for older people Name: Address: Birkdale Park 6 Lulworth Road Southport Merseyside PR8 2AT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Margaret VanSchaick     Date: 2 5 0 5 2 0 1 0 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 32 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Birkdale Park 6 Lulworth Road Southport Merseyside PR8 2AT 01704566055 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Carol Patricia Cunningham Name of registered manager (if applicable) Type of registration: Number of places registered: care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Service users to include up to 25 OP Date of last inspection Brief description of the care home Birkdale Park provides nursing care for 25 older people. It is owned by Mrs C Cunningham and the acting manager is Christine Hazelton. The home has been converted from a large house to a care home and is situated in a residential area of Southport. It is on the main bus route to town and is close to Birkdale village. Recreational areas comprise of a lounge to the front of the building and a conservatory overlooking the garden. This room is also used as a dining room. The home has single and double bedrooms but all rooms are currently used to provide single accommodation. There is lift access to both floors and the mezzanine level (floor not serviced by a lift) has 2 bedrooms. These bedrooms are accessed by a short flight of stairs and a chair lift has been fitted. The home has 2 bathrooms with adapted baths to Care Homes for Older People Page 4 of 32 Over 65 25 0 1 2 0 8 2 0 0 9 Brief description of the care home assist those who are less independent and a call system with an alarm facility. Gardens are landscaped to the front and rear; the rear garden is spacious and enclosed. The home has ample car parking space and a minibus is available for hospital appointments and trips out. The weekly fees are £474-£550. Care Homes for Older People Page 5 of 32 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: A site visit took place as part of the unannounced key inspection. It was conducted over one day by one compliance inspector. An expert by experience, Mrs June Trumble accompanied the inspector for part of the inspection. The inspection lasted approximately 9 hours. Fourteen residents were accommodated at this time. As part of the inspection process most areas of the service were viewed including residents bedrooms. Care records and other documentation was viewed. Discussion took place with residents, one relative and staff. The inspection was conducted with Jonathan Cunningham the administration manager. During the inspection two residents were case tracked (their files looked at and their views of the service obtained). Medication and their storage was looked at. All of the key standards for the older people were inspected except finances, which had been assessed in August 2009 as met. Previous requirements and recommendations made at the last inspection in August 2009 have been met. Care Homes for Older People Page 6 of 32 A number of comments included in this report are taken from interviews of residents, a relative and staff. An AQAA (Annual Quality Assurance Assessment) has been completed. The AQQA consists of two self assessment questionnaires that focus on the outcomes for people. The self assessment provides information as to how the manager and staff are meeting the needs of the current residents and a data set that gives basic facts and figures about the service including staff numbers and training. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 32 Care plans and care documentation that is not active needs to be archived so that the up to date care plan and other care documentation are easier to follow. Care plans need to evidence that the resident or their representative agrees the care planned and any changes. The multi disciplinary records need to be more detailed to ensure full information is documented. This will ensure staff are clear about residents needs. A care plan should be in place for each wound that shows the treatment and progress of each area. It is recommended that wound mapping is used to show the progress of residents wounds. Staff will then be able to monitor the effects of treatment more closely. It is strongly recommended that the resident who was identified as being uncomfortable in their chair should be reassessed. This will ensure that the resident is able to be positioned in a more suitable armchair that will provide the required support. It is recommended that the resident who has been refusing to use their dentures has a dental assessment. This will clarify the residents problems with eating their meals. The resident may then be able to have a more enjoyable meal time, without their food getting cold. All registered nurses need to sign the medication administration records so that we know if the resident has had their prescribed medication or not. The service should not order any more paracetamol for the resident identified during the visit until the large amount stored is used up. When creams have been applied to residents skin the name of the cream needs to be identified so that staff know what is being used. It is recommended that staffing levels should be kept under review to enable activities to be in place for residents. Residents should be canvassed for their views on what kind of activities they would like to do. This will prevent them from feeling isolated. Each resident needs to have an activities record that documents what activity they have attended. All staff should have a training and development file, that evidences all on line training and practical training attrended. This will evidence their individual training needs and training record to date. All staff files should evidence that staff have a contract that shows the terms and conditions of employment. The staffing rota should show the full names of staff who who work there. This will make it easier to identify who is on duty. It is strongly recommended that a senior nurse is employed to manage and supervise Care Homes for Older People Page 9 of 32 the nursing needs of the residents. This will ensure that residents care is not compromised. 