Inspection on 03/09/09 for Barley Brook Care Home

This is the latest available inspection report for this service, carried out on 3rd September 2009.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Barley Brook Care Home Elmfield Road Wigan WN1 2RG Lead Inspector Sarah Tomlinson Key Unannounced Inspection 3rd September 2009 07:25 DS0000073271.V376334.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Barley Brook Care Home DS0000073271.V376334.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Barley Brook Care Home DS0000073271.V376334.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Barley Brook Care Home Address Elmfield Road Wigan WN1 2RG 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) 01942 497114 Rosewood Healthcare Ltd Mrs Edith Anne McGovern Care Home 20 Category(ies) of Dementia (20) registration, with number of places Barley Brook Care Home DS0000073271.V376334.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only- Code PC To people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia- Code DE The maximum number of people who can be accommodated is: Date of last inspection 24th July 2008 20 Brief Description of the Service: Barley Brook is a private care home, registered with us (the Care Quality Commission) to provide specialist care for up to 20 older people with confusion (dementia). Rosewood Healthcare Limited owns the home. The company is based in the ‘north west’ and has one other home. Barley Brook is a large, converted, Victorian semi-detached house. It has three floors with a lift (residents use ground and first floors only). There is a large, main lounge and dining area and a second, separate, smaller lounge. A small smoking room is also provided. All 20 bedrooms are singles, 17 have ensuite toilets and wash hand basins, the remaining 3 have wash hand basins only. Seven bedrooms are on the ground floor, 13 are on the first floor. There is a communal toilet, an assisted bathroom with a further toilet and an assisted shower room on the ground floor. The home is on a main road, close to Wigan and Standish town centres. There is a car park and a garden with large mature trees to the front and a small, enclosed patio at the rear. Current fees (at September 2009) range from £409.32 to £456.00 per week (hairdressing and toiletries are extra). A copy of our latest inspection report is available from the home. Barley Brook Care Home DS0000073271.V376334.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. Our inspection visit, which the home was not told about beforehand, took place over 1 day (lasting 12 hours). It was carried out by one inspector. (References to ‘we’ or ‘our’ in this report mean the Care Quality Commission). During our visit we spent time watching how staff cared for residents. We also talked with 2 residents and 3 relatives. We looked around parts of the building and at some paperwork. We talked with the manager, the owner, 6 care staff, the cook and the handyman. A further 2 relatives returned surveys we had sent out before our visit. Their views are included in this report. We have also used information from an Annual Quality Assurance Assessment form (AQAA). The home has to complete this each year. It includes information about what they think they do well, what they would like to do better and what they have improved upon since our last visit. This inspection was carried out as the home had recently been sold. Rosewood Healthcare Limited bought the home from Century Healthcare Limited, the previous owners, on 19th March 2009. The manager, Mrs Anne McGovern, had not changed. What the service does well: Relatives felt residents were well cared for. Staff were patient, warm, kind and helpful. The staff team was small. This meant residents, relatives and staff all got to know each other very well. One relative said staff were “fantastic”. Another felt their aunt had been looked after by staff in a “wonderful way”. Residents were helped to enjoy good food. The home was attractive, safe and comfortable. Barley Brook Care Home DS0000073271.V376334.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Barley Brook Care Home DS0000073271.V376334.R01.S.doc Version 5.2 Page 7 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 Barley Brook Care Home DS0000073271.V376334.R01.S.doc Version 5.2 Page 8 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 (Intermediate care is not provided by the home. Consequently, standard 6 does not apply and was not assessed). People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. To enable informed admission decisions to be made, information provided about the home still needed to be clear and correct, and information obtained about prospective Social Services funded residents still needed to improve. EVIDENCE: Since our last inspection, the home had requested we remove the condition that allowed up to 5 older people without confusion to live there. We had agreed. All 20 places were now just for older people with confusion. Prospective residents and their families were given information about the home in a ‘Handbook’. This was a combined Service User’s Guide and Statement of Barley Brook Care Home DS0000073271.V376334.R01.S.doc Version 5.2 Page 9 Purpose. The manager said apart from the owner’s details being updated, no other changes had been made to this document since our last inspection. Consequently, changes we had requested at our last two inspections were still needed (to meet Schedule 1 of the Care Homes Regulations 2001). These included a clear explanation that the home offered a specialist service. And as a specialist service, the Handbook also needed to say how the home met the additional