Care Home: Silverbirches

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What the care home does well Prior to coming to stay at the home, people are given information to assist them to make an informed decision about whether they would like to live at the home. People who use the service have access to a range of Health and Social care professionals and this ensures that any healthcare needs are met. Care plans are detailed with personal preferences so that staff know how to meet the persons needs in a sensitive and individual manner. Visitors are made to feel welcome in the home and can visit at any time. This means that people can see their visitors at any time to suit themselves. Complaints are addressed in a timely manner so that people can be confident that their views are listened to. Aids and adaptations are provided so that the independence, choice and dignity of people using the service are promoted whilst maintaining their safety. Regular maintenance checks of this equipment ensure it is safe to use. People are offered a choice of meals, which meet any dietary, cultural needs or personal preferences. Personal allowances are held safely and any transactions are carried out appropriately. This protects people from financial abuse. People living at the home are frequently asked about their views and opinions of the home as part of the quality assurance check. This shows that people are involved in how the home is run. People told us: "I am happy here" "I have enough care received to me" "Mom has not been well of late but the staff have kept me and my family in touch at all times. We are never kept in the dark, thank you" "I can always ask the carers if I have a problem" "Those girls from manager to domestic work very hard" "I find that the staff are very good and they listen to me" What has improved since the last inspection? The management and staff have worked hard to meet the previous requirements made and this shows that the home is keen to make improvements for the benefit of the people who live at the home. Pre admission assessments are comprehensive and provide information so that the home and the person know that their needs can be met before they move into the home. The management of medication has improved so that people receive their medication as required. Any incidents at the home have been appropriately referred to other professionals and local adult teams of the social services and this ensures that people are safeguarded from harm. There have been some improvements to the environment such as upgrading of bathing facilities, redecoration of the dining room and new carpets laid. A conservatory has been built to enhance the environment. Staffing levels have been reviewed to ensure that staff are available to assist people, as they require. Some staff have received various training to ensure that they have the knowledge and skills to meet the needs of people living at the home. What the care home could do better: Individual preferences for activities should be reviewed so that people`s needs are met. The home should review the control of odours within the home to ensure that people have a comfortable environment to live in. People told us: "There are not activities all the time, but I like to take part in them" "Its very clean but I think the home could be a bit fresher" "It depends if we have a domestic in" "They should try to eliminate the bad odours on Kingfisher unit" The recruitment process must be improved to ensure that people are safeguarded from harm. CARE HOMES FOR OLDER PEOPLE Silverbirches 23 Tyne Close Chelmsley Wood Birmingham West Midlands B37 6QZ Lead Inspector Lisa Evitts Unannounced Inspection 8th November 2007 09:20 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Silverbirches DS0000004520.V354393.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Silverbirches DS0000004520.V354393.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Silverbirches Address 23 Tyne Close Chelmsley Wood Birmingham West Midlands B37 6QZ 0121 788 3758 0121 788 3956 smsilverbirches@accordha.org.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Accord Housing Association Ltd Vacant post Care Home 50 Category(ies) of Dementia (15), Old age, not falling within any registration, with number other category (35) of places Silverbirches DS0000004520.V354393.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Currently under review 1. 2. 3. Can admit one named Service User (CH) aged 61 years. Can admit one named Service User (CS) aged 62 years. That the home can admit up to three residents outside the registration category who are 60 years or over. 29th November 2006 Date of last inspection Brief Description of the Service: Silver Birches is a purpose built two storey residential home for older people set in the Chelmsley Wood area of Solihull. The home opened in 2001 and is divided into three units. One unit Kingfisher is registered for 15 older people with dementia. Robin & Jay units are registered for frail elderly people and can accommodate 17 and 18 residents respectively. The home is within easy reach of public transport and amenities such as shops, library, a park and sports centre are located a 10-minute bus ride away. The home is fully accessible on all floors from a passenger lift; there are wide corridors with handrails providing ease of access throughout. Each unit has its own dedicated communal lounge and there is a large additional lounge on the ground floor that is used regularly by people who live there and staff for activities. The room is also used to host meetings. Recently a conservatory has been added to the home. There is a dedicated dining area for the people on Kingfisher and Robin and Jay unit share a large dining room on the ground floor. The home has a designated smoking room for people who may wish to use this facility. On each unit there are facilities for bathing and taking a shower, these are large assisted facilities providing a safer environment for staff to support people with their personal care needs. All bedrooms are single with en suite facilities. Inside the home, the reception area has notice boards, which display information about forthcoming events and other articles that may be of interest. The service user guide states that the current fee to live at Silver Birches is £381.00. This fee was accurate at the time of this visit and may be subject to change. Details can be requested from the home. Additional charges include hairdressing, optical and dental services. Silverbirches DS0000004520.V354393.