Care Home: Silver Birch Lodge Nursing Home

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What the care home does well There is a good system in place to make sure that the individual needs and requirements of each resident is known and that relevant information is regularly updated to ensure it is current. Staff are given very good guidance and direction so that a consistently high level of care and support is provided that meets the individual needs and requirements of each resident. The health care needs of people living at the home are well met meaning that residents have confidence that the staff team would arrange for medical assistance quickly if they were unwell. Privacy and dignity is well respected. The staff team work well together and showed a good understanding of the needs of individual residents. There is a very good relationship between residents, relatives and staff. Residents and relatives spoke very positively about the care, kindness and helpfulness of the staff group. One resident told us that the home, "Could not be bettered". A relative spoken with told us the care provided was "Excellent" . Another person said, "Makes everybody feel welcome, always clean and tidy, good meals, excellent gardens, could not ask for more". Staff also spoke very positively about the service provided. One member of staff told us, "The home cares for residents well, treats staff well. All checks are carried out and induction was very good". There are good systems in place to manage any complaints or concerns. There is an open door policy whereby residents and relatives can speak with the registered manager at any time, should they be concerned about something or require some information. The people spoken with at the time of the site visit expressed no concerns or complaints what so ever, however there were many complements. The protection of people living at the home is considered very important. All staff receive mandatory training so that people living at the home are kept safe and free from any sort of abuse or discrimination. The home has recently achieved the Investor in People gold standard award. This is to be commended and shows a that a very high standard of service is consistently provided. What the care home could do better: The staff team at Silver Birch Lodge worked very hard to ensure that a high quality service is consistently maintained that meets the individual needs and requirements of each person accommodated. However there are a couple of things that could still be done to strengthen the service further. Although there are very detailed and informative individual care plans in place for all areas of assessed need, on one occasion, for one person a care plan had not been developed even though a need had been identified during the pre admission assessment process. It was recommended that a care plan is put in place in respect of this issue, so that staff have clear written guidance on how to address this specific need.There is a very good system in place to make sure that medication is well manged and that medication is administered as prescribed. It has however been recommended that individual protocols are put in place to guide staff for `when required` medication has been prescribed. This is medicine that is not necessarily taken regularly. This would help to strengthen an already robust medication system and help to ensure consistency of use. Random inspection report Care homes for older people Name: Address: Silver Birch Lodge Nursing Home Silver Birch Lodge Bold Lane Holt Green Aughton Lancashire L39 6SH three star excellent service 19/06/2007 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: Denise Upton Date: 1 3 0 5 2 0 1 0 Information about the care home Name of care home: Address: Silver Birch Lodge Nursing Home Silver Birch Lodge Bold Lane Holt Green Aughton Lancashire L39 6SH 01695424259 Telephone number: Fax number: Email address: Provider web address: jiminorm@aol.com Name of registered provider(s): Name of registered manager (if applicable) Mrs Joan Parr Type of registration: Number of places registered: Conditions of registration: Category(ies) : Holt Green Residential Homes Limited care home 30 Number of places (if applicable): Under 65 Over 65 30 old age, not falling within any other category Conditions of registration: 0 The registered person may provide the following category of service only: Care home with Nursing - N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 30 Date of last inspection Care Homes for Older People Page 2 of 11 Brief description of the care home Silver Birch Lodge is a registered care home providing personal and nursing care. The home is registered to accommodate people over the age of sixty-five. Accommodation is provided for thirty residents of either sex. Mr and Mrs J Parr privately own the home. Mrs Parr, a registered general nurse is also the registered manager with overall responsibility for the day to day running of the home. Residents accommodation is located at ground floor level. There is a lounge/conservatory and lounge /dining facilities. The home is situated in a quiet village location, set in well-kept grounds. The home has a Statement of Purpose and Service User Guide providing information about the care provided, the qualifications and experience of the owners and staff and the services residents can expect if they choose to live at the home. A copy of the Service User Guide and most recent inspection report is issued to all prospective residents and their relatives/representatives to help them make an informed choice whether to move into the home. The current fees for accommodation at Silver Birch Lodge range from £525:00 per week to £640:00 per week and is dependent on assessed needs. Further details about the fees and what is included in the fees can be obtained from the registered manager at the home. Care Homes for Older People Page 3 of 11 What we found: This short random inspection did not look at all the minimum standards identified in the National Minimum Standards - Care Homes for Older People but focused on the health and personal care delivered and the systems in place for managing issues relating to complaints and the protection of people living at the home. These are important issues that directly affect the quality of care delivered and whether positive outcomes for residents has been achieved. Individual care plans were in place for each person that were detailed and informative, three of these were viewed. A separate care