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. Care Homes for Older People Page 10 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 32 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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. Prospective residents have a detailed assessment of their needs carried out prior to admission. Evidence: The service invites prospective residents to view Birkdale Park prior to admission. This ensures they and their families meet with residents and view what the service has to offer them. The prospective resident and their family can see what facilities are provided and make choices about their bedroom. The care documentation evidenced that two families had helped to choose the service and bedroom for their relative. A family visitor interviewed confirmed their relative had been assessed prior to admission. The relative interviewed stated, Yes, someone came out to assess ...... before they came in, I looked at twenty homes and chose this one, I am happy with it. Documentation showed that one of the residents was admitted for respite before Care Homes for Older People Page 12 of 32 Evidence: becoming a permanent resident. Information with regard to personal details including family and other health professional contacts were in place. Both residents case tracked were assessed prior to admission. Care assessment documentation evidences this. The pre admission assessment shows that many areas were covered including, reason for admission, previous medical history, immediate care needs such as mobility, nutrition, skin care, personal hygiene, mental health, communication, sight, hearing, oral care and other information such as religious needs. The information gained was comprehensive and provided sufficient detail to set up a care plan to manage their individual needs. Care Homes for Older People Page 13 of 32 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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. Residents now have a care plan in place on admission to the service. Evidence: Both residents had a care plan in place from admission. The care plans viewed showed that they had been updated monthly. In March this year their care was fully reviewed and new care plans were put in place. The care plans were lengthy and provided lots of information about residents care needs. Some of the previous care information was still on file and made the care files difficult to follow at times. The information recorded was in duplicate therefore it would be of benefit to staff, if files were audited to ensure only the up to date care plan and care documentation should be kept in use. The remaining information including daily evaluations should be archived so that staff can follow the records easily. The care plan documentation has however improved a lot since the last inspection. There was a care plan for every identified need. A night care plan was also in place, which provided residents preferences in regard to their night pattern. Care Homes for Older People Page 14 of 32 Evidence: Residents interviewed told us they were happy with the care provided. Residents interviewed stated, Im very happy, Oh yes, Im happy, I like the staff, they help me a lot, they help me turn in the night and help with my bath. A family visitor interviewed stated, ......has seen the Dr a couple of times, the dentist and optician, I dont think ....could be looked after any better, anywhere else. Staff were observed using a hoist to transfer a resident from their wheelchair to a lounge chair. This was done very gently and carefully. Care documentation showed that residents had input from other health professionals including Gp,s opticians, chiropodists, dietitian and tissue viability nurse. One of the entries showed a GP was asked to visit, as a resident was suffering pain but there was no record on the document of where the pain was. This needs addressing so that staff are fully aware of the residents condition including where the pain is so that their needs can be met. We observed one of the residents having difficulty eating their lunch. Their meal was getting cold. This resident refuses to wear her dentures,which has been noted in the pre admission assessment and the care plan, yet there has been no reason given as to why the resident refuses to wear their dentures. The nurse on duty told us it might be because the dentures were too big. An oral and dental assessment needs to be carried out to see if the ability to eat and enjoy their meals can be improved for this resident. This resident has also been identified as being nutritionally compromised and they have lost 3 kg since admission. The community dietitian has visited and the resident has been prescribed nutritional supplements. One of the care plans has recorded that a resident has a superficial graze and has cream applied but the cream has not been identified. Wound care is recorded on the care plans also. The wound care description is not very clear at times although treatments are recorded. It would be of benefit if each wound had a separate care plan and treatment record. Wound mapping would also be recommended as this will evidence how the wound is progressing. This will make it easier for staff to follow . There was no evidence in the care plans that we looked at to confirm that residents or their families had agreed their