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. Two inspectors undertook the visit to the home, over six and a half hours and the assistant manager and temporary manager assisted us throughout. The inspectors were assisted by an Expert by Experience (in this report known as “the Expert”). This is someone with personal experience of using care services who had been trained to accompany inspectors during a visit to a service. Experts by Experience observe what happens in the home and talk to people who live there, to gain their view of the home. The Expert talked with many people living here and provided a report of her findings, parts of which have been included in this report, three staff were also spoken to. The home did not know that we were visiting on that day. There were 49 people living at the home on the day of the visit. Information was gathered from speaking to and observing people who lived at the home. Four people were “case tracked” and this involves discovering their experiences of living at the home by meeting or observing them, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files, training records and health and safety files were also reviewed. Random questionnaires were sent to some people who live at the home and to their relatives. Four relative and four questionnaires from people who live at the home were returned. These contained a range of comments about the service provided and are included within this report. Prior to the inspection the Acting Manager had completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This gave us some information about the home, staff and residents, improvements and plans for further improvements, which was taken into consideration. Regulation 37 reports about accidents and incidents in the home were reviewed in the planning of this visit. No immediate requirements were made at the time of this visit. What the service does well: Silverbirches DS0000004520.V354393.R01.S.doc Version 5.2 Page 6 Prior to coming to stay at the home, people are given information to assist them to make an informed decision about whether they would like to live at the home. People who use the service have access to a range of Health and Social care professionals and this ensures that any healthcare needs are met. Care plans are detailed with personal preferences so that staff know how to meet the persons needs in a sensitive and individual manner. Visitors are made to feel welcome in the home and can visit at any time. This means that people can see their visitors at any time to suit themselves. Complaints are addressed in a timely manner so that people can be confident that their views are listened to. Aids and adaptations are provided so that the independence, choice and dignity of people using the service are promoted whilst maintaining their safety. Regular maintenance checks of this equipment ensure it is safe to use. People are offered a choice of meals, which meet any dietary, cultural needs or personal preferences. Personal allowances are held safely and any transactions are carried out appropriately. This protects people from financial abuse. People living at the home are frequently asked about their views and opinions of the home as part of the quality assurance check. This shows that people are involved in how the home is run. People told us: “I am happy here” “I have enough care received to me” “Mom has not been well of late but the staff have kept me and my family in touch at all times. We are never kept in the dark, thank you” “I can always ask the carers if I have a problem” “Those girls from manager to domestic work very hard” “I find that the staff are very good and they listen to me” What has improved since the last inspection? The management and staff have worked hard to meet the previous requirements made and this shows that the home is keen to make improvements for the benefit of the people who live at the home. Pre admission assessments are comprehensive and provide information so that the home and the person know that their needs can be met before they move into the home. Silverbirches DS0000004520.V354393.R01.S.doc Version 5.2 Page 7 The management of medication has improved so that people receive their medication as required. Any incidents at the home have been appropriately referred to other professionals and local adult teams of the social services and this ensures that people are safeguarded from harm. There have been some improvements to the environment such as upgrading of bathing facilities, redecoration of the dining room and new carpets laid. A conservatory has been built to enhance the environment. Staffing levels have been reviewed to ensure that staff are available to assist people, as they require. Some staff have received various training to ensure that they have the knowledge and skills to meet the needs of people living at the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Silverbirches DS0000004520.V354393.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Silverbirches DS0000004520.V354393.