Care Home: Silver Birches Residential Home

What the care home does well The home kept a record of complaints and compliments. Complaints had been managed and responded to appropriately. Some of the comments from relatives included, `thank you for the help you gave to our mum and for looking after her`, `thank you so much for your support and fantastic care you have give my relative over the years`, `thank you for the loving care and attention shown to our relative during their short stay with you. We couldn`t have asked for better` and `can I say how grateful I am for the way the home has looked after my mum in her last few days. Telling others of this has enabled me to see what a rare jewel Silver Birches is,` and `your caring and loving environment shows the highest level of commitment and professionalism. The staff are exceptional people in this day and age, who genuinely cared about my relative. The luckiest day of my mum`s life was when she was accepted at Silver Birches.` Staff training was good and staff from all departments had received up-dated training in the Protection of Vulnerable Adults. All mandatory training was kept up-to-date and there was a commitment to ensure that staff were trained to support the specific needs of the residents with respect to dementia and challenging behaviour. This training was also offered free of charge to relatives and representatives of residents. The acting Manager was well qualified and kept herself up to date with current practice and legislation. The AQQA gave detailed information about the development of the service. A staff member wrote in the survey they completed, `I am really enjoying working here at Silver Birches and like the fact that there is a good rapport between the staff and the acting manager. We are always going on training, which I feel is a good thing and everyone is included, not just the care staff, but the domestic staff too.` A staff member wrote in a survey, `residents are cared for by the care staff to a high standard and the company provide good training and support.` What has improved since the last inspection? The AQAA recorded, `a mini care plan for each resident has been implemented, which can be more easily understood by new or bank staff`. Improvements instigated by the service for better outcomes for the residents included the installation of a new adapted bath with a fitted hoist enabling more choice and flexibility with respect to bathing times. Over the previous twelve months, the home had become involved in `the dignity challenge campaign`, which was designed to increase staff awareness on preserving residents` dignity during personal care. A notice board in the home dedicated to this project was headed, `Opening the door to Dignity` and comments from residents and staff, confirmed the home was putting this important aspect of care at the centre of everything they do. Residents` relatives and representatives were encouraged to visit the home and invited to regular meetings. Minutes of a recent meeting confirmed that relatives were encouraged to join forthcoming events, that they were offered a weekly surgery todiscuss anything which might affect their relative and that the home involved them in creating a story book for their relative to support reminiscence work. Relatives were also invited to join in the home`s dementia training, `Yesterday, Today and Tomorrow`, to help them to understand their relatives` diagnosis and behaviour better. The acting manager wrote in the AQAA, `the introduction of a nutritional analysis software programme, designed by dieticians to support flexibility, had been installed over the last twelve months, to support the chef in trying new recipes and increasing the variety of home made meals.` A small room had been adapted as an activity/sensory room and contained sensory optical, aromatherapy, reminiscence, and beauty equipment. A wide variety of activity materials were available for the residents` entertainment and to enhance their social lives. Residents` artwork was displayed on the walls and a staff member stated that residents, who just wanted to relax, listen to music, and enjoy the mobiles and light features could use this room. The home also provided a minibus for access to the community. What the care home could do better: There were no areas identified for improvement at the previous site visit and no requirements or recommendations had been made, however over the previous twelve months, a safeguarding investigation had highlighted a number of areas for improvement and an action plan had been drawn up to improve outcomes for the residents. Procedures for the protection of the residents and the staff had not been followed and the registered manager had since left the employment of the company. A full and detailed response had been made by the home, of the actions to improve outcomes for the residents and to resolve the issues, including safeguards to ensure those improvements would be sustained. These improvements have been reflected in the report. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Silver Birches Residential Home London Road Rake Liss Hampshire GU33 7PG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Christine Bowman     Date: 1 7 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for 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 Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Silver Birches Residential Home London Road Rake Liss Hampshire GU33 7PG 02079293444 Telephone number: Fax number: Email address: Provider web address: silver.birches@ashbourne.co.uk Name of registered provider(s): Name of registered manager (if applicable) Mrs Tina Mary Foster Type of registration: Number of places registered: Ashbourne (Eton) Limited care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 27 The registered person may provide the following category/ies of service only: Care home non-medical - NM to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia DE Mental Disorder, excluding learning disability or dementia - MD Date of last inspection Brief description of the care home Silver Birches is a care home for twenty-seven service users over the age of sixty-four. It is registered to take service users who have a mental disorder or dementia. Silver Birches is situated on a site with two other homes owned by Ashbourne (Eton) Ltd. The twenty one single and three shared rooms, as well as the communal areas, are arranged across two floors and there is a lift. The home has well-maintained and Care Homes for Older People Page 4 of 31 Over 65 0 0 27 27 Brief description of the care home secure gardens that are accessible to service users. Silver Birches is in a rural setting near to local amenities in Liss. Fees range from #400 to #655 per week. Care Homes for Older People Page 5 of 31 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: This inspection report includes information gathered about the service since the previous site visit in August 2006 under the Commissions Inspecting for Better Lives (ILB) process. The acting manager manager, Mrs Jacquiline Govere, who is also the registered manager of the adjacent home, Heath Mount, had completed an Annual Quality Assurance Assessment (AQAA) giving some up-to-date factual evidence about the running of the home and informing us of what they think they are doing well, how they have improved the service and of their plans for further improvements. Residents completed three service user surveys giving their views on the running of the home. Four staff and one healthcare professional also returned surveys, giving their views on the care and support given to the residents. An unannounced site visit was conducted on 17th December 2008, to assess the outcomes of the key inspection standards for Care Homes for Older People Page 6 of 31 older people with respect to the residents living at the home. The acting manager and deputy manager were interviewed and provided support for the inspection process by making residents and staff files and other documents available to be sampled. A partial tour of the premises was undertaken and some of the residents bedrooms and communal areas were viewed. A number of staff and residents were spoken with throughout the day and observations were made of the residents and of staff as they carried out their duties. Residents and staff records, maintenance certificates and complaints and compliments records were sampled and the Statement of Purpose, the Service User Guide and policies and procedures were viewed. What the care home does well: What has improved since the last inspection? The AQAA recorded, a mini care plan for each resident has been implemented, which can be more easily understood by new or bank staff. Improvements instigated by the service for better outcomes for the residents included the installation of a new adapted bath with a fitted hoist enabling more choice and flexibility with respect to bathing times. Over the previous twelve months, the home had become involved in the dignity challenge campaign, which was designed to increase staff awareness on preserving residents dignity during personal care. A notice board in the home dedicated to this project was headed, Opening the door to Dignity and comments from residents and staff, confirmed the home was putting this important aspect of care at the centre of everything they do. Residents relatives and representatives were encouraged to visit the home and invited to regular meetings. Minutes of a recent meeting confirmed that relatives were encouraged to join forthcoming events, that they were offered a weekly surgery to Care Homes for Older People Page 8 of 31 discuss anything which might affect their relative and that the home involved them in creating a story book for their relative to support reminiscence work. Relatives were also invited to join in the homes dementia training, Yesterday, Today and Tomorrow, to help them to understand their relatives diagnosis and behaviour better. The acting manager wrote in the AQAA, the introduction of a nutritional analysis software programme, designed by dieticians to support flexibility, had been installed over the last twelve months, to support the chef in trying new recipes and increasing the variety of home made meals. A small room had been adapted as an activity/sensory room and contained sensory optical, aromatherapy, reminiscence, and beauty equipment. A wide variety of activity materials were available for the residents entertainment and to enhance their social lives. Residents artwork was displayed on the walls and a staff member stated that residents, who just wanted to relax, listen to music, and enjoy the mobiles and light features could use this room. The home also provided a minibus for access to the community. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 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 31 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 are supplied with all the information they need to make an informed decision about moving into the home and the home ensures that individuals needs are assessed prior to the offer of a placement. Evidence: The home had an up-to-date Statement of Purpose and Service User Guide giving prospective residents all the information needed to make a decision about the suitability of the service to meet their needs. The Service User Guide was also available on audiocassette to enable those with visual impairment to access the information. The philosophy of care included a statement of non-discriminatory practice, assuring prospective residents that they would be treated with respect regardless of their age, gender, sexual orientation, race or religious belief. These documents were well presented and included a photograph of the home, a list of contents and were easy to read. The provider company also provides a website Care Homes for Older People Page 11 of 31 Evidence: offering information about the home and responding to enquiries promptly. The three residents, who completed surveys, confirmed they received enough information about the home before they moved in to decide if it was the right place for them and one commented, moving to Silver Birches made me feel very happy. I felt happy the moment I walked into the home. The referral process was described in the AQAA and included recommending that prospective residents visit the home to assess the suitability of the facilities, and the completion of a pre-admission assessment to review the prospective residents current care needs. The acting manager wrote, the prospective resident is encouraged to have as much input to this process as possible to ensure their preferences are incorporated into their care plan. A registered nurse on admission completes a full assessment of the residents needs. The assessment documentation of two residents was sampled. This was a full nursing assessment and included important personal information, medical history, infection status, current medication, a full dependency assessment with levels of risk recorded, moving and handling, pressure area, nutritional, continence, and dementia assessments, and included an assessment of personal and social care needs. Individuals needs with respect to diet, specialist equipment, and other special requirements were recorded and information with respect to equality and diversity gathered, to be used in the compiling of a comprehensive care plan. Care Homes for Older People Page 12 of 31 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 have care plans in place, which have been developed with input from themselves or someone close to them, and which are regularly updated to inform the staff. Safe arrangements are in place for the management of medication to protect the residents and the staff, and the home takes the residents rights to privacy and dignity very seriously by raising awareness and promoting these rights. Evidence: Care plans sampled contained a separate section for each identified need with advice to staff on maintaining safety and preventing identified risks. For each care need, the planned care was recorded to instruct the staff and an explanation given of the aim. Care plans recorded individuals needs with respect to equality and diversity and their likes and dislikes to enable an individual approach to be taken to their care. When moving and handling equipment was used, there was a description of the type of equipment, the number of carers required and details of how the individual should be moved safely and to prevent injuries. Care plans had been reviewed in a timely manner to ensure the information was up to date to inform the carers. The AQAA Care Homes for Older People Page 13 of 31 Evidence: recorded, a mini care plan for each resident has been implemented, which can be more easily understood by new or bank staff. The three residents, who completed surveys or whose surveys, were completed by visiting relatives or representatives on their behalf, confirmed they always received the care and support they needed. A healthcare professional, who completed a survey, recorded that the care service usually seek advice and act upon it to manage and improve individuals healthcare and that the individuals health care needs are usually met by the care service. They also recorded that, they now have a good relationship with the current manager, after unstable years with changing staff. Services were available, on referral from General Pratitioners (GP), via the primary care trusts or hospitals, for specialist nurses, psychiatrists, district nurses and occupational therapists. The AQAA recorded that residents retain their GPs on admission if they wish, but where this is not possible, they are registered with the local practice to ensure continued medical treatment. Chiropody, dental, optical, physiotherapy, aromatherapy and reflexology services were also available and the the service user guide was clear about which of these services incurred an additional cost. Improvements instigated by the service for better outcomes for the residents included the installation of a new adapted bath with a fitted hoist, more choice and flexibility with respect to bathing times, regular support by key workers to assist with sorting out old and worn clothes for disposal and the organisation of a clothes party, which involved relatives and staff supporting residents to buy new clothes and accessories, which had been brought into the home for this purpose. Medication was administered by trained staff only, and the staff training matrix confirmed they had all received a recent up-date with regard to the safe handling of medication. Records confirmed that regular audits were carried out of medication held and that an audit trail of medication received into the home, administered and disposed of, was kept to confirm safe handling and to ensure the residents rights were protected. Photographs of the residents to confirm their identity and a list of the signatures of the staff responsible for signing the Medication Adinistration Records were also kept for identification. A controlled drugs register was used and a sample of medication counted matched the number stored in the