Care Home: Silver Birches - North Yorkshire County Council

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What the care home does well People are properly assessed before any decision is made as to whether Silver Birches would be a suitable place for them to live. People are involved wherever possible in these decisions. People say generally that they get the care they need, and that staff understand them. They can have their visitors when they wish, and can maintain links with the local community. Steps are taken to meet people`s spiritual needs. A varied menu is offered people, which has been designed after taking account of people`s collective views. People know they can complain, and have confidence that their concerns would be listened to. Staff take concerns about people`s welfare seriously, and would report any concerns they may have. This helps to keep vulnerable people protected from harm. The environment is warm and comfortable. It provides a choice of communal areas, so people do not have to sit in the same room every day if they do not want to. It is kept maintained so it is a safe place for people to live. The manager is well regarded, and is keen to make positive improvements at Silver Birches. She is talking to people, and listening to their comments. Where the home looks after people`s personal allowance, this is managed well, and proper records kept, so people who wish to, can see how much they have, and how their allowance has been spent on their behalf. What has improved since the last inspection? There were no requirements made at the last key inspection. There have been management changes at the home since. The new manager is keen to make improvements to the service, where she has recognised areas of shortfall. What the care home could do better: People could be assessed where areas of risk have been identified, both before their admission, and after. This assessment could always be written down, with instructions advising staff how to minimise the risk. Care plans could be kept updated. This will help to make care consistent and safe. The medication systems at the home could be much better organised and managed by staff. The manager could audit these, to make sure staff are taking their responsibilities seriously, so people get their medication as prescribed, and when they want it. People who look after their own medication could have a risk assessment completed, and regularly reviewed, to make sure they are safe, able and willing to carry on doing so. Staff availability could be kept under constant review, so people and staff can be assured that there will always be someone at hand to support individuals when needed. People could always be put at ease, by staff making sure they always speak respectfully to them when they ask for help. This will encourage people to call for assistance whenever it is needed. Care could be taken to make sure that when staff are being recruited, the references supplied to support their application are filled in with the necessary information to help decide whether they will be suitable workers. Compulsory training for staff could be updated, and additional training to help them understand people`s specific needs could also be provided, so people can be assured that staff identify and understand their individual needs well, and record these in the care plan. So that every step is taken to reduce the risk to people from the spread of fire, advice from the fire officer could always be sought, and the fire safety risk assessment updated, before making a decision that it is acceptable to wedge open fire doors. Hazardous chemicals could be kept locked away when not in use, to protect people who may access them from harm. The manager could be given sufficient supernumerary time so she is able to complete her management duties. This would give her more time and opportunity to make the changes she has planned, so she can be sure that the home is run in people`s best interests. People, their family, and professionals who support them, could be surveyed periodically to collect their views. This would help to make sure that improvements made at the home take into account their collective comments. Key inspection report Care homes for older people Name: Address: Silver Birches - North Yorkshire County Council Silver Birches Station Avenue Filey North Yorkshire YO14 9AH     The quality rating for this care home is:   one star adequate 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: Anne Prankitt     Date: 1 3 0 1 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 35 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Silver Birches - North Yorkshire County Council Silver Birches Station Avenue Filey North Yorkshire YO14 9AH 01723513563 01723513006 silver.birches-nycss@btinternet.com www.northyorks.gov.uk North Yorkshire County Council care home 31 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) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: All service users for intermediate care (up to a maximum of 4), will be accommodated within the rehabilitation unit on the top floor and be in category OP. Date of last inspection Brief description of the care home Silver Birches is a purpose built property standing in its own well maintained grounds. It is situated a few minutes walk from the town centre. The building, occupying two floors, provides accommodation for a maximum of thirty one residents. There are twenty four places offered on a permanent basis, and three provide short term, or respite care. A four-bedded intermediate care/rehabilitation unit is also provided jointly with the health authority. Communal bathrooms and toilets are sited on each floor, and there is a passenger lift. Communal rooms are located throughout the