plan was written for each area of need that included areas such as personal hygiene, continence, pressure areas, mobility, oral hygiene, arthritis, sleep disturbance, and dietary requirements. There was evidence of at least monthly reviews of the individual care plans taking place, with on-going amendments made as necessary. This helped to make sure that a clear and up to date record was maintained of each persons current strengths and needs so that staff were aware of any changes that needed to be made to the level of support and assistance required. The very person centred care plans gave clear and detailed instruction in order to guide and direct staff. This enabled staff to provide a very individualised service that was delivered in a consistent way. This also helped to make sure that people living at the home were encouraged to do what they could for themselves and promote independence whilst ensuring that all staff were giving the same amount of help when required. There was also clear evidence in the individual care plans that individual risks been identified and action taken to minimise those risks. Good risk assessments were in place. A number of staff, including the registered manager, have recently completed an advanced care planning course and more training is planned to take place for a further group of staff in the near future. This shows that the staff group are proactive in updating their skills and knowledge for the benefit of residents. However it was noted that for one recently admitted person who occasionally has hallucinations at night, there was no care plan in place in respect of this issue. We were told that no hallucinations had occurred since admission. Never the less, it is recommended that a care plan is developed to ensure that if an incident did occur, all staff would have clear written instruction as to what they should do in order to assist the resident. This helps to ensure that there is a consistent approach is adopted by all staff. For each resident there was also an assessment of needs for daily living completed. This covered areas such as likes and dislikes, allergies, routines of waking , meal times, retiring to bed, daily routines and interests, medication and personal hygiene. Care was also taken to capture requirements relating to social needs and relationships and activities or links with the community. We were told that residents are encourage to complete this assessment themselves or alternatively with a person who knows them well such as a relative. Alternatively a member of staff will assist the resident to complete the assessment if requested. There was good evidence to confirm that what the individual resident wanted was very much taken into account when developing the individual care plan. This is a real strength of the service that helps to ensure that expectations are met and at times, exceeded. One resident spoken with told us, The more I am here, the more amazed I am about how much they do for you. I am astonished by their coverage, Care Homes for Older People Page 4 of 11 when I say they do everything for you, they really do. There was good evidence from documentation and discussion that physical and mental health care needs are very well met. Strategies were in place to ensure that people living at the home always got the medical care and support that they needed when they needed it. There is a very good relationship with medical staff to ensure that as far as possible, the optimum health of each person is maintained. The relationship observed between the people living at the home and staff group was relaxed and caring. This comfortable relationship enables staff to get to know people well and any changes in health and well being are quickly noted and speedily addressed. As part of the visit, we checked how medicines were being handled. We checked a sample of medicines stocks and medicines records. Overall we found the handling of medication to be very well managed that helps protect the health and wellbeing of people who live in the home. There is a good system in place to make sure that medication is administered safely and as prescribed. Only qualified members of staff administer medication to people assessed as requiring nursing care. Senior care staff, that have received specific medication training to ensure competency, administer medication to people that are accommodated in the none nursing unit. There is also provision for people living at the home to hold and self administer their own prescribed medication within a risk assessment framework. A locked facility is available in individual bedroom accommodation to store personal items such as medication. The medication administration records of three people were viewed. These had been completed correctly and a photograph of the person was available, this is good practice and helps prevent mistakes being made. Medicines stock was seen to be well organised, records were clearly presented and spare stock was stored securely. Records of medicines received into the home, given to people and disposed of were signed and up to date. Short life medication was dated on opening to prevent this medication being used past its use life date and any handwritten entries that were required in the drug administration record were signed, dated and countersigned by a second person to confirm accuracy of the recording. This is good practice and helps to keep people safe. We were informed that regular recorded checks are carried out to make sure staff were giving and recording medicines correctly. If any mistakes were found action was taken immediately to help prevent them happening again. Although medication is well managed, it was noted that there were no protocols in place to advise staff with regard to when required medication. This is medication that is not necessarily taken on a regular basis. The already good medication system in place could be further strengthened by developing individual protocols for each persons when required medication. This would advise staff under what circumstances it would be appropriate to give this medication to ensure consistency of use. Privacy and dignity is well respected at the home. A member of staff gave a good account of how she respected residents privacy and dignity when assistance with personal care was required. The health and personal care that people receive is based on their individual needs so they receive personal care in the way they prefer and in a way that shows respect for their privacy