controlled drugs cabinet. No residents had been assessed as able to take care of their own medication at the time of the site visit. Over the previous twelve months, the home had become involved in the dignity challenge campaign, which was designed to increase staff awareness on preserving residents dignity during personal care. A notice board in the home dedicated to this Care Homes for Older People Page 14 of 31 Evidence: project was headed, Opening the door to Dignity and comments from residents and staff, confirmed the home was putting this important aspect of care at the centre of everything they do. Comments included, please respect my privacy and knock on my door before entering, please be sensitive because I am a very private person, please respect my wishes and desires and work always with my best interests at heart, help me to remain independent, have the freedom to choose and take all the decisions about my life, and please take the time to find out more about me, my likes and dislikes and see me as an individual. Another new initiative of the home was for, each resident to be resident of the day, on the day his or her care plan was under review. This involved the resident receiving special attention from all staff and included choosing their favourite activity. Care Homes for Older People Page 15 of 31 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 supported to maintain links with their relatives and the local community and provided with a variety of activities to enhance their personal and social lives. The meals provided are well balanced, nutritious, attractively presented, provide choice and are served in pleasant surroundings. Evidence: The homes activities organiser was available to be interviewed and showed great enthusiasm for her work. She had been a senior carer for six years, had been trained in the organisations dementia awareness training as an instructor, and was responsible for mentoring new staff. She explained that a new initiative of the home was for, each resident to be resident of the day. This was designed to make each individual feel special and spend a day doing all the things they enjoy. Residents had chosen a variety of outings including a drive over the Downs, visiting a garden centre and attending the Catholic Church. One resident, who really likes trains, had enjoyed a trip to the Milestone Museum and a staff member had brought their pet dog to visit a resident, who really likes dogs. The home had a minibus to enable residents to access to the community. On the day of the site visit, the activities arranged for the residents included a visit from the hairdresser, musical movement in one of the lounges in the Care Homes for Older People Page 16 of 31 Evidence: morning and Christmas card making in the afternoon. Daily activities and menus were posed on notice boards to inform the residents. A monthly newsletter was produced to let the residents, their relatives and representatives, know about events arranged for their entertainment and enjoyment. Over the week of the site visit, a Christmas party was planned and an entertainer had been engaged. A Catholic Priest had been booked to attend the carol service, during which, wine and mice pies would be available. There were plans in place to take residents, who wished to attend, to the Christmas Eve Mass. The activities organiser explained that there were regular parties arranged throughout the year for the entertainment and enjoyment of the residents, including celebrating the Chinese New Year, Valentines Day, Mothers Day, Halloween, a Summer Fete and a winter Open Day, which included a concert. Residents relatives and representatives were encouraged to visit and invited to regular meetings. Minutes of a recent meeting confirmed that relatives were encouraged to join forthcoming events, that they were offered a weekly surgery to discuss anything which might affect their relative and that the home involved them in creating a story book for their relative to support reminiscence work. Relatives were also invited to join in the homes dementia training, Yesterday, Today and Tomorrow, to help them to understand their relatives diagnosis and behaviour better. Records were kept of individuals involvement in activities, provided to the residents as a group, and to the individual as one-to-one time, and included comments on the participation of the resident. One resident, whose records were viewed visited the hairdresser each week, enjoyed manicures, videos, church services, completing jigsaws and visits from the PAT dogs. Residents, who completed surveys, confirmed that there were always activities arranged by the home that they could take part in, but one commented, I choose not to participate in any activities. Another resident stated, I enjoy cooking and am able to do this in the home. The dining room was set for three or four residents to each table to promote socialisation. The floor was laminated; the furniture solid, and the chairs had soft seats. Lighting was by fluorescent strips, which could be improved upon to enhance the domestic setting. Christmas music was playing softly in the background and the meal was nicely presented and gave off a very appetising aroma. The first course consisted of lentil soup, grapefruit segments or fruit juice and there were two choices of main course including lamb casserole with vegetables or smoked haddock with spinach au gratin. The four-week menu was very varied and gave the residents choices for all meals with the possibility of fresh fruit, yoghurts and cheese and biscuits as alternatives to sweet puddings. Residents spoken with thought the meal was, very nice. Of the three residents, who completed surveys, two always liked the meals