Inspection on 21/07/05 for Barchester Tower

This inspection was carried out on 21st July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Barchester Tower 21/05/07

Barchester Tower 30/06/06

Barchester Tower 24/11/05

Barchester Tower 09/02/05

Barchester Tower 13/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Barchester Tower 31 De Cham Road St Leonards-on-sea East Sussex TN37 6JA Lead Inspector Jason Denny Unannounced 21 July 2005 08:30 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 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. Barchester Tower H59-H10 S21038 Barchester Tower V231324 210705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Barchester Tower Address 31 De Cham Road St Leonards-on-sea East Sussex TN37 6JA 01424 435398 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Paul Hughes Mrs Indra Hughes Care Home 22 Category(ies) of Dementia (DE) 22 registration, with number of places Barchester Tower H59-H10 S21038 Barchester Tower V231324 210705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of service users to be accommodated is twenty two [22] 2. Service users must be aged sixty-five (65) years or over on admission 3. Service users with a dementia type illness only to be accommodated Date of last inspection 9 February 2005 Brief Description of the Service: Barchester Tower is a large detached property situated in St Leonards-on-Sea approximately 1 mile form the sea front. The home is set within its own grounds, and is a close walk to local amenities including public transport links. The external grounds offers a large garden and parking area. An alarmed gate separates the property form the outside road. The home is not ideally suited for people with mobility needs who would have difficulty with the lack of level access in the home or the steep steps in the rear garden. However those Residents who can walk easily with the aid of a Zimmer frame or minimal support can be accommodated in the home. The home has a chair lift. The home’s key code system of exiting allows freedom to those appropriately assessed service users who wish to have the freedom of leaving the building without support. The home is registered to provide care for up to twenty-two older people with dementia needs. Accommodation consists of twelve single rooms and five shared rooms. Communal areas comprise of a large lounge and dining room. There are two bathrooms and additional toilets. The home also has smoking area for those service users who wish to smoke. Barchester Tower H59-H10 S21038 Barchester Tower V231324 210705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an Unannounced routine inspection carried out by two inspectors [first of two planned before April1st 2006], which took place between 8.30am and 1pm. The Inspection found that 13 of the 19 National Minimum Standards inspected, had been fully met with the others nearly met. Discussions with Residents, staff, and management, took place along with a tour of the home, and looking at paperwork records. One inspector focused on the building including bedrooms, communal areas along with looking at medication arrangements, and health and safety. The other inspector focused on Residents and staff, looked at care records, assessed progress since the last inspection and looked at other paperwork such as staff recruitment and training. The timing of the inspection allowed a chance to observe breakfast and general morning routines. At least 10 residents were spoken with, although their varying level of dementia affected their participation. Meal arrangements were assessed along with activities. Care and staff records, along with safety documentation were inspected. The inspectors both interviewed and observed staff. At the time of the inspection the home was providing services to 16 people. What the service does well: What has improved since the last inspection? Those residents who could participate were found to have recently took part in a survey of their views with their suggestions acted upon. How the home Barchester Tower H59-H10 S21038 Barchester Tower V231324 210705 Stage 4.doc Version 1.40 Page 6 manages odours in the home has further improved. All staff have either started or completed formal medication training with a London college. The home has purchased a new care-planning booklet system, which is user friendly and allows staff to fully record and review all aspects of Residents care. One resident was found to have been transferred to this improved system. The owner of the home was found to be making arrangements to enrol her manager on a National Vocational Qualification in Care [level 4] and the rest of her care staff on the same qualification at level 2. Other staff were found to have made further progress with this qualification. The home now fully records and responds to even minor concerns with a clear record of what action was taken and how the concern was resolved. 