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have the information they need to make an informed choice about whether they want to live at the home. Comprehensive pre admission assessments are completed by the staff to determine if they can meet the needs of the person prior to them moving in. EVIDENCE: The home has produced a comprehensive statement of purpose and service user guide, which contains all the information required and ensures that people are given information about the home. This will enable them to make an informed decision about whether they would like to live there. These documents can be made available in other languages and/or a suitable format for a variety of needs upon request so that anyone could access this information. Silverbirches DS0000004520.V354393.R01.S.doc Version 5.2 Page 10 The certificates of registration and public liability insurance are on display in the reception area of the home, which enables anyone to see them when visiting. A copy of the previous inspection report is displayed and this ensures that information is available to people should they choose to read it. Staff at the home undertake comprehensive pre admission assessments and this ensures that the home can meet the needs of people prior to them moving in. One person’s assessment stated that the person would “go back to bed” and we observed that the person had got back into a made bed and then had got up again. This shows that the home gained enough information about the person prior to them moving in to enable them to continue with their individual routines. The home does not offer intermediate care facilities. One person told us “I am happy here”. Silverbirches DS0000004520.V354393.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans provide sufficient information for staff to assist people to meet their individual needs and preferences. The management of medication ensures that people receive their medication as prescribed. EVIDENCE: Each person has a care plan written. This is an individualised plan about what the person is able to do independently and states what assistance is required from staff in order for the person to maintain their needs. Four care plans were reviewed and these gave good information for staff to follow to assist people to meet their identified needs and preferences. The care plans are written in a way that is person centred, as if the person was saying what they required. Lots of personal preferences were recorded within the plans, for example “ I would like to attend the hairdressers once a week for a set” and “I would like a carer to help me to bathe when I choose”. Pictures were also used so that people could express their feelings. Silverbirches DS0000004520.V354393.R01.S.doc Version 5.2 Page 12 Risk assessments were completed each month for skin sores and nutrition so that action could be taken if required. Moving and handling assessments are completed and these provided staff with details of all the equipment to be used. Individual risk assessments are written where required. One person had been displaying difficult to manage behaviour and the staff had referred the person to the community psychiatric nurse for further assessment. In preparation for this appointment the staff were completing a half hourly monitoring form so that behaviour was monitored. This would provide the nurse with information about any trends or patterns in the behaviour. There had been an incident between two people living at the home and staff had acted appropriately to deal with the incident with the exception that a GP had not seen one person following the incident. This was discussed with the assistant manager on the day of the visit and the home is aware of the need to inform all relevant parties when incidents occur. One person had had an increase in the number of falls and staff had referred this person to a falls clinic for assessment in order to try and reduce the number of falls. A care plan for diabetes did not include details of what the signs of high or low blood sugars are and this is recommended so that staff know what is wrong if they observe these signs. Daily records were very detailed about how people had spent their day and what activities they had taken part in. People are involved in their care planning and sign a monthly care plan review. There was evidence that external healthcare professionals such as optician, general practitioner, social worker, chiropodist, district nurses and community psychiatric nurses review people living at the home. People told us: “I have enough care received to me” “They always try to encourage them to be mobile when it’s appropriate” “Mom has not been well of late but the staff have kept me and my family in touch at all times. We are never kept in the dark, thank you” The Expert spoke to one family visiting who said that they were very happy with the care given to their mother and the person said that they would not want to go home and was very happy. The management of medication was reviewed and people had identity photographs to reduce the risk of errors occurring. All boxed medications are counted before and after a drug round in order to monitor that stock balance is correct. Audits undertaken were correct. Handwritten Medication Administration Charts (MAR) had only one signature and it is recommended Silverbirches DS0000004520.V354393.R01.S.doc Version 5.2 Page 13 that two people sign these so that potential for error is minimised. Assessments were in place for people who wished to self-administer their medication to ensure that they were safe to do this. Fridge temperatures were recorded daily but were a little higher than recommended. Temperatures should be between two and eight degrees in order to store medication within its product licence. Controlled drugs were correctly stored and recorded. Following the visit the Expert advised us that she had found some medication on the smoking room floor and staff must look out for this in future. Staff were observed to speak to people in a respectful manner and maintained their privacy. People were well presented and were supported to wear clothing, which reflected their personal choices. Hair was neat and fingernails were clean. Silverbirches DS0000004520.V354393.