premises. People are offered a copy of the homes brochure, or service users guide, before they decide to move there. The inspection report written by our predecessor, the Care Homes for Older People Page 4 of 35 Over 65 31 0 Brief description of the care home Commission for Social Care Inspection, is also available in the foyer. The manager told us on the day of the site visit, that the weekly fees range from £390 to £450. The manager should be contacted direct for more information about how peoples care on the intermediate care/rehabilitation unit is paid for. People pay extra for hairdressing, chiropody, newspapers and magazines, and items from the trolley shop. Care Homes for Older People Page 5 of 35 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: one star adequate 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: The last key inspection took place on 13 February 2007. This key inspection included a review of the following information to provide evidence for this report: Information that has been received about the home since the last key inspection A self assessment, called an Annual Quality Assurance Assessment (AQAA). This assessment told us how the registered manager thinks outcomes are being met for people using the service. it also gave us some numerical information about the service. Completed surveys, returned by six people living at the service, two staff and two health professionals. Care Homes for Older People Page 6 of 35 A site visit to the home, carried out by one inspector on 13 January 2010, which lasted approximately seven and a half hours. During the visit to the home, several people who live there, some staff, a Team Leader and the manager were spoken with. Three peoples care plans were looked at in detail, and a further two where we wanted to look at specific information. We also looked at two staff recruitment files, some health and safety records, and some information about staff training. We looked around some of the environment, including peoples bedrooms, after asking their permission. We observed care practice where this was appropriate, and spent time watching the general activity, to get a better idea about what it is like to live at Silver Birches. The manager was available for half of the day, and we provided her with feedback at the end. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: People could be assessed where areas of risk have been identified, both before their admission, and after. This assessment could always be written down, with instructions advising staff how to minimise the risk. Care plans could be kept updated. This will help to make care consistent and safe. The medication systems at the home could be much better organised and managed by staff. The manager could audit these, to make sure staff are taking their responsibilities seriously, so people get their medication as prescribed, and when they want it. People who look after their own medication could have a risk assessment completed, and regularly reviewed, to make sure they are safe, able and willing to carry on doing so. Staff availability could be kept under constant review, so people and staff can be assured that there will always be someone at hand to support individuals when Care Homes for Older People Page 8 of 35 needed. People could always be put at ease, by staff making sure they always speak respectfully to them when they ask for help. This will encourage people to call for assistance whenever it is needed. Care could be taken to make sure that when staff are being recruited, the references supplied to support their application are filled in with the necessary information to help decide whether they will be suitable workers. Compulsory training for staff could be updated, and additional training to help them understand peoples specific needs could also be provided, so people can be assured that staff identify and understand their individual needs well, and record these in the care plan. So that every step is taken to reduce the risk to people from the spread of fire, advice from the fire officer could always be sought, and the fire safety risk assessment updated, before making a decision that it is acceptable to wedge open fire doors. Hazardous chemicals could be kept locked away when not in use, to protect people who may access them from harm. The manager could be given sufficient supernumerary time so she is able to complete her management duties. This would give her more time and opportunity to make the changes she has planned, so she can be sure that the home is run in peoples best interests. People, their family, and professionals who support them, could be surveyed periodically to collect their views. This would help to make sure that improvements made at the home take into account their collective comments. 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 9 of 35 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 10 of 35 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. Peoples needs are properly assessed before a placement is offered at Silver Birches. Evidence: The manager said in the Annual Quality Assurance Assessment In the past twelve months we have been out to assess almost every person requesting the service. Apart from emergency admissions, for which we receive a care plan from the Care Manager involved in the delivery of services. At this site visit, we looked at the pre admission assessment for three people. This confirmed that appropriate information had been gathered from the person, hospital and social services, where applicable, to help decide whether the home would be able to meet the persons needs. People are also given written information about the home before they move there. Out of the six people who returned their completed surveys, four