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. Barchester Tower H59-H10 S21038 Barchester Tower V231324 210705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Barchester Tower H59-H10 S21038 Barchester Tower V231324 210705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 & 3 The home provides a good level of information to assist prospective new residents and their representatives to make a decision on the home. The way in which the home assesses prospective new residents ensures that it meet needs. The home needs to maintain an equal level of assessment evidence to show that it can meet the needs of existing residents such as those looking to be readmitted from hospital. EVIDENCE: The home’s service user [resident] guide was found clearly on display in the homes entrance lobby area. The box containing the guide included recent inspection reports, views of residents on the home, and the homes statement of purpose along with is colour brochure. The homes brochure along with all basic information such as complaints policy and general contractual terms and conditions is sent to prospective new residents before admission. The home never admits anyone without doing their own assessment, which benefits from the skills and experience of the management team. The inspector sampled the assessment of the newest resident and found it to be in order. The assessment also took place several weeks before the person eventually moved into the home. The inspector observed the new resident who had settled in well in to her preferred routines with records showing that Barchester Tower H59-H10 S21038 Barchester Tower V231324 210705 Stage 4.doc Version 1.40 Page 9 she was participating in all the homes activities. Despite some confusion the resident was able to indicate in discussion that she liked the home. Another resident was found to have been re-admitted into the home following a stay in hospital after breaking her hip. No written reassessment was found except for 2 additional lines on her previous pre-assessment form completed when she first moved in the home. The two lines entered on this sheet stated that she had a hip operation and needed 2 staff to transfer her. The inspector observed this person moving with 2 staff at all times. The home’s manager confirmed that that they had sufficient staff to meet these higher changing needs and that they were confident that over a period of time the resident will become less dependent on staff to mobilise. The manager agreed that a fuller written reassessment should have been completed with written confirmation to all relevant people that the home could continue to meet her need. The resident’s family have confirmed to the inspector that they are pleased she returned to the home. Barchester Tower H59-H10 S21038 Barchester Tower V231324 210705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 & 9 The management team clearly demonstrated a full knowledge of resident’s needs including changes but need to ensure that this knowledge is passed on to all through the plans of care. Care plans show some choices and preferences but not enough. Care plans though improved need to be fully completed. Care-plans need to fully show how assessed needs will be met in practice including the whole needs of the person whether it be social, personal, or occupational. The care-plans are now more regularly reviewed along with risk assessments such as those dealing with mobility needs. Once the home more promptly transfers all residents to the new care-planning system then clearer evidence of outcomes will be seen Medication arrangements were found to be sound with all staff now working through formal training. EVIDENCE: The Inspectors examined 4 care-plans including one of a newer resident. Some of those plans examined just showed the persons breakfast and drink choice. Some sections of the care-plans where found not to have been filled in such as health, or safety issues and problems. Some care-plans had no entry for activity interests. Some parts of the plans had statements, which were not Barchester Tower H59-H10 S21038 Barchester Tower V231324 210705 Stage 4.doc Version 1.40 Page 11 clear or confusing. One resident was described as “fairly deaf” but that communication was described as “very good but has a problem explaining things”. A number of sections of the homes assessments had not been fully transferred to the day-day plan of care. Some of the plans indicated where someone needed full assistance in a certain area such as personal care. This area would include help with dressing, bathing or eating. All of the plans examined were found to have been reviewed within two months of the inspection. One stated that someone’s need for support with washing has increased. Plans showed where residents needed to be observed when taking medication. When residents had recently changed rooms no record of the decision making process was seen in the plans. The inspector saw a new care-planning book where one of the 16 residents information had been half transferred over. The manager responsible for the care-plans indicated that she is trying to find time to complete this for all residents. The inspector advised that more admin time is freed up for this task. The new care-planning books were found to all be comprehensive. The manager was asked to clarify care records written on the resident recently readmitted from hospital. In one section of her new care-plan book it ticked the box-restricted mobility as opposed to the box stated two staff needed to escort/ mobilise. In other parts of her plan it states that 2 staff are needed to mobilise and escort her. The newest resident was found to have a care-plan with most sections filled except activity interests although daily notes showed participation in outings and exercise. All plans had detailed Moving and Handling risk assessments. The inspectors observed staff dispensing medication to residents along with their system of recording. Staff was observed to fulfil all aspects of best practice including infection control. Medication was observed to be dispensed to residents on an individual basis. The manager confirmed how medication needs of residents are regularly reviewed. The supplying pharmacist carried out a question and answer training session earlier this year. Staff were also found to have began formal workbook medication training organised by a London college. The managers of the home also confirmed that new staff complete the homes own monitoring assessment before they can dispense medication and go on to formal training. Barchester Tower