care. When care is reviewed there needs to be evidence on care documentation that the resident or their representative has agreed the planned care. One of the residents was noted to be in some discomfort whilst sitting in their Care Homes for Older People Page 15 of 32 Evidence: armchair. Despite some assistance from staff the resident did not look to be in a relaxed and comfortable position. This resident needs to be reassessed to ensure they are resting in a comfortable position and that the chair they are sitting in is suited to their individual needs. Other residents were noted to be comfortable in their armchairs. One residents general condition has deteriorated recently and staff have contacted the GP as the resident was having difficulty swallowing some of their medication in tablet form. A request has been made by staff to the GP to provide medication in a different format. This will ensure the resident has their prescribed medication. Care documentation evidences risk assessments have been carried out to include nutrition, mobility, use of bed rails and risk of falls. These are reviewed and updated monthly. Where bed rails are in place comfort bumpers were in place to prevent injury. With regard to special preferences of the individual resident the care plans identify some of these including, request of a female or male carer, how they like to be dressed and who they wish to allow to visit them. It was evident during the visit that residents had access to various pieces of equipment to promote their health and safety including specialist mattresses, air cushions, bed rails and protectors. Medication is stored in a locked room. The storage of the medication was tidy and organised. A medication trolley is used to store medication in blister pack form. One of the residents had an over supply of Paracetamol therefore the service need to ensure that no more are ordered until the supply has been used. Good stock control was evidenced of the other medication viewed. The medication administration sheets were viewed and showed that on isolated occasions staff signatures were missed therefore it is not known if residents have had their medication or not. The medication sheets evidenced photographs of the individual resident, date medication received and signature of registered nurse. All of the residents were noted to be well groomed and dressed appropriately. Each resident has their own bedroom although there is a facility for them to share if they wish to. Privacy screens were available. Some of the residents preferred to stay in their own rooms and this was respected. For those residents who wished to, there were two public rooms for their use. Residents were supported by staff to spend their Care Homes for Older People Page 16 of 32 Evidence: time where they wished. Staff were observed to be kind and respectful in their approach to residents. Visiting health professionals and others see the residents in their own room. A relative told us they were encouraged to visit when they wish. Residents are then able to keep in contact with their families and friends. All of the residents have their own telephones. Care Homes for Older People Page 17 of 32 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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. Residents are encouraged to make choices about how they wish to live and staff assist and support them where needed. Evidence: Residents have some say in how they wish their daily routine to be. Care documentation evidences their preferences. Some residents like to socialise with others and are assisted to the public room they wish to sit in. Other residents who prefer their own company usually spend most of their time in their bedrooms. Residents told us they were happy living in Birkdale Park. One resident interviewed stated, I think its very nice, Ive been in a couple of places but this is the best place Ive ever been, I sleep all night here, I never use to at home, Some of the residents are very frail and unable to participate in activities. Although activities are listed for each day, residents interviewed did not remember any. One resident interviewed stated, Im bored, I have nothing to do. A staff member told us that they use to do a lot more with the residents but gradually over the past months residents dont want to participate. One of the staff interviewed stated, They have activites on Wednesday afternoons. The hairdresser visits in the morning and they Care Homes for Older People Page 18 of 32 Evidence: have film shows, bingo, dominoes and the owners son occasisonally does excercises with them, they dont do activities every day. The service needs to look at finding out what activities residents would really like to do. It may be that they would prefer one to one activities with staff. Staff interacted well with residents, they were observed to be patient and caring but staff were busy during our visit and did not seem to have time to engage with residents. When asked about activities one resident stated, I dont think they have enough trips, it would be nice on occasions to go out. Visitors are made welcome by staff and are encouraged to visit when they wish. Residents who have specific wishes in regard to who visits them have their wishes accommodated. This is documented in care files. Residents are encouraged to keep in contact with their families and friends. One relative interviewed stated, Staff welcome me, we are on first name terms, I am offered drinks when I visit. All of the residents have a telephone line in their bedroom and are also able to use internet access to communicate with friends and family. Some of the residents have used this facility. Residents interviewed stated, My daughter visits regularly and I have three children and nine grandchildren. They