at Care Homes for Older People Page 17 of 31 Evidence: the home and one sometimes did. The chef catered for special diets. The acting manager wrote in the AQAA, the introduction of a nutritional analysis software programme, designed by dieticians to support flexibility, which had been installed over the last twelve months, supported the chef in trying new recipes and increasing home made meals. Care Homes for Older People Page 18 of 31 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 know how to complain and are confident they will be listened to, taken seriously and that their concerns will be acted upon. Procedures are in place to protect the residents from abuse and staff are trained with respect to taking appropriate action to safeguard them. Evidence: Residents and their relatives had access to the homes complaints procedure in the Service User Guide, giving them information about timescales for acknowledging a complaint and of being informed of any outcomes. The complaints procedure was also displayed in the entrance hall. Two of the three residents, who completed surveys, confirmed they knew how to make a complaint. The acting manager recorded in the AQAA that six complaints had been received over the previous twelve months, that they had all been resolved within twenty-eight days, and that four complaints had been upheld. The complaints and compliments log contained details of how the complaints had been resolved and a copy of the letter to the complainant where this was appropriate. The Commission had received no complaints about this home. The home also kept a record of compliments. Some comments from relatives included, thank you for the help you gave to our mum and for looking after her, thank you so much for your support and fantastic care you have give my relative over the years, thank you for the loving care and attention shown to our relative during their short Care Homes for Older People Page 19 of 31 Evidence: stay with you. We couldnt have asked for better and can I say how grateful I am for the way the home has looked after my mum in her last few days. Telling others of this has enabled me to see what a rare jewel Silver Birches is, and your caring and loving environment shows the highest level of commitment and professionalism. The staff are exceptional people in this day and age, who genuinely cared about my relative. The luckiest day of my mums life was when she was accepted at Silver Birches. The home held a copy of the local authority Safeguarding Adults policy and procedure along with the whistleblowing policy, which demonstrated that staff would be well supported if they reported bad practice. The staff training matrix confirmed that the staff from all departments had received up-dated training in the Protection of Vulnerable Adults to ensure they were aware of what consistutes abuse, and how and to whom, a referral should be made to protect the residents. Recruitment checks had been carried out on pospective new staff prior to the offer of a post, to ensure that only suitable people were offered a post working with vulnerable adults. Over the previous twelve months there had been one referral to safeguarding adults and one investigation had taken place. Procedures for the protection of the residents and the staff had not been followed and the registered manager had since left the employment of the company. The home had been placed under caution by the local authority whilst residents reviews had been undertaken. Areas for improvement had been highlighted throughout the investigation and an action plan had been drawn up to improve outcomes for the residents. Areas for improvement included cleanliness and hygiene, staff recruitment and retention, staff training and supervision, medication practise, care planning and the recording of nutritional and fluid intake, the complaints procedure, medical support for the home and the procedure for transfer to hospital. A full and detailed response had been made by the home, of the actions to improve outcomes for the residents and to resolve the issues, including safeguards to ensure those improvements would be sustained. Care Homes for Older People Page 20 of 31 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 home provides the residents with a homely and comfortable environment, which is suitably furnished, safe, and well maintained. Evidence: The home was situated in a rural location on a site with two other homes owned by the same company. Silver Birches was linked to one of the other homes by an attractive garden room, and accessed by a drive. There was car parking to the front of the home and the entrance was not directly accessible from the car park but situated around a corner. The home had been purpose built in the twentieth century and housed the kitchen, which serviced the three homes. A tour of the shared accommodation was undertaken and two sitting rooms were viewed. Both had been nicely decorated for Christmas with colourful trees, Christmas lights and decorations. In the larger of the two lounges, were a dining table and four chairs as well as comfortable easy chairs, an organ, and a widescreen television. A collection of DVDs and compact discs were available for entertainment and a staff member explained that some residents attended a luncheon club in this location for socialisation accompanied by pleasant music. The lighting was domestic, framed pictures were hung on the walls and the fireplace was pleasantly decorated. Both the lounges were comfortable, domestic, heated to a suitable temperature and provided with appropriate furnishings and entertainment for the comfort and enjoyment of the residents. Cold drinks were Care Homes for Older People Page 21 of 31 Evidence: available in the lounges and hot drinks were served at regular intervals. There was another seating area outside the main lounge and a piano. Some residents were quietly sitting there, viewing the garden, and more seating areas were available along the corridors. The garden was secure to ensure those at risk from wandering would be safe. A small room had been adapted as an activity/sensory room and contained sensory optical, aromatherapy, reminiscence, and beauty equipment. The visiting hairdresser used this room and the residents had been supplied with a comfortable adjustable chair and a hair dryer. The activity materials were also stored in this room including art and craft materials, puzzles, board games, quizzes, knitting equipment, mini golf, skittles and paintings completed by the residents were displayed on the walls. A staff member stated that residents, who just wanted to relax, listen to music, and enjoy the mobiles and light features could use this room. The dining room had already been described under the daily life and social activities section of the report. The residents bedroom doors were furnished with brass door knockers and a staff member stated that they chose the colour for their own front door. Three bedrooms were sampled and all contained personal items of furniture, which the residents had brought with them to personalise their rooms and make them more familiar. One resident had a huge display of photographs of family members, another had brought favourite pictures, cushions and a standard lamp and a third had brought ornaments, photographs, plants and a television. The bedrooms viewed all had ensuite facilities for the convenience of the residents, and a new adapted specialist bath with a fitted hoist had been installed in a bathroom nearby, for the comfort and safety of the residents. The AQAA recorded that a refurbishment programme involved residents in making decisions about improvements to their bedrooms, and that there would be a digital upgrade of all televisions by early next year. The home had a full time maintenance programme in place and monthly audits were completed on the environment, taking into consideration health and safety matters. Actions arising from the audits were promptly addressed, the manager stated. The home had a special budget set aside for the replacement of large equipment and for refurbishment purposes. The laundry was based in one of the other homes on the same site and was not viewed on this occasion. The staff training matrix confirmed that 100 of the staff team had received up-dated training on infection control, staff were observed wearing suitable clothing such as aprons and gloves to protect themselves and the residents and to prevent the spread of infection. Care Homes for Older People Page 22 of 31 Evidence: There were no unpleasant odours in the home on the day of the site visit and the three residents, who completed surveys, thought the home was always fresh and clean. Care Homes for Older People Page 23 of 31 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 residents are supported by staff, who have been safely recruited to protect them, well inducted and trained to care for them and in sufficient numbers for them to be treated as individuals. Evidence: The AQAA recorded that there were nine permanent carers, two part time care staff and eight other staff, covering a variety of roles including activities co-ordinator, administrator, maintenance, catering and domestic work within the home. Senior carers included a deputy manager and one other senior carer and the manager was shared with the adjacent home. The acting manager confirmed in the AQAA that, over the previous twelve months, the home had fully recruited on all positions, that agency staff were no longer being used, and that this had led to improved continuity of care for the residents. However, the post of manager has been lost from this home and to support the acting manager and deputy the management should consider recruiting another senior staff member to ensure full support. Of the four staff, who completed surveys, one thought there were always enough staff to meet the individual needs of all the people who use the service, two thought there usually were and one that there sometimes were. Comments included, at times we are short staffed and feel under pressure, and in an ideal world, a one to one situation would be ideal, and staffing levels usually are the problems that most people face, but here at Silver Birches, we Care Homes for Older People Page 24 of 31 Evidence: are meeting the needs of individuals with our staffing levels. Two of the three residents, who completed surveys recorded that the staff were always available when they needed them and one that they usually were. They all confirmed that the staff listen and act on what they say. The staff training matrix recorded that a senior staff member had completed a National Vocational Qualification (NVQ) at level 4 in care, that three carers, including a senior carer, were in the process of completing a NVQ in care at level 3, and that two carers had completed a NVQ at level 2 in care. The AQAA recorded that six staff had completed an induction in line with the Skills to Care Common Induction Standards, which provides a good introduction to the caring role and emphasises the residents rights to be treated as an individuals and with dignity and respect. Completed induction workbooks were viewed to confirm this. The four staff, who completed surveys, recorded that their induction covered everything they needed to know to do the job when they started, very well. They also confirmed they were receiving training, which is relevant to their role, helps them to understand and