H59-H10 S21038 Barchester Tower V231324 210705 Stage 4.doc Version 1.40 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 & 15 The home provides a limited range of activities based on some resident preferences. Some of these activities occur on regular basis. A high number of residents enjoy regular mini-bus outings and some enjoy walking around the grounds of the home. Activities occur for all those motivated towards them. Once care-plans are complete then further evidence will be seen of activities meeting everyone’s needs and expectations. Routines were found to be flexible and unhurried for Residents such as with breakfast times. Food is good, varied, healthy, popular with Residents, and served in good portions. EVIDENCE: The home has structured activities on a Monday and Tuesday in the form of keep-fit by qualified instructors and a mini- bus excursions, respectively. Other activities such as arts and crafts, occupational pursuits such as housework, or community trips are informally organised depending on individual need. The monthly review of care-plans includes a review of Residents hobbies and interests. The inspector saw evidence of Residents reading their own newspapers and magazines, which the home organises on their behalf. Discussions with management and staff indicated that other activities such as Bingo have previously been in existence. However, it is felt that the present Barchester Tower H59-H10 S21038 Barchester Tower V231324 210705 Stage 4.doc Version 1.40 Page 13 service user group no longer benefits from such activities although this will be reviewed depending on the future composition of the service user group and individual needs. The current group have been assessed to enjoy sing-along’s, which was found to be taking place during the last inspection. During this inspection the manager stated that no planned activities were due to take place as it was a Thursday. One resident was observed going into the garden area. Most residents were observed to be relaxing in the main lounge or their room during the inspection. The home benefits from a library and a front courtyard and back garden which some Residents access. The inspector was satisfied that reasonable steps had been taken by the home to provide the stimulation of appropriate activities within the constraints dictated by Residents varying dementia needs. Care-plan’s [Standard 7] were found to have made a start in recording residents preferred interests. Records of food served along with menus were examined. Residents were observed eating both breakfast and lunch. Breakfast was observed to take place between 8.30am and 10am with 3 residents having breakfast in bed. The kitchen was inspected along with food stocks and their storage. Alternative meals were found to be served on occasion to those residents declining the advertised main meal. One resident was found to have been granted her wish indicated in a recent questionnaire, for steak. Barchester Tower H59-H10 S21038 Barchester Tower V231324 210705 Stage 4.doc Version 1.40 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 The home operates in an open and pro-active manner with minor concerns clearly recorded and promptly responded to so avoiding these escalating to serious complaints. No formal complaint or concern has been upheld over the last year. The home maintains a clear record of complaints made. Staff continue to demonstrate a sound understanding on how to prevent and report abuse in accordance with the homes policy. The home advertises its complaint policy within the guide to the home. EVIDENCE: The last formal complaint, which was communicated directly to the Commission, which was found to be upheld, occurred over a year ago. The inspector found a record of 3 concerns raised with the home by visitors or residents. No fault on the home’s part was found. All 3 concerns were promptly resolved by the home as seen in records. One concern involved getting additional advocacy for a resident to support her understanding. Staff interviewed at this and the last inspection including newer members was clear about how to both identify suspected abuse, and report it. The home has a written policy on adult protection and whistle blowing and has developed a new handbook over the last year, which was issued to all staff. The owner/manager of the home confirmed that they do not handle resident monies and invoice families or representatives for any extras, which the home initially pays for. The home has a clear disciplinary code. This area is covered during the first two weeks of induction with all staff clear who to report concerns to. The quality of care was assessed to have been good throughout the inspection. Barchester Tower H59-H10 S21038 Barchester Tower V231324 210705 Stage 4.doc Version 1.40 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,24 & 26 Barchester Tower has a homely and well-appointed feel throughout most areas of the home. The home was found to be well maintained in the main, with suitable décor. The external grounds and large rear garden are popular with some residents. The home does not level access internally or externally which posses some hazards although this risk is managed by the home with the home responding if mobility needs change. The home only offers first floor rooms to those who can easily manage stairs. The cleanliness of the home continues to improve. EVIDENCE: One of the inspectors toured the home including an inspection of bedrooms, communal areas such as the lounge, dining rooms, kitchens, and bathrooms. One of the bedrooms had a slight odour, which the home was managing and were fully aware of, and which was related to a medical condition. The upstairs bathroom has been modernised over the last year. The downstairs