needs of older people with confusion (e.g. through any décor or signage used to help residents find their way around the building; any dementia care training for staff; any specialised social activities). Clearer admission criteria were still needed - the statement that older people with “significant mental health problems” were cared for was confusing (as this was a general term that includes functional mental health disorders such as schizophrenia and bi-polar disorder, rather than just older people with confusion). The age range of residents was also needed. Also, the organisational structure diagram in the Handbook had not identified the deputy post; information about complaints had been incorrect (regarding the inference the complainant could only contact us for serious issues); our contact details had needed updating; and prospective residents needed to know the home had a pet dog. The Handbook had also contained factual errors (regarding the number of en-suite bedrooms and bathrooms; the existence of a residents’ committee; and public telephone arrangements). How the views of residents and relatives were sought had also been needed. In addition to the Handbook, there continued to be an innovative ‘photo guide’. The home had worked hard to ensure this was in a format many older people with confusion would find helpful, with clear photographs of the home and brief, large print text. This required minor updating. Most of the residents living in the home had been referred by Social Services. At our last inspection we had advised a copy of their Care Management assessment and care plan, or a copy of their Care Programme Approach care plan should be requested and received by the home prior to them being offered a place. Although the manager carried out the home’s own preadmission assessment, receipt of this information would provide a better picture of a prospective resident’s specialist needs (e.g. past risk issues and behaviours). This would allow the home to consider all relevant and available information in order to decide if Barley Brook had the capacity to meet their needs. However, at this inspection, this information was still not being requested prior to admission. It was usually received after the new person had moved in. We advised the home it had a responsibility to ensure it received all relevant information (which the statutory bodies had a responsibility to provide in a timely manner). We again advised the manager to contact team leaders of local Community Mental Health Teams and Social Services older people teams to confirm this expectation of good practice. We advised the home to review its admission policy, with places offered to people referred via Social Services only once their statutory assessments had been received. Barley Brook Care Home DS0000073271.V376334.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the 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 benefited from a staff team that provided good, flexible and responsive care. Improvements in care records would better match and guide this. Improvements in medicine ordering and recording were needed to ensure residents’ health needs were met. EVIDENCE: Due their confusion, communication difficulties and short term memory loss, most residents were unable to tell us what it was like to live at the home. However, we were able to speak to several residents and relatives, and we also spent time watching how staff spoke to and looked after residents. Residents were cared for by a small staff team, many of whom had worked at the home for a number of years. This meant they had a very good understanding of the help and support residents needed and how they liked this to be given. Due to Barley Brook Care Home DS0000073271.V376334.R01.S.doc Version 5.2 Page 11 residents’ specialist orientation needs and short term memory loss, we advised all staff should have clear name badges to act as a helpful prompt. The manager was aware this needed addressing. (Staff should also ensure these are not covered when wearing protective aprons). Staff on duty were very warm, kind, patient and respectful (e.g. responding quickly to residents who needed help; discreetly asking residents about using the toilet). Relatives felt residents were looked after very well. One said staff were “fantastic”. Another relative had written to the home thanking staff for the “wonderful way” they had looked after their aunt. Residents were neatly and appropriately dressed. Whenever possible, staff supported residents to walk rather than use a wheelchair, helping to retain and improve their mobility. Further good practice was noted, as the home’s key worker system continued to promote residents’ dignity, with each staff member having responsibility to assist ‘their’ residents to bathe or shower (rather than this intimate task be shared across the staff team). At our last inspection we had observed personal care being given in the communal lounge area (e.g. brushing hair; moving along a row of male residents, cutting their fingernails). The manager confirmed to protect residents’ dignity, such care was now given on an individual basis and in private. We also discussed the length of staff fingernails. To reduce the risk of causing skin tears, we advised staff should keep their fingernails short. We joined staff for the morning handover. These meetings between shifts continued to take place in the communal dining area. Although one resident was gently and appropriately guided away before it started, another resident was not, with personal information about other residents being discussed within earshot of them. We looked at 3 residents’ care files