of these said they had Care Homes for Older People Page 11 of 35 Evidence: received enough information to help them decide if the home was the right place for them, before they moved in. We spoke to one person who had been admitted in an emergency, where it would not have been possible to provide this written information. They were happy with the service they had received since arriving. The home provides a rehabilitation service for a maximum of four people. This is sometimes called intermediate care, and provides short term care, with emphasis placed on the person concerned returning to their home after they have regained their independence. This support is provided on a separately staffed unit, and is funded by the health authority. We spoke to a visiting professional who arranges placements there. They spoke highly of the service that Silver Birches provides. We also spoke to a staff member working there, who said that, although the pre admission assessments are carried out by the health authority, the staff at Silver Birches are still able to make decisions about whether the unit can meet the persons needs, when balanced against those of others living there. They said that the placing authority always consider their views. This joint working helps to keep peoples care consistent, because the right staff support is available to help them regain their independence before returning home. Care Homes for Older People Page 12 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst people are generally satisfied with their care, care plans do not currently support consistent care. And improvements are needed to the way medication is managed by staff, to ensure people are safe from the risk of harm and error. Evidence: Once people are admitted to the home, the staff complete a personal profile, record important health information, and also a plan about how they will support the person in promoting their independence. Some of the information recorded was individual to the person, and looked at how good outcomes could best be achieved. However, sometimes this information was not dated, so it was difficult to tell when it was written, and whether the information was still relevant. Some of the plans were signed by the people to whom they belonged, to show they agreed with them. Others were not. Sometimes the care plans and risk assessments had been reviewed and updated regularly. In other cases, they had not. Instead, staff were recording important information about changes in care in peoples daily records. This information is Care Homes for Older People Page 13 of 35 Evidence: archived quite quickly, and increases the risk that this information will get forgotten, or overlooked. Staff said in their surveys that they are always or usually given up to date information about the needs of people they support or care for. They gave a mixed response of always, usually or sometimes though when asked if the way they share information works well. The care plans need to be kept up to date as peoples needs change. There was also important information missing about possible risks to peoples health and welfare, which had been passed on as part of their pre admission assessment, or had been learnt after admission. This meant it had not been considered when the care plans were written and updated. The fact that this information was missing, means it would be more difficult for staff to monitor areas of a persons care which, without support, may affect their good general and mental health, and psychological needs. For instance: There was no care plan or risk assessment in place for one person who, before being admitted, had been at risk from falls and weight loss. Nor was there any record that they had been weighed since arriving. In another case, someone assessed as having specific psychological and mental health needs had not had this area of their care planned for, or any risk to them assessed. This could result in the support staff provide being inconsistent. Short term care plans were not in place where advice had been provided by the persons doctor. For instance, where they needed to be encouraged to keep their legs elevated, or had been instructed to have specific additions to their diet. And staff were not clear whose responsibility it was for making sure this person was encouraged to follow the dietary advice given. Information was provided in one pre admission assessment, which stated regular chiropody was needed. The manager said these appointments had taken place. But there was no reference made to this activity having happened, nor was there a care plan to explain the signs staff should look for which would alert them to the fact that further foot care may be needed. We were told that staff working on the intermediate care/rehabilitation unit, do not complete their own care plan. Instead, they follow the action plan written by the professionals who have placed the person there. This meant there were no care plans to show how the staff should work consistently to make sure that the actions listed were followed. For instance, one person had problems eating. But there was no clear plan to follow to show staff what the person liked, what they could manage, and how Care Homes for Older People Page 14 of 35 Evidence: they should be encouraged to eat a healthy diet. And despite problems in maintaining weight, there was no record to be found to show that this was being monitored by staff on the unit. However, we spoke to a visiting health professional to this unit, who said it was a brilliant service. They said the staff follow through the care plans for people and give really good support. They were pleased that any issues they might raise with the unit are addressed. And, when asked their general views about