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are able to exercise some choice and control over their lives, which promotes their individuality and independence. Not all peoples recreational needs were met which may result in boredom and isolation. People are offered a choice of meals, which meet any special dietary, cultural needs or preferences. EVIDENCE: The Expert reported that less mobile clients were happy with the “in house” activities provided but some did not feel that their needs were catered for and felt a need for more mental stimulation. Others were happy to sit and watch television and sit in the garden when the weather permitted. A schedule of daily activities was evident with a dedicated activities coordinator in full time employment. Activities included card making, painting, board games, bingo, games, sing a longs, coffee afternoons, reminiscence and film afternoons. There had been trips outside of the home to the safari park and Mad O’Rourke’s Pie factory. External entertainers provide entertainment to people and a Christmas lunch had been arranged. Progressive mobility visits the home so that people can undertake exercise to music if they wish to. Silverbirches DS0000004520.V354393.R01.S.doc Version 5.2 Page 15 People’s birthdays are celebrated and there had been food-tasting nights, a Halloween party and a clothing sale. People told the Expert that they were not able to maintain contact with the community as they wished and felt that lack of staff was the main problem. The activities coordinator takes individuals out shopping as time permitted but one person said that visits were brief when they occurred. A local ‘ring and ride’ service was not freely available, as many did not have bus passes since moving into the home. This was discussed with the manager and it was recommended that people are asked if they would like to use this facility, if they were assessed as safe to do so. The hairdresser visits the home and a church service is held once a fortnight. Five people at the home visit a church lunch club every fortnight. People are able to maintain contact with family and friends, entertaining in the lounge areas or bedrooms if required. One visitor confirmed that they could visit freely. People told us in questionnaires: “There are not activities all the time, but I like to take part in them” “I like to play bingo now and again” One person who had visual impairments had not been offered talking books as an alternative pastime, however the activities coordinator addressed this at the time of our visit. Activity records are maintained and indicated that people had participated in activities. People had completed evaluation forms following the trips out in order to measure their success. Care plans provided detailed social background information so that staff had knowledge of past interests. The home has a four-week rolling menu. The meals are ordered a day before with the menu displayed in the dining room. The Expert reported that comments on the food standard were varied from “excellent” to “no attention to likes or dislikes are noted when serving vegetables”. Drinks were available with meals and people can choose where they would like to eat their meal. Tables were well presented and furniture was disabled friendly. The water dispenser was empty and there were no cups in the dispenser, which would not enable people to get their own drinks if they chose to. There were stains on the wall around the serving hatch and this does not promote a clean environment for people to live in. One person said ““I’m bloated, I’ve enjoyed my lunch today” Silverbirches DS0000004520.V354393.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedure is comprehensive and is accessible to people should they need to make a complaint. The home has policies, procedures and staff training, which should safeguard residents from harm, however not all staff had received this training. EVIDENCE: The home has a comprehensive complaints procedure for people and their representatives to use if they need to make a complaint. This is on display in the main reception area and is included in the service users guide. The home has a “suggestions box” which is located in the main reception area and this enables people to raise any ideas or concerns. The home had received a number of compliments, which suggests satisfaction with the service provided. Since the last visit to the home, we had received one complaint that had been referred to the providers to investigate using their own complaints procedure. The home had received eight complaints and there was evidence of how the complaint had been investigated and details of the actions that had been taken. Copies of staff interviews and policies were kept alongside the complaint along with the outcome. Silverbirches DS0000004520.V354393.R01.S.doc Version 5.2 Page 17 People told us: “Have not so far needed to raise any concerns” “I can always ask the carers if I have a problem” The home has leaflets on display advising people of a helpline for advocacy services and this is good practice as enables people to make their own choices. The home had an adult protection policy in place and had the local multi agency guidelines to follow; this ensures that staff have guidelines to follow in the event of any situation occurring. Since our last visit there had been two adult protection referrals raised by the home and both of these cases had been appropriately dealt with and the cases closed. The staff training matrix evidenced that the majority of staff have received training in adult protection however the remaining staff should also receive this training so that they have the knowledge and skills to act appropriately to safeguard people in the event of an allegation being made. This training was scheduled but staff must ensure that a rolling programme is in place. One member of staff said, “ I can’t remember when I last had adult protection training, it was a long time ago”. Silverbirches DS0000004520.V354393.