in detail. At our last inspection these had generally been in good order, with up to date and accurate information about residents’ care needs. Since then, the care paperwork had been updated. Only minor changes had been wanted, mainly reflecting the name of the new owner. However, the new version bought had been revised, requiring the home to make more substantial changes. The manager said they were finding this difficult to implement. This was due in part to a lot of duplication, which we had discussed at our last inspection. In addition to a daily ‘Kardex’ file, residents had individual files with care plans, risk assessments, review information etc, plus a further file with day and night care plan summaries. Although care plans and risk assessments were in place, information was difficult to find; was not in format accessible to residents or their relatives; and did not reflect the in depth knowledge staff had and the good standard of care given. We advised the home to review what care documents were needed and found helpful. Also, removing blank forms and old documents to overflow files or placing them at the rear would make files easier to manage. Barley Brook Care Home DS0000073271.V376334.R01.S.doc Version 5.2 Page 12 We advised two areas where more information would be helpful. Firstly, high risk issues such as physical aggression and anxiety that can cause distress to the resident and harm to others. One file we looked at described a resident’s aggression as ‘challenging behaviour’. A clear description of what behaviour has been displayed, to whom and how often would be more helpful. Any known triggers (to help avoid the behaviour happening), plus clear, practical, guidance if the behaviour does occur was also needed. Secondly, where relevant, individual files should also show Care Programme Approach information (with details of a resident’s CPA care co-ordinator, CPA level; and copies of their most recent CPA care plan and CPA review minutes). With regard to monitoring residents’ health, regular access to specialist services was evident (e.g. GP, continence advisor, opticians). Care staff identified and referred health concerns promptly. For example, a District Nurse visited during our inspection to assess and organise pressure relieving equipment for one resident staff felt was at risk of developing pressure sores. Accident records continued to be well kept, including a monthly audit to identify any patterns, with responses noted in risk assessments. The new care paperwork had introduced a body map, which was proving helpful in documenting and monitoring bruises and skin wounds. With regard to monitoring and responding to changes in residents’ weight, only domestic weighing scales were still available. We were concerned one care file had no record of the resident’s weight as they could not stand to be weighed. To remedy this and generally improve nutritional screening, the new owners were about to purchase seated weighing scales. We discussed one resident’s increasing need for a hoist to enable staff to move them safely. This had been recognised by the home; was documented in their care file; and a hoist, the manager said, was on order. The manager agreed a quicker response was now needed and later confirmed a hoist was hired the day after our inspection visit (until the new hoist could be delivered on 10/9/09). With regard to medicines, we looked at how they were handled. Suitable arrangements were in place. Only senior staff administered medicines. They had all received basic certificated training and were currently improving this with additional training. There was generally a clear audit trail of medicines entering the home and being administered. The unnecessary practice of signing an additional record sheet at the end of the medicines round, as well as individual medicine administration record sheets (MARs), had stopped. MARs were generally clear and complete. However, we looked at two that were not. For one resident, a mid-cycle change in both dose and frequency of a long term medicine had been poorly recorded, increasing the risk of error: preprinted dates had been overwritten, making it difficult to confirm when medicines had been given; the alteration itself was unclear; it had not been signed, dated or countersigned; and the in-use MARs had not been cancelled (so the medicine appeared on 2 separate MARs, increasing the risk of it being Barley Brook Care Home DS0000073271.V376334.R01.S.doc Version 5.2 Page 13 given incorrectly). We provided details of the new guidance from the Royal Pharmaceutical Society regarding MARs - ‘Principles of safe and appropriate production of medicine administration charts’ (2/2009). A consistent approach was needed regarding heart medicine for another resident. Although their heart rate was usually checked and recorded before this medicine was given, 2 gaps on their MARs showed this was not always done or recorded (although the medicine had been given). We found a new resident had not received their previous evening’s medicine as the home had run out. They were also going to miss it for a second night as the new stock had not arrived. The manager was aware this should not have happened. They explained this situation was compounded by the local hospital’s discharge practice of providing 1 week supply of medicines. We discussed this matter after our inspection with our pharmacy inspector and health assessor. Although common practice that homes need to plan for, they advised the home write to the hospital requesting it review this practice and copy both the PCT and ourselves in. Medicines were stored safely in a locked cupboard. However, as discussed at our previous inspections, this was very small; with very limited storage and working space. The cupboard was also immediately outside the lounge and on the corridor to the toilets. Consequently, working in the cupboard, which necessitated the door being open, was impractical, with a high potential for disturbance (increasing the risk of error). The manager said new secure storage space was now planned. Barley Brook Care Home DS0000073271.V376334.