how successful the service is in meeting peoples health and social care needs, another health professional who visits the home answered always or usually. The manager is already aware that there are a number of shortfalls in the way peoples care needs are written down. She has introduced a plan to make sure this is improved as soon as possible. The staff responsible for this task need to make sure that priority is given to highlighting and recording any risks to people, so these can be effectively monitored, and people supported to remain safe and independent. Of the six people who returned their surveys, five of these answered always when asked if they received the care and support that they need, and if staff listen and act on what they say. The sixth said this was usually the case. Their comments included Staff very helpful, Look after me very well, and Staff are always kind and helpful. On the day of the site visit, we saw staff speaking to people in a respectful way. They demonstrated patience and understanding. People we spoke with made comments like Staff are respectful, We are well looked after here, Staff are generally very good. We get the right care. They seem to know what we need, Staff are nice and kind, Its fine here - no problems. We were told by one person though that staff were sometimes snappy at night. And another said that, although the care was generally very good, staff were sometimes bossy. They thought this was because the staff were overworked. They said they had been told by staff that their call bell was for emergencies only. One person told us they often had to wait too long for their pain relief to arrive, when they asked for it. This meant they were uncomfortable for longer than necessary. Staff look after medication for people who have been assessed as being unable to manage their own. They have received training about how to do this safely. Other people manage their own. However, there had been no risk assessment completed to check these people were safe and willing to do so. People have locked facilities in which to store their medication. However, some did not use these. We asked the staff to make sure this medication was kept locked away safely. Care Homes for Older People Page 15 of 35 Evidence: We were told that there is no formal audit system in place for checking peoples medication. This was apparent when we carried out a small audit on the day. We raised the following concerns: On four occasions, the number of tablets remaining, where medication had arrived at the home in boxes, did not tally with the number which staff had recorded should have been left in stock. The amount of medication staff had given one person did not agree with the directions written on the Medication Administration Record (MAR) written by the supplying pharmacist. And the MAR did not give the same instructions as those provided by the chemist, on the box. We told staff to follow this up with the persons doctor straight away. One person had run out of liquid medication, and there was none in stock, or on order, to replace it. This would mean that the person would have to go without until further supplies were ordered and received. A staff member said sometimes they will use someone elses medication when this happens. However, this is not acceptable practice, because medication remains the property of the individual for who it has been prescribed, and should not be shared with others. One medication had not been signed for for some time. We were told that this was because the person had not needed it. However, it had not been reviewed with their doctor, to check whether or not it was still required. The directions on one persons MAR sheet about a liquid medication gave no instruction about the strength of medication prescribed, and how much the person was to take. Although staff had written on the sheet that the person did not wish to take this, there was no evidence that it had been reviewed by the persons doctor. The member of staff was not aware that there was any in stock, because they had never offered it to the person. This individual was prescribed nutritional supplements. But again, there was no evidence to show that these had been given regularly. This MAR sheet was not recorded with a start date, and different medications had been commenced on different days. Therefore it was very difficult to see what had been given on what day. We observed that staff had removed two peoples medication from their supplies at the same time to administer to them. However these people were not ready for their medication. Medication should only be dispensed from the container at the point where the person is ready to receive it. Care Homes for Older People Page 16 of 35 Evidence: The manager was informed about each of these issues. She was already aware that improvements are needed, and explained what she has already done to make some improvements in staff practice in the handling of medication. Action must be taken to make the medication system safer, so people are protected from the risk of harm caused by poor practice. Care Homes for Older People Page 17 of 35 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. People can maintain contact with family and friends that are important to them, and planned improvements to the activities programme should help in making their lives more interesting. Evidence: When asked about the activities at the home, two people said that they were always available, and three said this was usually the case. One person said these were not applicable to them at the time of responding. The activities are provided by care staff each afternoon, and are advertised in the dining area. They are mainly group activities, such as baking, crafts, bingo, physical exercise