Inspection on 10/08/09 for Barnetts

This is the latest available inspection report for this service, carried out on 10th August 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.

Other inspections for this house

Barnetts 05/06/06

Barnetts 15/11/05

Barnetts 27/04/05

Barnetts 09/09/04

Barnetts 13/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Barnetts Frant Road Tunbridge Wells Kent TN2 5LR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Gary Bartlett     Date: 1 0 0 8 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Barnetts Frant Road Tunbridge Wells Kent TN2 5LR 01892542983 Telephone number: Fax number: Email address: Provider web address: eileen.gilbertson@kcht.org.uk www.kcht.org Name of registered provider(s): Type of registration: Number of places registered: Kent Community Housing Trust care home 42 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 42. The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE). Date of last inspection Brief description of the care home Barnetts is owned and operated by the Kent Community Housing Trust. Twenty four hour residential care is provided for older people with dementia. The Homes senior staffing team comprises the Manager, an Assistant Manager and some Team Managers. The Home employs Care Services Assistants and other staff for catering, domestic, administration and maintenance duties and Activities Coordinators. Barnetts is located on a main road on the outskirts of Tunbridge Wells where there are the usual facilities of a large town. It is a detached, purpose built premises with Care Homes for Older People Page 4 of 27 Over 65 0 42 Brief description of the care home accommodation on two floors. There are a total of 42 bed-spaces. There are gardens to the rear of the Home for residents to use. A small day centre is run on the site. Current fees range from £482.15 to £598 per week. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection was conducted by Gary Bartlett, Regulatory Inspector, who was in Barnetts from 9.00 a.m. until 3.50 p.m. During that time the Inspector spoke with some residents, 2 visitors, the Manager, some staff and a visiting community nurse. Parts of the home and some records were inspected and care practices observed. The Manager had completed an Annual Quality Assurance Assessment, from which information was used to inform the inspection process. We received a number of completed surveys prior to our site visit. Four were from residents relatives, 3 from staff and 1 from a health care professional. They indicate good standards of care and overall satisfaction with the service. Comments made include They are very supportive of the relatives who find it hard to cope with their Care Homes for Older People Page 6 of 27 loved ones with Alzheimers etc, I know I dont have to worry about mum, Home and residents always clean and tidy, My aunt could not have better care, Very caring of the residents and As far as Im concerned Barnetts meets all my mothers needs. The Care Homes Regulations 2001 and the National Minimum Standards for Care Homes for Older People refer to people who use the service as service users. People living at Barnetts prefer to be referred to as residents. Accordingly this shall be done in the text of this report. The Inspector would like to thank everyone involved for their contribution to the inspection. What the care home does well: What has improved since the last inspection? What they could do better: No requirements are made as a result of this inspection. Care Homes for Older People Page 8 of 27 The medicines trolley is too small to easily accommodate all of the blister packs. This makes it difficult for staff to administer medicines and readily lock the trolley when necessary. Therefore, it is recommended a larger or additional medicine trolley is obtained. Some of the garden paths are overgrown and this causes potential trip hazards, especially to people with mobility difficulties. The Manager agreed to address this as soon as possible. Likewise, she undertook to arrange for the courtyard outside of the laundry to be made safer. Although residents do not use this area, the uneven surface is potentially dangerous to staff. It would also be safer if it was kept tidier. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that they are appropriately placed due to good pre admission assessment procedures and benefit from having the opportunity to visit the home prior to admission. Evidence: The organisation has clear policies and procedures for their home managers to follow when assessing and admitting a resident to the home. The assessment process includes recording the findings of the assessment, the detail of which then informs the initial care plan. The forms seen included facilities for the assessments of personal support, health care needs, religious and cultural needs and social interests. The Manager said that, where possible, they visit the person at their home or in hospital and also get information from families, advocates, and relevant health care professionals. Care Homes for Older People Page 11 of 27 Evidence: Residents said they or their families had been able to visit Barnetts before moving in. Some relatives who were visiting confirmed this and said staff are very helpful in assisting new residents to settle in. The home does not offer intermediate care. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents personal health needs are assessed and maintained through their individual care plans and with good liaison with relevant health care professionals. Evidence: Each resident has a care plan and five were inspected in detail. They are up to date and regularly reviewed. The care plans give staff the information they need to know to meet residents needs and include the residents preferred ways for this to be done. This includes getting up in the mornings, personal hygiene arrangements, meals and bedtimes. There is also a night care plan. The daily records seen are detailed and of a good quality. They convey how the resident has responded during the day and how they feel emotionally. This gives a full picture of the persons lifestyle and helps when it comes to reviewing care plans. A survey completed by a health care professional stated Good understanding of complexity of care. The Manager has a very good understanding of getting a balance between perceived Care Homes for Older People Page 13 of 27 Evidence: risks and promoting independence and this is generally shared by those staff spoken with. Risk assessments