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the 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 were benefiting from continued improvements in social activities and in food (with better record keeping now supporting the former). EVIDENCE: The home did not employ an activities co-ordinator. Rather, care staff carried out social activities with responsibility for these allocated each morning at the handover meeting. Several more able residents were able to follow their own hobbies and interests, such as knitting and reading. However, most residents were completely reliant on staff to provide social stimulation. Good practice was noted, as there was a range of social and physical activities. These took place in both lounges and on a 1 to 1, small and large group basis. Residents benefited from a morning daily armchair exercise session (‘breakfast booster’). This was a fun and enjoyable start to the day, plus it maintained and improved residents’ balance, muscle strength and mobility. Other organised activities Barley Brook Care Home DS0000073271.V376334.R01.S.doc Version 5.2 Page 15 included quizzes, other physical games, dominoes, dancing and communion. Calendar events were also celebrated, with bonnets being made at Easter and attendance at the armed forces day in the local park. The home was working hard to try out new activities, with residents encouraged to take photographs of flowers and plants in the garden, plus ‘everyday’ activities such as having lunch in the garden during hot weather. The frequency of external entertainers had also increased, with residents now benefiting from monthly social events. At previous inspections we had difficulty in confirming what activities were being provided and which residents took part. This had now improved, with a new notice board in the entrance hallway. Although there was no formal timetable, this displayed general details about what was provided during the week and where. Information about individual residents was also improving, with entries now in their daily record sheets. As discussed at our previous inspections, we again advised continuing to develop informal activities. These particularly benefit residents unable to join in organised activities. Doing practical, familiar household tasks helps them feel useful and involved, and reduces anxiety and confusion. For example, we advised lowering the washing line in the internal courtyard would enable residents to peg out laundry; plus formal reminiscence groups could be extended by having ‘themed’ tables around the home (with objects and equipment left out to look at, touch and pick up). Visitors felt they were made welcome. Residents and their families were able to personalise bedrooms (e.g. with photographs, ornaments and bedding). Nine residents were up when we arrived in the home (at 7.25am), some enjoying a hot drink. Night staff confirmed residents choose when to rise. Later in the day we observed lunchtime. This took place in a calm and unhurried manner, with residents given time to enjoy their food. Staff helped appropriately and food continued to be cut up in the kitchen rather than in front of residents (to maintain dignity and lessen embarrassment). Since our last inspection, previous improvements in seating arrangements had been hampered by smaller tables being replaced with larger ones. This had been recognised by the new owners and new, smaller tables were due to be provided (allowing greater flexibility and opportunity to meet residents’ specialised needs). We also advised staff could sit and eat with residents (as part of their work). This would encourage those residents who needed greater support to eat and help make the meal a social occasion. We discussed guidance from the National Patient Safety Agency, asking all care homes to ensure staff have the skills to deliver effective first aid, in particular the management of choking. The manager felt senior staff were competent, although we discussed the adequacy of recent training as staff said it had only covered the theory of choking. Barley Brook Care Home DS0000073271.V376334.R01.S.doc Version 5.2 Page 16 Since our last inspection, the previous long standing cook had left with two new cooks now working in the home. Menus were currently being revised. Improvements had already been made with more hot food served at tea time and fresh, soft fruit now served every afternoon. Residents continued to enjoy a cooked breakfast on alternate mornings and a ‘chip supper’ from the chip shop once a month. Once the new menus were confirmed, the home was going to display a weekly menu (for relatives) and a large print daily menu on the white board in the dining area (for residents). Although only one main meal continued to be served at lunchtime, there was clear and detailed information about residents’ likes and dislikes to guide the new cooks. Plus individual daily records continued to show alternatives were provided. Special dietary needs were catered for and the new cook was aware of the need to serve any pureed foods separately (to maintain taste, texture and appearance). Good practice was noted, as nutrition training was going to be made available to the new cooks, as they did not have a background in care catering. We also gave details of the National Association of Care Catering (NACC), who would also be able to provide advice and information. Barley Brook Care Home DS0000073271.V376334.