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,24,25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are provided with a comfortable environment to live in, where they appeared to feel relaxed and secure. Some odours in the home do not ensure that the home is pleasant for people to live in. EVIDENCE: Entrance to the home is via a bell and this ensures that staff know who is entering the building and this assists in maintaining the safety of the people who live at the home. The Annual Quality Assurance Assessment told us that the home has a planned maintenance and cyclical works programme. In the last twelve months, baths have been upgraded and the dining area had been redecorated and carpets had been replaced. Silverbirches DS0000004520.V354393.R01.S.doc Version 5.2 Page 19 A partial tour of the building was undertaken. Robin unit has a large dining room and separate lounge room. There are plans to refurbish the lounge area as is used for activities. There is a large cinema screen television and a computer game system for people to use if they choose to. The lounge carpet was heavily stained and the temporary manager advised that quotes were being sought so that this could be deep cleaned, however it is recommended that consideration is given to replacing carpets to ensure a comfortable and homely environment. A new conservatory has been built recently and the garden had raised flowerbeds so that people could continue with their interest in gardening if they chose to. On the day of the visit there was no ramp to the conservatory, however we have been advised that a portable ramp is to be purchased so that people in wheelchairs and people with mobility difficulties will have access to the garden. The home has two hoists to assist people who have decreased mobility and specialised equipment for sore skin can be arranged through the district nurses if required. There are assisted bathing and showering facilities within the home to meet the needs of people who live there. There had been a number of toiletries and bars of soap left behind in bathrooms and toilets and this was brought to the attention of the temporary manager as poses a potential infection risk. It is recommended that all toiletries are returned to individual rooms after use. One shower room had a very offensive odour from the drain and the maintenance person was addressing this. There was a very strong smell of air freshener on Jay unit and staff should ensure that air freshener is not used to mask odours without dealing with the actual cause of the odour. Although there were no odours noticed on the day of the visit, there had been concerns raised at the last visit to the home about odours and this continued to be a concern in the recent questionnaires received by us. This will need to be reviewed again as the home must provide a home free from offensive odours. People said: “Its very clean but I think the home could be a bit fresher” “It depends if we have a domestic in” “They provide a safe and caring environment” “They should try to eliminate the bad odours on Kingfisher unit” The temporary manager has numerous plans for development of the Kingfisher unit so that people with dementia are stimulated. This will be further reviewed at the next visit. Lighting throughout the corridors and communal areas was quite dim and it is recommended that this is reviewed so that people live in safe and comfortable surroundings. Silverbirches DS0000004520.V354393.R01.S.doc Version 5.2 Page 20 All bedrooms have an ensuite facilities and door locks so that people can choose to lock their rooms if they require. Bedrooms seen were personalised to reflect individual needs and interests. A recent inspection form the Environmental Health Office stated “Standards of cleanliness and hygiene excellent at the time of the visit”. One requirement regarding staff training had been made and this had been actioned. Silverbirches DS0000004520.V354393.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Lapses in the recruitment procedure do not safeguard people from harm. Staff receive some training to ensure that they have the knowledge and skills to perform competently within their roles. EVIDENCE: There are eight care staff on duty throughout the daytime and four staff throughout the night time hours. A senior worker is on duty 24 hours per day and the manager is supernumery. The home had four care staff vacancies on the day of the visit but was actively recruiting to these positions. No agency staff are used as the home maintains a core group of staff and this means that people know who will be assisting them to meet their needs. In addition to the care staff the home also have domestic, laundry, kitchen, administration and maintenance staff to ensure that all the needs of the people living at the home are met. The assistant manager confirmed that 62 of the staff had completed National Vocational Qualification (NVQ) Level 2 or above. This should ensure that skilled and knowledgeable staff support people to meet their identified needs. People told us: “Those girls from manager to domestic work very hard” “Due to short staff you cant always get the staff you need” Silverbirches DS0000004520.V354393.R01.S.doc Version 5.2 Page 22 “Sometimes they are not available due to being with others” “I find that the staff are very good and they listen to me” The home has both male and female care staff so that care can be delivered in a sensitive manner. Two staff files were reviewed. One file had good recruitment checks in place to ensure the safety of people living at the home. The second file had references from a previous line manager but this had been sent from a home address rather than from the previous organisation. The person had started employment prior to the return of the POVA first (Protection Of Vulnerable Adults) check and this does not ensure the safety of people living at the home. These lapses in the recruitment process were discussed with a senior external manager via the telephone following the visit. People living at the home had been involved in a recruitment and selection open day and this shows that people have a say in how the home is run. A staff-training matrix is available and this showed that training is available to many staff. Some staff have received training in challenging behaviour, moving and handling, fire, health and safety, customer care, food hygiene, medication, dementia awareness, infection control and the mental capacity act. There were some gaps in the training and not all staff had received updates in training and this needs to be addressed to ensure that staff have up to date knowledge. One staff member told us that she had completed an advanced course in Alzheimer’s disease and had done adult protection training at the home. Silverbirches DS0000004520.V354393.