and a movie night. People can join in the activities provided at the day centre, which is based at the service, but run separately to the services registered with the commission. There is also a computer room for people to use, although the manager said this was not very popular at present. Other events are provided to make peoples lives more fulfilled. For instance, a religious service takes place monthly, and a priest visits individuals at their request. This helps to meet peoples spiritual needs. There is a hairdressing salon at the home, where people can have their hair done each Friday by the visiting hairdresser. Care Homes for Older People Page 18 of 35 Evidence: Some people spoken with on the day said they would like more activities. One said they had managed to get a game of dominoes the previous two afternoons, but were not aware that there had been a craft afternoon planned for the day we visited. When asked about activities, another person said There arent any. The manager is aware that this is an area which needs to be improved upon, following discussion with people at the regular monthly residents and relatives meetings she has introduced at the home. She told us in the Annual Quality Assurance Assessment that from April, she will be allowed to recruit an activities person. This will allow more time to focus on individual activities to meet peoples identified needs. In peoples care plans, there was little written about peoples preferred social activities, and how staff should support individuals to continue with these interests. Although the manager could tell us that the people concerned had taken part in these, the plans did little to support peoples social needs, and how these were to be met on a daily basis by the staff at Silver Birches. The planned improvements to the activities programme should help to develop this area of peoples care further. People were pleased that they can have their family and friends to visit whenever they wish. This helps people to maintain contact with those who are important to them. There is a sitting room for people to use, if they wish, when their visitors come, so they can see them in private. There are drinks making facilities, and a toy box for younger visitors, in the room. People were also pleased that they are able to make choices about how they spend their day. One person said Its OK here. Staff let me do what I want. I can come and go as I wish. Theres plenty of choice. Another said Staff take me to bed when Im ready. But I can stay up if I want. People who returned their surveys said they always or usually liked the food at the home. One person added Food is excellent and plentiful. People on the day also said they liked the food. One said The food is good - we always get more than plenty. Those who joined in the conversation agreed. Another said that the food was OK, and that they were putting on weight, but that sometimes they did not always get their choice when they requested an alternative to the menu. They said If I ask for something to go with bread, I dont get it. The manager said she now holds regular residents meetings, where people are invited to make choices about their menu. She said that changes have been made in Care Homes for Older People Page 19 of 35 Evidence: accordance with their views. This is good practice because it keeps people involved in decision making. We visited the kitchen and spoke to the cook. She said that staff are good at passing information about individual dietary needs. This will help to make sure that people get the right diet. The cook receives a weekly supply of fresh meat, and fruit and vegetables are delivered whenever required. There is a four weekly menu, which provides choice at each mealtime. Breakfast, lunch and tea are provided, as well as supper. We were told that the kitchen is open during the night so staff can make snacks for people should they become hungry. Drinks and snacks, such as biscuits and cakes, are offered between meals. Fresh fruit is offered to people each afternoon. The main dining area was nicely set out. The menu choice for the day was displayed on the wall, and people had individual copies on their dining table. The mealtime seemed unhurried, and staff sat with individuals who needed help. This stops people from feeling they have to rush their meal. Meals are served separately in the rehabilitation unit, and there was a sign displayed, telling people that they can choose to have their meal in their own room if they wish. Care Homes for Older People Page 20 of 35 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. People are protected by a staff group who will listen to, and act on, any concerns they have about them. Evidence: People are given information about how to complain before they move into the home. The manager reminds them at each residents meeting that she welcomes complaints, and that she needs to know when people are not happy, so she can put any problems right. There are also leaflets on the notice board which anyone can take, and use to tell the council what they think about the home, anonymously if they choose. The commission has received no complaints in the last year. Neither has the home received any complaints relating the part of Silver Birches registered with the commission. Everyone who returned their surveys said that there was someone they could speak to informally if they wanted to complain about anything. Four out of six people knew how to make a formal complaint. People asked, said they felt confident that the manager would deal with any issues brought to her attention. One said about the manager I would go to her with any grumbles. Im sure she would sort these out. Staff said they would pass on any concerns about people to the manager, so she