all come to visit, they are made to feel welcome. Residents have regular visits from local clergy who provide Communion and religious support. Residents bedrooms showed that many were personalised with some of their own items in place. The menus on display for the four weeks showed that a varied and nutritious diet is offered to residents. There was evidence of choices at each meal. During the visit we observed the meals served and they looked nutritious and well presented. There was also evidence of home baking in the kitchen and a plentiful supply of fresh fruit, vegetables and other foods observed in the store room and fridges. Residents interviewed told us they were satisfied with the meals served. Residents interviewed stated, I like the food, its very good, I look forward to the meals. I like everything, I get choices, It is always a surprise. We are not told what lunch is going to be, not always what youd choose but cooked very well, I can never eat the potatoes, they do not agree with me, I send them back, it would be better if they gave them to someone else and On the whole very good, I would like some bacon for breakfast. A relative interviewed stated, It was home made steak pie and fresh vegetables today, if it is not what my wife wants, the cook will do something else. Care Homes for Older People Page 19 of 32 Evidence: Residents ate their meals in their bedrooms or in the conservatory. Some of the residents required some assistance from staff with their meals and this was provided discretely and with patience. One of the residents was noted to need some more support, possibly a cushion to help improve their position at the table. Another resident was having difficulty trying to eat her food and the meal became cold whilst they were eating it. Staff told us that this resident wishes to eat unaided. There needs to be further assessment of this resident to try and promote their ability to eat at mealtimes. Cold drinks were served at lunch time. It may benefit the residents if they were offered a warm drink as many older people prefer this. Care Homes for Older People Page 20 of 32 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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. Residents are being protected by the service procedures. Evidence: The complaints process is displayed on the reception notice board and a relative interviewed told us they were aware of the complaints procedure. The procedure is clear and easy to follow. A relative interviewed stated, If I had a complaint, I would go the Matron, the procedure is all up on the notice board. I have never had any reason to complain. One of the residents interviewed stated, If I were worried, I would speak to the girls. A complaints log was in place and records show that three complaints have been raised since the last inspection. Two were not upheld and one was. The complaints record shows that an investigation had been carried out for each complaint and the complainant informed of the result. The service have a copy of the local adult protection procedure. The AQQA stated that most of the staff have been provided with adult protection training. Staff interviewed were knowledgeable about the processes involved. Some of the staff told us that they had attended adult abuse training. One staff interviewed stated, I have done it on line and some of the other staff have done it outside. Care Homes for Older People Page 21 of 32 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, 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. 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 service provides a clean, comfortable and well maintained environment for residents. Evidence: The service employs a maintenance person to manage the ongoing programme of maintenance and it was evident during our visit that the building and gardens were maintained to a good standard. Two public rooms are provided for residents use. One overlooks the front garden and provides a comfortable and quiet sitting room. The other is the conservatory/dining room, which provides residents with a light, spacious and airy room overlooking the gardens. A home cinema is fitted to this room so that residents can watch films. Residents bedrooms, hallways and stairs were all decorated in a domestic style providing residents with a comfortable and homely environment. Residents spoken with were happy with the environment and their bedrooms. One resident stated, I like to sit in my room, I like it, I have a lovely view of the garden. A few of the residents were observed watching the opening of the new parliament on the large screen television. All of the areas viewed were clean and tidy. Many of the residents bedrooms showed Care Homes for Older People Page 22 of 32 Evidence: that each had their own belongings, which personalised their bedrooms. Bedrooms have been fitted with a personal telephone line and television. The well established gardens provide sitting out areas for residents and their visitors. Residents are able to access the gardens easily and suitable garden furniture has been provided for them and their visitors. Fire escapes were checked and were well maintained with fire doors opening easily. A call bell system is fitted throughout the service and was in good working order. The laundry service is managed by an appointed laundress. It was clean and well organised during our visit. Sufficient equipment was in use to provide an efficient service. Hand washing facilities and protective clothing was available for staff. The kitchen was clean and well organised. We spoke with the cook who told us she was happy with the equipment and budget she had. Cleaning schedules were in place and surfaces were easy to clean. All hot foods and fridge/freezer temperatures were recorded. New