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run in the best interests of the people who live there. There are systems in place to monitor the quality of the service on offer and the systems for consultation are good. Maintenance checks of equipment used ensure that people’s safety is protected. EVIDENCE: Since our last visit a manager had commenced employment at the home however had very recently gone onto maternity leave. It is recommended that an application for her to be registered with us is submitted upon return to work. There are two assistant managers who have both achieved a management qualification. A temporary manager had been appointed to cover Silverbirches DS0000004520.V354393.R01.S.doc Version 5.2 Page 24 this period of leave and had been working at the home for two weeks. The temporary manager has previous management experience and has experience in care of older people with dementia. He is a Registered Nurse and is currently working towards the Registered Managers Award and this will assist his skills in managing the team. External managers visit the home and are available to support the temporary manager. They also complete Regulation 26 visit reports on the quality of the service being provided. These reports were available for us to review; these were very comprehensive and included action plans. The home has staff meetings so that topics can be discussed and staff are given the opportunity to raise any concerns or share ideas for improvements. Each of the units has separate team meetings and there was evidence that action was taken to address any issues raised in the best interests of the people living at the home. Senior staff, domestic and night staff meetings are also held so that everyone is able to voice their opinions. Tenant participation meetings are held and there was good documentation about people being asked if they would like a pet, where they would like to go on a trip, what they would like on a tuck shop trolley, menus and the upgrade of the reception area. This means that people are actively involved in how the home is run. Questionnaires are sent out to people regarding the service and an annual report is written based on the findings. Individual records are maintained for people where the home holds personal monies. Receipts were available to confirm all expenditure on the accounts and balances audited were correct. Health and safety and maintenance checks had been undertaken in the home to ensure that the equipment was in safe and full working order. The maintenance person completes a monthly health and safety audit and this should ensure that any potential problems are highlighted. Weekly fire checks of the system and fire doors are undertaken to ensure that they are in full working order. Eight staff had not received a fire drill, however six had undertaken fire training. The two staff that had not received training was brought to the attention of the assistant manager who advised that they would receive a drill the next day. This should ensure that staff have the knowledge to safeguard people in the event of a fire. Accident records were good and each person has a monitoring form, which shows a snapshot of incidents, and this enables staff to monitor for any trends and take any appropriate action. Silverbirches DS0000004520.V354393.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 3 3 X 3 2 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 X X 3 Silverbirches DS0000004520.V354393.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP29 Regulation 19 Sch 2 Requirement Satisfactory recruitment checks must be completed prior to staff being employed in order to safeguard people from harm. Timescale for action 20/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP9 Good Practice Recommendations Diabetes plans should provide details of signs of high and low blood sugars so that staff have guidelines to follow. Two signatures should be recorded on hand written Medication Administration Records. Fridge temperatures should be kept between 2 and 8 degrees. People should be asked if they would like a bus pass in order to use the ring and ride service. The water dispenser should be clean and have cups available so that people can get their own drink if they require. A rolling programme for adult protection training should be in place so that staff have up to date knowledge. It is recommended that heavily stained carpets in DS0000004520.V354393.R01.S.doc Version 5.2 Page 27 3. 4. 5. 6. OP13 OP15 OP18 OP19 Silverbirches 7. 8. 9. 10. OP26 OP25 OP26 OP31 communal areas are replaced. Toiletries and soap should be returned to people’s rooms to minimise the risk of infection. Lighting should be reviewed to ensure that the home is bright and the environment is safe for people. Untoward odours should be effectively managed so that people have a pleasant environment to live in. The manager should submit an application to us to become the Registered manager upon return to her role. Silverbirches DS0000004520.V354393.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Silverbirches DS0000004520.V354393.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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