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements for protecting residents from abuse or harm and taking concerns seriously were in place. EVIDENCE: Information about how to make a complaint was in the home’s Handbook. As noted, this needed revising to explain that complainants can contact us at any time. The complaints procedure also used to be displayed in the entrance. It had been taken down to be updated. The manager was aware it needed to be replaced. No complaints had been received by either us or the home since our last inspection. No safeguarding alerts had been made since our last inspection. Nine staff members had now completed abuse awareness training. Good practice was noted, as this had included domestic staff. Eleven staff were still due to do this training. We discussed the recent introduction (from the 1st April 2009), of the Deprivation of Liberty Safeguards (DOLs), which ensured residents who lacked capacity were not prevented from doing things unless absolutely necessary for Barley Brook Care Home DS0000073271.V376334.R01.S.doc Version 5.2 Page 18 their safety. It also introduced a new legal role and responsibilities for care home managers. Good practice was noted, as the manager was aware of the legislation; had completed training regarding it; and although confirmed no residents at Barley Brook were having their liberty currently deprived, had gained understanding of what could be involved through a potential referral where there had been deprivation of liberty issues. The new care paperwork provided a form where capacity issues and any associated decision making could be recorded. Barley Brook Care Home DS0000073271.V376334.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Barley Brook provided residents with an attractive, comfortable, safe and homely place to live. Better odour control and minor improvements would further benefit residents and ensure their specialist needs were met. EVIDENCE: Barley Brook was bright and welcoming, with generally a good standard of décor and furnishings (including the wide use of wallpaper to help it appear more homely). Barley Brook Care Home DS0000073271.V376334.R01.S.doc Version 5.2 Page 20 The entrance hall had recently been re-decorated to a high standard. Two small seating areas had also been created, enabling residents (and visitors) to now sit and enjoy this area. We advised a second handrail was fitted to the stairs in the entrance to improve access (as although residents usually used the lift, we saw one resident using these stairs during our visit). Unsuitable bedroom door locks had had their deadlocking facility removed; ensuring staff could now gain access in an emergency. Star locks were being fitted to all remaining bedroom doors. We again advised residents may find these difficult to use and more suitable alternatives should be considered. At our last inspection we had also advised bedroom doors should be personalised, e.g. with residents’ names in large, easy to read print (‘Mr John Smith’) and with an image to help them find their way around and maintain their independence. Although not yet in place, the home advised us this was now due to start and we saw pictures and photographs that were to be used. New flooring had been fitted in the communal toilet. However, as noted at our last inspection, it still did not smell fresh (with a strong odour of urine). We advised the toilet was lifted completely to allow new flooring to be sealed around the base. Also the seat hinges were rusty and needed replacing. As also noted at our last inspection, there was still a malodour on entering the building (despite the old carpet being removed, new boards been fitted and new carpet about to be laid) and still in the main lounge area. The home still needs to investigate and remedy these problems (e.g. by having the lounge carpet regularly professionally cleaned). Armrests on chairs in the main lounge had been re-varnished, but this had now worn away, and as noted previously, these chairs looked tired and were not to the same high standard of décor as the rest of the room. The manager advised new armchairs were due to be bought. We advised a settee was retained, as the current one enabled people to sit together (e.g. visiting husbands/wives/partners). Access to the television was also to be improved, with a new wall mounted, flat screen television planned. The new owners were planning to have all bedrooms to the same high standard of decoration, with 6 rooms due to be upgraded. We advised, for the comfort of residents and to keep a more homely environment, the existing practice of 50:50 carpet and hard (poly-) flooring should continue, rather than all hard flooring. To improve hand hygiene and reduce the risk of cross infection, all bedrooms should also have hand washing facilities for staff (e.g. liquid soap and paper towels). We discussed other possible improvements that could be made in the future, e.g. providing a walk-in shower and removing (or changing the appearance of) the small enclosed fenced area in the front garden and extending fencing around all the front garden. This would allow residents greater freedom without the need for close supervision. With regard to improving access and Barley Brook Care Home DS0000073271.V376334.R01.S.doc Version 5.2 Page 21 reducing the risk of falls: providing a ramp at the main front door (currently level access was via a secondary entrance); corridors with sloping floors (outside the second lounge and on the first floor landing) should have carpets with contrasting colours to help residents identify the uneven surface and close fitting handrails; short handrails fitted on the ramp into the rear yard; plus reviewing the design of the main entrance (it was very noticeable as an exit, which at times caused distress for those residents who then wished to leave). Barley Brook Care Home DS0000073271.V376334.