windows have been fitted to some of the downstairs rooms to include the kitchen, preparation room and staff room. A new wet room has also been added for residents use. Care Homes for Older People Page 23 of 32 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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 pre employment procedures have improved significantly. The service needs to fully evidence induction and training on staff training and development files. Evidence: The staffing rota showed that sufficient staff were on duty during our visit. However, the service need to continue to monitor staffing levels as staff told us they are busy in the afternoons with bathing and caring for residents and may not have time to do activities. At 2pm one of the care staff goes off duty therefore reducing the staff levels. Staff told us that care was not compromised. The staffing rota document could be improved by ensuring full staff names are recorded on duty sheets. Staff interviewed during the visit told us they enjoyed working at Birkdale Park. Staff interviewed stated, The Cunninghams are good to us The manager is approachable, we can have flexible off duty I think the residents are well looked after, we have enough time too and I can talk to the manager and Mrs Cunningham and her son Jonathan are approachable. Residents and relatives told us that they liked the staff who worked at Birkdale Park. Residents interviewed stated, Staff are always nice to me, Id be lost without them, Care Homes for Older People Page 24 of 32 Evidence: I think the staff are all very nice, Staff are exceptionally nice, very patient, We are looked after well, Staff come straight away when buzzed for and Some staff are more patient than others. The AQAA stated that 4 of the care staff had the NVQ Level 2 qualification in care with 6 others enrolled for this course. One of the care staff files evidenced that one carer had the NVQ Level 3 qualification. There has been a big improvement in the management of staff personnel files. Files were organised and easy to follow. Pre employment checks were in place in all of the files that we checked. Staff files included two written references, police checks, application forms with job history and previous training attended. The registered nurse qualification had been checked to ensure nurses are legal to practice. Not all of the staff files had a contract of employment in place, therefore this needs addressing. The AQAA stated that all staff had completed an induction programme. We could not find any evidence of induction on the staff files that we viewed. Staff interviewed stated, I had an induction as a care assistant for one day that included a tour and worked with an experienced carer for a few days, my induction training is all on file, I had an induction and tour on one afternoon and I did not really have an induction. Staff need to have a training and development file that shows individual staff have a record evidencing what their specific and individual training needs are. The file needs to evidence training they have attended, date of attendance and certificates to evidence they have completed it. We looked at the training audit dated 25th May 2010. This shows a list of mandatory training completed by staff, with most recorded as having attended the training. The administration manager told us that staff were now able to carry out some of their training on line. A facility has been set up in the service for those staff who wish to use it. Staff interviewed confirmed this. Staff interviewed with regard to training gave us mixed messages. Staff interviewed stated, I have not done any training here and I have done quite a lot of training and can now do some on line, it should be on my file. The administration manager also told us that when regular staff meetings have been held that a discussion takes place to cover fire training. This is good practice but not all of the staff were able to attend the meetings. Individual staff training needs should be reviewed and this will identify the training needs of each member of staff. Care Homes for Older People Page 25 of 32 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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 service needs to provide a senior nurse to ensure the nursing care of the residents will be well managed. Evidence: The service has been without a registered manager for approximately 2 years. The acting manager has given notice to resign her position, whilst continuing to work as a registered nurse on a part time basis on night duty. The administration manager has applied to the commission to become the registered manager. Meanwhile the service have advertised for a senior nurse to manage the nursing care of the residents. So far no one has been appointed. The service continues to keep us informed of any changes. The service has an external quality assurance award. The administration manager carries out internal audits on a monthly basis and we viewed the results of May 2010 audit. This showed that many areas are audited including, fire alarm testing, cleaning schedules, staff files and training, health and safety checks and room risk Care Homes for Older People Page 26 of 32 Evidence: assessments. The audit also evidences comments made by the administration manager with regard to areas that need action. The service hold meetings with staff on a regular basis throughout the year. We viewed the agenda and minutes of the most recent meeting in March 2010. The service has also commenced surveys for residents and their families and plan to do them 3 monthly. The most recent was carried out in March 2010. The results of which were positive and were displayed with the staff meeting minutes on the notice board in the reception hallway. Policies