are being written or reviewed in response to incidents and accidents to help safeguard people at the home. There is a key worker system to help provide a good exchange of information about residents health and welfare. Visiting relatives and survey forms say staff are good at keeping them informed. A survey completed by a relative included the comment Always keep in touch with me about falls or changes in medications. Records show that staff administering medications have been trained and signed off as being competent to do so. The medicines room has been refurbished recently and is well maintained, although small. It was seen that the medicines trolley is too small to easily accommodate all of the blister packs. This makes it difficult for staff to administer medicines and readily lock the trolley when necessary. It is recommended a larger or additional medicine trolley is obtained. Medicines were seen to be given in accordance with good practice guidelines. The Medication Record Administration Record (MAR) sheets inspected had been completed appropriately. The home has a good working relationship with the specialist and local health care professionals. This assists in supporting residents with their health care needs. Residents and visitors say staff are polite and kind, this was confirmed by observation. Staff are considerate of the age and dignity of residents and treat them with courtesy. Comments made in surveys completed by relatives included The residents are treated as individuals and as human beings, and They are treated with respect regardless of their disabilities. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to exercise choice and control over their daily lives as far as is practicable and to maintain links with friends and relatives. Evidence: Barnetts cares for people with varying degrees of dementia and lifestyles can be very challenging for some. Residents are offered choices where practical and full support is given taking into account each residents known preferences. The Trust has developed a philosophy of care influenced by The Eden Alternative and Eden at Home Principles. These are based on the core belief that aging should be a continued stage of development and growth, rather than a period of decline. Due to the nature of the service, most residents are dependant on support. The home strives to enable residents to participate in the daily routine of the home as much as they wish and are able. For example, in helping prepare vegetables for lunch. Some participate in domestic activities they would usually have undertaken in their own homes, such as the cleaning of their bedrooms, doing their laundry etc. A washing machine, tumble dryer, cooker, floor sweepers etc have been purchased for this. This is being carefully risk assessed and staffing levels will be amended to reflect the increased 1:1 support residents will need. The Manager is aware that this is a Care Homes for Older People Page 15 of 27 Evidence: significant change in culture through which staff have to be offered guidance and training. Two Activities Co-ordinators are employed and the availability and diversity of activities and outings continues to be improved, being more person-centred. One example being that a resident has a piano lesson at the home each week. Residents wishes in respect of any religious and cultural observances are ascertained at time of admission. If residents have strong spiritual beliefs the home supports them in meeting these. Family and friends feel welcome and know they can visit at any reasonable time. Comments made in surveys completed by relatives included The staff are always happy to receive visitors and always ready to discuss matters and The staff have to deal with some very difficult situations but are so caring and always so friendly and helpful to visitors and residents. During the inspection a number of visitors were seen in the home and the visitors book records regular visits by families, friends and others. The design of Barnetts provides seating areas within the communal areas where residents can entertain their visitors, in addition to the privacy of their own room. There is a visitors room should they choose to not meet with guests in their bedrooms, though this is rarely used. The home encourage individuals and groups from the community to visit. Meal times are set for practical reasons but can be flexible to accommodate residents needs as necessary. The home now has permanent cooking staff and is not reliant on agency staff in the kitchen as previously. Residents views about the food are mixed. Most are complementary of the food served and say their tastes are met as best possible with a choice of menu always being offered. Some say the quality of the meals is variable. The Manager is aware of this and is monitoring the quality of the meals being cooked. Mealtimes are relaxed and staff are patient and helpful and allow residents the time they need to finish their meal comfortably. Hot and cold drinks are available through out the day, as well as snacks. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their relatives know their complaints are listened to and acted on. There are systems to protect residents from abuse. Evidence: Residents say they feel safe and well supported at the home. This is confirmed by their relatives. The complaints procedure is readily available to residents and their relatives. They say they feel confident they are listened to and any necessary action is taken. A visitor said The staff always take any concerns, no matter how small, seriously and address things quickly if they have to. The AQAA indicates there have been two complaints in the last twelve months, one of which was upheld. The records of these include the result of the investigation and how the complaint has been resolved. The Commission has not directly received any information regarding complaints about the home since the last inspection. There are procedures for responding to suspicion or evidence of abuse or neglect and ongoing training for staff to ensure the safety and protection of residents. Staff members spoken with have a sound understanding of what constitutes abuse and the need to report suspected abuse without delay. The home has raised two safeguarding alerts since the last inspection, one of which was accepted by the local authority and Care Homes for Older People Page 17 of 27 Evidence: investigated. The results did not find the home had to change its practices. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Barnetts provides a homely environment and comfortable place in which to live. Evidence: Barnetts is a detached, purpose built premises with accommodation on two floors. It is located on a main road on the outskirts of Tunbridge Wells, where there are the usual facilities of a large town. The home is registered for 40 bed spaces with 34 single and 3 shared rooms. As part of the Trusts philosophy of care and in line with good practice, it is intended for the use of shared bedrooms to be phased out and for all bedrooms to be used for single occupancy. Most bedrooms reflect residents individual tastes and some have items of their personal furniture. Some areas of the home have been redecorated and refurbished since the last inspection as part of an ongoing programme. Residents were seen to be able to find their way around easily and they say they think Barnetts is comfortable. There are now larger prints on the walls which residents find easier to see and focus on. The doors to Peach lounge have been fitted with automatic closing devices, so residents do not have to struggle opening or closing them. The parts of the home inspected were clean and free from unpleasant odours. The laundry and sluice rooms have been refurbished to better promote infection control and there are improved facilities for washing and sterilising commodes. Equipment Care Homes for Older People Page 19 of 27 Evidence: seen, for example wheelchairs, lifting hoists etc, are kept clean. Staff say the bathing and toileting facilities are adequate. The temperature of the hot water was tested by hand at several outlets and found to be safe. The Manager stated there are regular environmental checks is aware of the assessments that need to be done in respect of Deprivation of Liberty Safeguards There are well-maintained gardens to the rear of the Home for residents to use, which they enjoy. There is some new fencing to improve security. Some residents like to tend to the raised beds and growing some vegetables and strawberries. The produce is sometimes used by the kitchen for residents meals. Courtesy of the Friends of Barnetts, there is a new path giving safer access around parts of the garden. However, some of the older paths are overgrown and this causes potential trip hazards, especially to people with mobility difficulties. The Manager agreed to address this as soon as possible. Likewise, she undertook to arrange for the courtyard outside of the laundry to be made safer. Although residents do not use this area, the uneven surface is potentially dangerous to staff. It would also be safer if it was kept tidier. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment processes are robust and offer protection to people living at the Home. Training is available to the staff so they have the skills to meet the residents needs. Evidence: Residents and their relatives speak very highly of the staff and of the care given. Comments made include: The staff are always on hand and keep us in touch with everything, Carers are always cheerful and kind to my mother, Well trained staff and Staff interact well with residents. Since the last inspection there have been some changes in the staffing personnel of the home, including within the management team. There is still some reliance on using agency staff to maintain staffing levels, but the home manages to use the same staff so there is continuity of care. The Manager understands the need for there to always be experienced staff on each shift and monitors the staffing rotas to ensure this. Records seen show that robust recruitment procedures are used and the home employs only staff that have been properly vetted. People applying to work at the home have to complete an application form, attend an interview, provide references and satisfactory POVA and Criminal Record Bureau (CRB) checks. The files of the most Care Homes for Older People Page 21 of 27 Evidence: recently recruited staff show that appropriate checks were made prior to them commencing duties. Staff are required to undertake an induction programme. There is also an induction programme for agency staff to complete on their first shift at the home. Each staff member has a staff training analysis sheet to record training courses they have attended and a training matrix is used to give a management overview of staff training needs. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home benefits from a Manager who is experienced, accessible and supportive. Residents financial interests are protected. The home regularly reviews aspects of its performance through a programme of selfreview and consultations, which includes the opinions of residents and relatives. Evidence: The Manager has been at Barnetts for approximately 14 years. She has extensive experience in residential care and continues to demonstrate a commendable commitment to delivering a high quality service. The Manager is currently undertaking a management qualification. Residents, visitors and staff speak highly of her. Comments made include Eileen Gilbertson and her staff are excellent and Clear lines of responsibility. Feedback from residents and their relatives indicate there is a good atmosphere at the Care Homes for Older People Page 23 of 27 Evidence: home. One visitor described it as always very friendly and calm. There is a sound system of holding and recording residents cash, which is checked by the Trust as part of their audit process. The home is regularly audited by the Trust and residents and their representatives or relatives are asked for their views. The Manager is monitoring the quality of records made by staff with the aim of achieving a high level of consistency. Records seen are kept in a manner that maintains confidentiality. There are arrangements to ensure all staff receive the supervision necessary to ensure good standards of care practice and those spoken with have a sound understanding of emergency procedures. The standard of cleanliness in the kitchen and surrounding area, which has been awarded the local Environmental Health Departments Clean Food Gold Award, is satisfactory. There are records of fire systems checks and fire drills and training. The Manager believes all records of maintenance and safety checks are up to date. These were not inspected on this occasion. The Trust regularly reviews policies and procedures to ensure they comply with current legislation and good practice advice. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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