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the 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 were kept safe with improvements in recruitment practices and benefited from an appropriately trained staff team. Gaps in basic refresher training put this at risk. EVIDENCE: During our inspection, enough staff were on duty to meet residents’ needs. At our last inspection, agency staff were regularly being used at night. This situation had now been resolved, with a new permanent night staff team in place. We looked at a random selection of rotas. These showed staffing levels were maintained at a good level of 4 during the day and 2 at night. We advised the home to consider introducing a paid handover period between day and night shifts for senior staff (e.g. 15 minutes in the morning and at night) to support communication. The current situation relied on the presence of the manager (who did not usually work evenings or weekends) and the good will of staff to come in early or stay late in their own time. We also discussed care staff responsibility for laundry. Although staff generally felt they had time to do this, we advised the manager to monitor this closely, Barley Brook Care Home DS0000073271.V376334.R01.S.doc Version 5.2 Page 23 as the priority for staff must always be residents (with ancillary/domestic staff having responsibility for any laundry/cleaning). With regard to general cleaning duties the staffing situation had improved since out last inspection, with 2 new permanent domestics now employed. We looked at the recruitment files of 5 new staff. At our last inspection, we had been concerned references had not been obtained for 2 new staff. Also, whilst gaps in employment histories had been explored, no formal record had been made of this. At this inspection, files were in good order, with the necessary checks in place. Photographs were however, needed, and there was still no formal record kept when gaps in employment history were explored. We confirmed the legally required arrangements for the retention of criminal record disclosure certificates (CRBs) (and POVAFirst email confirmation). Although we saw correct evidence of these being obtained for staff employed since the change of owners, the home was not able to provide them for staff employed since our last inspection but before the new owners took over. After the inspection we advised the manager she needed to be satisfied these staff had been recruited properly (e.g. to have sight of their CRBs and confirm this in writing on their files). We advised the manager of the new forthcoming additional legal requirement for staff to be registered with the Independent Safeguarding Authority (new staff initially, from July 2010, and then existing staff later). With regard to training, new staff completed an induction over their first 12 weeks, with a formal record kept. NVQ levels had been very well maintained, with 78 of the staff team having an NVQ level 2 award or above. Of the 4 remaining staff, 3 were undertaking the level 2 and one the level 3 award. With regard to basic refresher training, we had difficulty checking this at our last inspection as training records had been incomplete and unclear. Records were now clearer, with a new team training matrix in place. Whilst this showed fire safety training was up to date, it also showed annual moving and handling refresher training for 6 existing staff was not. All care staff who worked in the kitchen (at each tea time) also needed to have food hygiene training. With regard to understanding and meeting residents’ specialised needs, good practice continued with all care staff undertaking dementia awareness training. A ‘challenging behaviour’ course was also being attended. We again advised the home’s management team should have an understanding of the Care Programme Approach system. We also discussed other future training areas and resources such as the Gold Standard Framework programme (regarding care of the dying and supporting a ‘good’ death); our own publication ‘See me, not just the dementia’ and the free ‘My Home Life’ bulletins from Help the Aged, which are aimed at care home staff. Barley Brook Care Home DS0000073271.V376334.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. People using the 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 staff benefited from a well managed home. EVIDENCE: The Registered Manager, Anne McGovern, had been in post for seven years. Mrs McGovern had an NVQ level 4 in management, an NVQ assessor’s award and over 19 years’ experience within the older people care field. Mrs McGovern continued to undertake regular training to update her knowledge and skills. At our last inspection we had still been concerned Mrs McGovern’s opportunity to carry out her management duties was hampered by her having Barley Brook Care Home DS0000073271.V376334.R01.S.doc Version 5.2 Page 25 to carry out some care duties. This situation had now been resolved, with all her hours being supernumerary. This was needed because with the change of owners Mrs McGovern now had sole responsibility for a range of administrative and management tasks that had been shared or delegated to others within the previous, larger