and procedures continue to be updated annually. We have not looked at residents financial records during this visit as the registered provider who looks after them was on holiday. We did assess them last August and there were no problems then. Staff supervision was evidenced in some of the staff files. The AQAA stated that all of the equipment and safety checks had been carried out and were in date. We looked at some of these certificates to confirm they were serviced at regular intervals. These included, servicing of boilers, gas, electricity, lift, hoists, fire alarms and equipment and emergency lighting. The fire log and fire risk assessment was evidenced. The fire log showed fire tests at various points and senior staff training. The maintenance log was viewed and showed where items had been raised by staff for the maintenance persons attention. Accident records were in place and have been completed correctly. The first aid box was stored in the kitchen. The service have commenced a near miss reporting document that is making staff more aware of where there could be a possibility of a hazard to residents, staff and visitors. The administration manager told us it is to highlight safety in the service. Care Homes for Older People Page 27 of 32 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 Older People Page 28 of 32 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 30 18 The registered provider must ensure that all staff have received a full induction programme and that this is recorded in their staff training file. This will ensure that all new staff are trained and competent to carry out their duties. 08/07/2010 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 1 7 It is recommended that wound mapping should be used with regard to any wounds that residents may have. This will ensure that staff can follow the progress of the wound. It is recommended that where a resident has more than one wound, a care plan should be introduced for each one. This will ensure the information is clear and easy to follow. It is recommended that the care plan documentation should be audited to ensure that only up to date information is on the working file. This will make the records clearer and easier for staff to follow. Page 29 of 32 2 7 3 7 Care Homes for Older People 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 4 7 It is recommended that residents or their representative should agree and sign their care planned. This ensures that the resident or their representative understand and agree the care plan. It is strongly recommended that the resident identified in this report as having difficulty in being comfortable in the armchair, should be re assessed. This will ensure the resident is seated in a chair that is more suited to their needs. It is strongly recommended that the resident who is refusing to use their dentures should be referred to a dentist for assessment. This may help the resident and improve their dietry intake. It is strongly recommended that all registered nurses should sign the medication administration form to evidence residents have been given their prescribed medication. It is recommended that where the multi disciplinary sheet is used to record health professional visits that clear information should be recorded . For one resident who was visited because of their pain there was no record of where the pain was. It is recommended that when creams have been applied to grazes or other skin problems the name of the cream should be identified on care documentation so that staff are fully aware of what is being used. It is recommended that no more paracetamol should be ordered for the resident who has an over supply of this medication until it is used up. Residents should be canvassed for their views on what type of activity would suit them. This should encourage residents to participate and prevent any isolation. It is recommended that residents should have an activity record that shows when they have attended an activity or when staff spend time with residents on a one to one basis. The service should ensure that all residents are seated comfortably during mealtimes. This will ensure that they are well supported whilst sitting at the dining table. The service should re assess one of the residents who was having difficulty trying to eat their meals, as their food was Page 30 of 32 5 8 6 8 7 8 8 8 9 9 10 9 11 12 12 12 13 15 14 15 Care Homes for Older People 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 getting cold. This resident may need additional discrete support, which will ensure their meal times are more enjoyable. 15 18 It is recommended that the service should take advantage of the Sefton adult abuse training that has been provided for staff locally. This will ensure all staff keep up to date with local procedures. It is recommended that the service should enure the duty rota evidences the full names of staff who work there. This will make it easier to identify which staff member is on duty. It is recommended that the staffing levels should be kept under review to ensure staff have time to provide activities for residents. It is recommended that all staff files should evidence that staff have a copy of their employment contract that states their terms and conditions. It is recommended that all staff should have a training and development file that will evidence their individual training needs and training record to date. It is strongly recommended that a senior registered nurse is employed to manage and supervise the nursing of the residents. This will ensure that residents care is not compromised. 16 27 17 27 18 28 19 30 20 31 Care Homes for Older People Page 31 of 32 Helpline: 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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