meet the individual needs of the residents with respect to equality and diversity issues, and keeps them up with new ways of working. The personnel files of two staff, recruited within the previous twelve months, were sampled. Application forms had been completed, full employment histories, with gaps explained and reasons for leaving employment involving the care of vulnerable adults or children, had been completed to ensure that only suitable people would be considered for the posts, for the protection of the residents. Important checks had been carried out including two written references, Criminal Record Bureau, and Protection of Vulnerable Adults (POVA) First checks, to confirm the suitability of applicants to work with vulnerable adults. The acting manager confirmed that the provider organisation supported the homes with the recruitment process, but that interviews were carried out locally to enable staff and residents to have some input. The four staff, who completed surveys, confirmed that their employer carried out checks, such as CRB and references before they started work. The staff training matrix showed that up to date training including fire safety training and fire drills, food hygiene, moving and handling, health and safety, abuse and POVA, infection control and the control of substances hazardous to health, had been accessed by all the staff. Most of the staff had received challenging behaviour and dementia awareness training and some staff were in the process of being trained in the organisations own dementia training, Yesterday, Today and Tomorrow. Sufficient staff were qualified in First Aid and a number of staff were trained in the safe handling of medication, nutrition and pressure care to ensure the residents needs would be met by suitably trained staff. Two staff training and development files sampled, contained Care Homes for Older People Page 25 of 31 Evidence: certificates to confirm that this training had been completed in a timely manner. Care Homes for Older People Page 26 of 31 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. Residents and their relatives and representatives can have confidence that there is good leadership and that systems are in place to ensure the home is run safely and in their best interests. Evidence: Since the previous site visit, the registered manager had resigned after a period of sickness, and the registered manager of the adjacent home, had been asked by the provider organisation to become the acting manager for the home. The acting manager confirmed that she was in the process of applying to become the registered manager of this home in addition to the adjacent home. The acting manager is a Registered General Nurse with twenty-three years of experience in a wide range of specialities and clinical areas, including general nursing, care of adults with learning and physical disabilities and elderly care. She had nine years of management experience and had been the registered manager of the adjacent home since January 2008. She had achieved the Registered Managers Award and completed the National Care Homes for Older People Page 27 of 31 Evidence: Vocational Awards Assessor training and Mentoring course. The AQAA recorded that, over the previous twelve months, the managers updated training included, medication management, the Mental Capacity Act Managers brief, the Mental Capacity Act Train the Trainer, the local authority Safeguarding Training and a Managers Development day arranged by the provider organisation. A staff member wrote in the survey they completed, I am really enjoying working here at Silver Birches and like the fact that there is a good rapport between the staff and the acting manager. We are always going on training, which I feel is a good thing and everyone is included, not just the care staff, but the domestic staff too. The AQAA recorded that the maintenance staff carried out weekly safety checks and the resulting record was checked and signed off monthly by the acting manager and bi-monthly by the operations manager. Regular regulation 26 visits had been carried out on behalf of the provider and copies of the reports were kept in the home. Minutes of meetings confirmed that the residents relatives and representatives were encouraged to be involved in the running of the home and that, their views were taken into account. The homes quality assurance system produced many positive comments from residents relatives and representatives including, we will be grateful for ever for the care that Silver Birches has provided for our relative, you have cared lovingly and patiently for them. I know they have enjoyed their time with you and nothing was too much trouble. A staff member wrote in a survey, residents are cared for by the care staff to a high standard and the company provide good training and support. Good records were kept of money held in safekeeping for the residents and receipts were kept as an audit trail. Residents money was stored securely, audited monthly by the acting manager and verified by the operations manager. As recorded under the staffing section of the report, mandatory staff training with respect to all aspects of health and safety was good. The AQAA confirmed that policies with respect to health and safety were in place, and that equipment had been serviced or tested as recommended by the manufacturer or other regulatory body, in a timely way, to protect the residents and the staff. A sample of certificates seen on the day of the site visit confirmed this. Care Homes for Older People Page 28 of 31 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 29 of 31 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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