could sort them out. A health professional said that the home has usually responded Care Homes for Older People Page 21 of 35 Evidence: appropriately if they, a person using the service, or another person, has raised concerns about the care. We asked staff what they would do if they believed or were told that someone living at Silver Birches had been abused. They were very clear that they would report straight away to the manager. They also knew that they could not keep this sort of information secret, and must always pass information like this on, so everyone is kept protected. Most staff have received training in safeguarding adults. The manager said that staff receive updates periodically, and was aware that some were due for an update, which she said would be provided in the near future. This helps to keep staff refreshed, and confident about what action they must take if they believe someone has been mistreated. On the day we visited, the manager had been made aware of an issue which had affected a persons welfare. This is being looked at through the local authoritys safeguarding procedures, and the manager explained what steps she was taking to keep people at the home protected. Care Homes for Older People Page 22 of 35 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. People live in a warm and comfortable environment. Evidence: The accommodation is provided on two floors. There is lift access to the first floor. This makes it easier for people with rooms there to access them more easily, and independently. The premises is also used by other services. It provides a day care centre on the first floor, run by the local authority, and overseen by the manager of Silver Birches. An audiology and podiatry clinic, run by the health authority and available to the local community, is also based at the home. As is an office for the home care services, and one sometimes used by the care management team. We were told that everyone who visits the home to access these services uses the front door of Silver Birches. This makes it a very busy environment for those who live there. The manager said though that people enjoy the comings and goings over the course of the day, and nobody on our site visit raised concerns that this was a problem for them. The bedrooms are mainly single, although there are three rooms which can be shared, but which are not currently used as such. One room in the intermediate Care Homes for Older People Page 23 of 35 Evidence: care/rehabilitation unit has an en suite facility. Otherwise, people have a wash hand basin in their room, and use the communal bathroom and toilet facilities. There appeared to be sufficient of these. There is a choice of communal sitting areas, most of which were occupied by people living at the home. There is also a separate lounge for people who choose to smoke. This was ventilated to make sure the smell of smoke did not travel through the home to areas where non smokers spend their time. Intermediate care/rehabilitation services are provided on a unit within the home, but this unit is run by separate staff. It has its own sitting and dining area, and has a kitchen, which people use to help them regain their confidence and independence before they return home. On the day of the site visit, the home looked clean, and was free from unpleasant smells. People in their surveys said this was always the case. One person said the home was Bright and clean. Another said Building and furniture all comfortable. Always clean and well maintained. Some areas have been redecorated, and some are still awaiting some refurbishment. The laundry was suitably equipped, and there was a stock of disposable gloves and aprons there for staff to use. The laundress said that care staff are good at letting her know if they are delivering soiled or contaminated linen. She said this arrived separately, in special bags. This will help to reduce the risk from cross infection. Care Homes for Older People Page 24 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Positive steps being taken to improve the staffing levels at the home, and training to update their skills, will help to maintain good consistent care for people. Evidence: The manager explained that the home is not full presently. This is because a decision has been made that only a certain number of people will live there until such time that the staffing levels have been improved. People who returned their surveys said staff were always or usually available when needed. The majority on the day we visited agreed that this was the case. Although, as stated in Health and Personal Care, one person commented that staff were sometimes bossy, and another that they were sometimes overworked, which they felt affected the response they received when they requested assistance. The manager said that she was actively recruiting into these vacant positions. On the day, staff appeared to have sufficient time to spend with people to make sure they received their care in an unrushed way, and enjoy their meals where they needed assistance. Although staff said that sometimes they are very rushed when trying to give people choice, and to meet their daily preferences. One said We always seem to be short staffed. Sometimes we are absolutely frazzled. However, they continued We all muck in - I would let my mother live here. Another said they were particularly busy on a weekend, when they perceived that less staff were available. They were Care Homes for Older People Page 25 of 35 Evidence: aware from the regular meetings the manager holds, that this is something which she is actively addressing. However, care should be taken, until additional staff are appointed, to make sure there are sufficient staff at all times make sure people get the