company (e.g. recruitment and maintenance responsibilities). These changes had also removed sources of professional support/supervision for Mrs McGovern. We discussed ways alternatives could be pursued. With regard to formal supervision for staff, at our last inspection we had found some gaps, with not all staff having it frequently enough. This situation had now improved slightly, although not for all staff (e.g. night staff who were in often greater need of such support due to the isolating nature and less informal supervisory opportunities of their shifts). The quality of the home was monitored by formal, monthly unannounced monitoring visits, which we required the owner (or an appropriate representative) to make. Feedback about the home was also needed from relatives and involved community professionals. The previous owners did this through surveys twice a year. The manager was aware these views would be needed, but no decision had yet been made when and how this would be done. When the new owners took over, letters were sent to relatives (and residents) explaining the change. We discussed ways the new owners could provide information to relatives (and residents) about the home’s development plan (which included possible extension of the home by using the 2nd floor). Small amounts of money were held on some residents’ behalf. Appropriate systems were in place to ensure these were held safely. With regard to safe working practices, before our inspection, the home provided details (in the AQAA) showing all safety and maintenance checks were up to date. During our inspection we looked at maintenance records of lifting equipment and fire safety records. These were generally satisfactory. However, we found the 6 monthly safety check on the bath seat (a manual floor-fixed bath hoist that enabled residents to be lowered into the bath), was out of date. The manager felt it had been re-done when the new owners took over, but was unable to find evidence of this. After our inspection, the manager promptly arranged for a new safety check to be carried out the next day (4/9/09). Barley Brook Care Home DS0000073271.V376334.R01.S.doc Version 5.2 Page 26 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 2 X 2 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 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 x x x x x x 2 STAFFING Standard No Score 27 3 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Barley Brook Care Home DS0000073271.V376334.R01.S.doc Version 5.2 Page 27 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 OP9 Regulation 13 (2) Requirement To ensure the health and wellbeing of residents, adequate stock of medicine must be kept to ensure it can be given as prescribed. Medication records must be completed clearly and accurately to show medicines can be accounted for and residents are being given medicines as prescribed. 2 OP30 13, 18 (1) To ensure residents are moved safely, all staff must have their moving and handling training kept up to date. To make sure food is handled safely; all care staff working in the kitchen must have food hygiene training. 30/11/09 Timescale for action 30/11/09 Barley Brook Care Home DS0000073271.V376334.R01.S.doc Version 5.2 Page 28 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 Refer to Standard OP1 Good Practice Recommendations To ensure prospective residents and their relatives have sufficient information to help them chose whether to live at Barley Brook, the combined Service User’s Guide and Statement of Purpose (the Handbook) should be updated and revised (taking into account the points identified in the report). (This was asked for at the last two inspections). A copy of the revised Handbook should be sent to us on completion. The Handbook should then be kept under review and revised where appropriate. We and the residents should be notified of any revision within 28 days of any change. 2 OP3 To support and inform the assessment process, Care Management and/or Care Programme Approach assessment information and care plans should be received prior to the home offering a place to a prospective resident referred by Social Services/CMHTs. (This was asked for at the last inspection). As planned, care records should be clearer and more organised, with less duplication. This will ensure staff have helpful guidance about the support residents need and how they like this to be provided. As planned, seated weighing scales should be provided to enable all residents to be weighed; contributing to accurate nutritional screening. As planned, more space should be created to store medicines; enabling easier and safer working conditions for staff. As planned, there should be smaller dining tables to allow greater flexibility with seating arrangements (and so DS0000073271.V376334.R01.S.doc Version 5.2 Page 29 3 OP7 4 OP8 5 OP9 6 OP15 Barley Brook Care Home better meet residents’ specialised needs). 7 OP26 To improve hand hygiene, hand washing facilities should be provided in all bedrooms for staff (e.g. liquid soap and paper towels). To ensure the home is clean and pleasant, the malodour in the communal ground floor toilet; entrance hallway; and main lounge area should be addressed. (This was asked for at the last two inspections). To ensure all staff receive appropriate support and monitoring, formal supervision should take place regularly (at least 6 times a year). (This was asked for at the last inspection). 8 OP26 9 OP36 Barley Brook Care Home DS0000073271.V376334.R01.S.doc Version 5.2 Page 30 Care Quality Commission North West Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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