and dignity. All care staff receive training in respect of maintaining privacy and dignity during induction training and National Vocational Qualification (NVQ) training. A privacy and dignity policy is also available to advise and Care Homes for Older People Page 5 of 11 guide staff and this issue is also discussed through formal and informal day to day supervision arrangements. Residents spoken with and comments from people that had completed a Care Quality Commission (CQC) survey prior to the site visit taking place, all said that they felt their privacy and dignity was always respected by staff working at the home. One person individually spoken with stated that, All the staff are very caring, I am very happy with the care, it could not be bettered, I feel very well looked after. The staff are sometimes very busy but they always have time to listen. Another person told us that they were very pleased with the care and support provided saying, I dont see how it could be any better. Comments on the CQC surveys confirmed these feelings. One person wrote, Good communication with staff, they take good care of me. Two relatives also made some comments. One person said, I am confident that the care and attention she receives meets her every need. Another relative had written, I cannot think of anything relating to my wifes care that the home does not do well. Members of staff spoken with also confirmed that a very high quality of care was consistently provided. We were told that excellent standards are maintained. One member of staff told us, I love working here, standards are as good as we can get. We are like one big happy family, same staff, staff are happy working here, excellent care provided. Another member of staff said, Excellent care service, good rapport with all residents and families - as much like a home as possible, this is what we strive to be. Silver Birch Lodge has a structured complaint policy and procedure in place, which includes details that any complaint would be responded to within a maximum of 28 days. From discussion with the registered manager, it is understood that a record of complaints is kept that includes details of any action or investigation undertaken and outcome. Written details of the complaint procedure is incorporated in the Service User Guide, a copy of which is provided to each resident. Since the last Annual Service Review inspection, one anonymous complaint regarding the service was received by the Commission. The Commission asked the registered manager to investigate the complaint by using the homes formal complaint procedure. Following a thorough investigation, the complaint was not substantiated. However this shows that complaints are taken seriously and acted upon, so that any short falls could be speedily addressed in order to improve the service. Staff spoken with were very clear about what they should do if a complaint was made to them. The residents and relative spoken with and residents that completed a CQC survey, all said they would have no hesitation in speaking with the registered manager or another member of staff if they did have any concerns. There was complete confidence that any concerns would be taken seriously and acted upon. There were no concerns or complaints expressed, however there were many complements. People living at the home have formed good relationships with staff, meaning that any issues could be raised and dealt with informally as part of day to day life at the home. Silver Birch Lodge continues to have a variety of policies and procedures in place for the protection of residents. This includes an adult protection policy and a whistle blowing policy to help protect people living at the home from abuse or discrimination. All staff receive mandatory training regarding protection and abuse that is regularly updated. Care staff also receive guidance in respect of adult protection as part of their National Vocational Qualification training (NVQ). Opportunity is also provided for this topic to be Care Homes for Older People Page 6 of 11 discussion during one to one supervision and at team meetings. This helps to remind staff of the importance of protecting residents and the responsibility of the staff group in this matter. Since the last inspection there have been no safeguarding issues regarding the home. What the care home does well: What they could do better: The staff team at Silver Birch Lodge worked very hard to ensure that a high quality service is consistently maintained that meets the individual needs and requirements of each person accommodated. However there are a couple of things that could still be done to strengthen the service further. Although there are very detailed and informative individual care plans in place for all areas of assessed need, on one occasion, for one person a care plan had not been developed even though a need had been identified during the pre admission assessment process. It was recommended that a care plan is put in place in respect of this issue, so that staff have clear written guidance on how to address this specific need. Care Homes for Older People Page 7 of 11 There is a very good system in place to make sure that medication is well manged and that medication is administered as prescribed. It has however been recommended that individual protocols are put in place to guide staff for when required medication has been prescribed. This is medicine that is not necessarily taken regularly. This would help to strengthen an already robust medication system and help to ensure consistency of use. 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 Older People Page 8 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 Older People Page 9 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 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 A care plan should be in place for every area of assessed need. This is especially so when a resident has been recently admitted, so that staff have a good understanding of what they should do should an incident occur. It is recommended that individual protocols are developed for each person that has been prescribed when required medication. This would ensure that all staff have written guidance as to when it may be appropriate to administer this medication to ensure consistency of use. 2 9 Care Homes for Older People 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 Older People 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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