support the need, when they ask for it. We looked at two staff recruitment files. These showed that the staff had not been allowed to provide care until a full police check had been returned. This helps to protect people from unsuitable workers. However, for one staff member, a written reference had been signed and returned by the referee, but they had not answered any of the questions asked about the applicant. Following recruitment, there was evidence that staff complete an induction, so they have a better understanding about what good, safe care is, and the standards they will be expected to reach when caring for people. Staff are then encouraged to complete National Vocational Qualifications in Care. A high proportion of staff have achieved this award, which means their practice has been assessed, and has been seen as being of a good standard, when supporting people. Other than compulsory training, staff get other opportunities to attend courses and learn new skills. For instance, a few have received training to make them more aware about the needs of people with dementia, equality and diversity, and the care of the dying. Some had not received any additional training for a while, but this is something that the manager is hoping to move forward as learning opportunities arise. Care should be taken to make sure staff receive specific training so they have a sound understanding about the psychological and mental health needs of individuals. This will help them to identify, and plan, peoples individual care needs in more detail. Care Homes for Older People Page 26 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is keen and enthusiastic, and wants to improve the service for those who live there. Evidence: Since the last key inspection in February 2007, there have been management changes at Silver Birches. The registered manager at that time no longer works there, and there have been two other managers who have taken on this role since. The currently employed manager has only been in post since October 2009, so is relatively new to the home. However, she has experience in running care homes. She said she needs to spend a lot of time updating practice there, to help raise the standards at the home. She currently has only one day to dedicate to her management duties, and said in the Annual Quality Assurance Assessment that As the manager is part of the operational staff it is difficult to get some of the management duties done in such a busy area.... She is looking forward to April, when she will be allocated more time so she is able to fulfil her role more effectively. She is in the Care Homes for Older People Page 27 of 35 Evidence: process of collecting the necessary information she needs, to apply to become registered with the commission. People and staff said the manager was very approachable, and listened to them. One person said We see plenty of (the manager). I hope she stays. A staff member said We get good support. Another said the manager was very interested in the unit where she works, and that she was involving herself in the running of it. Another said We have a stable management now. Things are greatly improved. Formal supervision for some staff has fallen behind. However, the manager was keen to make this more of a regular event for staff once she could commit more time to her management duties. Although, staff said they are getting more regular supervision, support, and feedback about their performance. This will help to promote good and consistent working practice. Peoples views are collected informally, and recorded in the minutes from monthly residents and relative meetings, which the manager has now set up. However, formal questionnaires have not been sent out to people, their families, nor to visiting professionals, for at least three years. This way of collecting information gives more people the opportunity to comment on how the home is running, and their views are important. Consideration should be given to completing a survey soon, so the manager can be sure that the changes she is making at the service are in agreement with the collective views of those who live there, and those who support them. The manager said she would be organising this after April, when she has more time to concentrate on her management duties. The manager is developing other ways to communicate with people, and to keep them up to date with what is happening in their home. For instance, she has introduced a monthly newsletter, which can be provided in large print on request so that more people are able to read it. The home will look after peoples personal allowance if they wish. Money is kept secure, and records and receipts are kept to show when money has been spent or received on peoples behalf. Lockable facilities can be provided for people to keep their own if they would prefer, and the manager said support would always be offered to people wanting to do this. This helps to keep people independent. There are systems in place to keep the home maintained. For instance, in house checks are carried out weekly to make sure that the fire alarm is in working order. And outside contractors complete planned services of equipment to keep it maintained. Care Homes for Older People Page 28 of 35 Evidence: We were unable to see the last report following the Environmental Health Officers planned inspection of the kitchen area. However, staff told us that they were pleased with the standards there, and that no recommendations were made following the visit. Records seen on the day of our site visit were up to date, and the kitchen looked clean and well maintained. The fire authority last visited in February 2008, and provided an action plan to address shortfalls noted during their visit. We asked the manager whether these were being addressed. She gave assurance that they were, within a planned timescale. We raised the following with the manager at the time of our visit: Staff receive compulsory training in fire safety, moving and handling, first aid, food hygiene and infection control. We were assured that everyone has recently attended fire safety training, and that there was always a staff member with a first aid qualification on duty. However, some compulsory training had fallen behind. The manager said she is going to plan further training for staff where this was the case. This must be given priority, so that staff are refreshed about how to work in a safe and competent way. Both sluice rooms were unlocked, and there were chemicals within which were not locked away, and which could cause people harm. These chemicals must be kept locked away to reduce risk to people who may enter the room. The fire doors into the rehabilitation/intermediate care unit were wedged open, as were some bedroom doors. We cannot give permission for these to be held open in this way, as they would not close automatically should the fire alarms sound. This increases the risk to people from the spread of fire. We asked the staff to seek advice from the fire authority, which they did during our visit. The fire authority have given staff advice to follow, and have asked that the risk assessment for the service be updated accordingly. Care Homes for Older People Page 29 of 35 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 30 of 35 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 7 15 Peoples care plans and 12/02/2010 associated risk assessments must provide a true reflection of their current physical, psychological and mental health needs, and be kept up to date. This is so people can be assured that staff will recognise these needs, and will work safely and consistently to meet them. 2 8 13 As stated in feedback, people who self medicate must have a completed self medication risk assessment, which must be regularly reviewed. This is to make sure that people are, and continue to be, able and willing to manage their own medication safely, and according to the instructions of their doctor. 31/01/2010 Care Homes for Older People Page 31 of 35 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 3 9 13 A full audit of the medication 31/01/2010 must be carried out by someone suitably experienced to do so, and must be repeated at regular intervals. This is to check that staff charged with the responsibility for the ordering, handling, recording and administration of medication are carrying out their responsibilities safely and properly. And to make sure that people are receiving their medication as and when prescribed. 4 10 12 Staff must at all times treat people living at the service with due respect. This is so people can feel reassured that they may call for staff assistance at any time they may need support or attention. 31/01/2010 5 29 19 As stated at feedback, two 28/01/2010 completed written references must be obtained from appropriate individuals as part of the recruitment process. This is so the manager has sufficient information on which to base a decision as Care Homes for Older People Page 32 of 35 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 to whether the prospective worker is suitable to provide care and support to vulnerable people. 6 38 13 As stated during the site visit, fire doors must not be wedged open unless this practice has been agreed with the fire officer. This is so the risk to people from the spread of fire is kept to a minimum. 7 38 13 As stated at the site visit, hazardous chemicals must be kept locked away when not in use. This will reduce the risk to people from harm, who may access them 8 38 13 Priority must be given to arranging compulsory training in moving and handling, food hygiene and infection control. This is so people can be assured that they are being cared for by staff who have up to date information about how to work in a safe way. 12/02/2010 28/01/2010 28/01/2010 Care Homes for Older People Page 33 of 35 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 Staff should make sure all information recorded in a persons care plan is dated, so that its relevance in respect of the individuals current needs can be better understood. Staff on the rehabilitation/ intermediate care unit should, after consultation with the placing authority, complete a care plan, to identify how the required action plan completed by the authority is put into practice, so goals for these individuals can be consistently worked towards. 2 9 If their pain relieving medication is due, there should be no delay when people request this. This will ensure that they do not experience unnecessary prolonged pain. People who are no longer taking their prescribed medication should be referred to their doctor, to request that this is reviewed. 3 30 Staff should be provided with training to help them understand peoples psychological and mental health needs, so these can be understood, and the right care given to individuals admitted who need staff support specifically in these areas. The manager should be given sufficient supernumerary time so she is able to complete her management duties, and drive forward and maintain improvements for the people who live at Silver Birches. People, their families and visiting professionals should be offered a periodic survey, so it is possible to assess their collective views about what the home does well, and where people would like improvements made. This will help to make sure the home is run in peoples best interests. 4 31 5 33 Care Homes for Older People Page 34 of 35 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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