bathroom was found to have been identified by the home as needing renewal. A small number of rooms and bathrooms have had laminated wooden flooring put down which has assisted cleanliness and odour management. Standard 19 Barchester Tower H59-H10 S21038 Barchester Tower V231324 210705 Stage 4.doc Version 1.40 Page 16 cannot be fully met due to the uneven floor levels along the ground floor with no level access provided. The rate of falls and accidents was not found to be high since the last inspection, nor was there any link to the lack of level access. There are some steep steps to the rear garden which is risk assessed to be only suitable for those who are agile and have no mobility needs. The building has not yet been assessed by an occupational therapist that could advise of any adaptations Bedrooms were found to be suitably equipped. There was an issue identified in one room in relation to the appearance of the furniture although this was related to the behaviour of the occupant. The home was advised to replace a trolley tray in one room. Residents have a sophisticated door locking mechanism which affords them privacy whilst at the same time maintaining their safety needs with staff having a master key to prevent Residents locking themselves in their room, this policy is also in compliance with fire-safety. When Residents are out of their rooms they are locked to prevent wandering Residents gaining unwelcome access. This policy has been discussed in resident meetings and is continuously reviewed. The manager/owner have purchased lockable safes, which attach to furniture and would be offered if any resident or relative requested this. The policy of the home is to discourage new residents bringing in to the home valuables. The home has a policy on infection control, which staff cover during their induction. The home has a washing machine with a sluice cycle. Barchester Tower H59-H10 S21038 Barchester Tower V231324 210705 Stage 4.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 28,29 & 30 Staff inductions are good and include all relevant areas. Recruitment practice ensures that the home employs suitable people. Staff training has improved in terms of enrolling staff on National recognised qualifications with the home closer to meeting targets. Residents praised the quality of the staff and gave examples of how well supported they are. Staff were seen to work well as a team with them calmly and confidently supporting residents. EVIDENCE: The rota demonstrated sufficient staff for each shift and the needs of residents. Day shifts include three staff, which includes the day [registered] manager with the owner/manager available where necessary. There is a number of ancillary staff such as two cooks, supper assistants, and domestic general housekeepers whose duties include cleaning enabling care staff to focus on Residents. Two staff who work the night-shift, receive support from 7am by one member of the day shift, with helping Residents morning routines such as getting ready for the day. The inspector was informed that 3 staff have at least NVQ level 2 or equivalent. Two staff interviewed confirmed that they continue to make progress on this course. The owner/manager stated that by September [2005] all remaining staff [5-6] will be on NVQ’s. The home also intends for 2 senior staff to go on to NVQ 3. Most staff did accredited training with a Moving and Handling specialist last autumn, which assisted staff’s knowledge in meeting resident’s needs. Barchester Tower H59-H10 S21038 Barchester Tower V231324 210705 Stage 4.doc Version 1.40 Page 18 The owners have over the last year purchased training material from a TOPSS [now Skills for Care] accredited company, which subsequently meets national training targets. The home have been obtained TOPPS style induction workbooks and consult with training bodies to get up to date advice. The home operates internal induction training, which is gradually signed off by both the inductee and supervisor and includes all policies and procedures. The inspector saw an induction book at a previous Inspection that had begun for the newest member of staff. No new inductions were examined as no staff had been employed since the last inspection. The joint owner confirmed that inductions continue to be carried out in this way with staff supervisions used to assess progress. All new staff are job coached and shadowed during their initial few shifts. Recruitment checks on some existing staff has previously been examined. As no new staff were employed since the last inspection it was not possible to evidence if all checks were currently being carried out. The owner/manager who carries out recruitment checks indicated her knowledge through discussion and clarified all issues involved when employing new staff. The home stated that they only use agency staff from those employers, which first carry out their own checks. It was stated that there has been no need to use agency staff over recent months. The home also runs Alzheimer specific training, which is revisited whenever a new resident moves in as evidenced in team-meeting minutes. Barchester Tower H59-H10 S21038 Barchester Tower V231324 210705 Stage 4.doc Version 1.40 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33 & 38 The home continues to benefit from a well-established, management team. The owner/manager demonstrates a good understanding of the needs of people with dementia type illnesses. Management time reserved for the administration of the home has improved but can improve further. The manager lacks the recognised qualification, which needs to be addressed in a timely manner. The home showed evidence that they are now regularly surveying residents and their representative’s views, to test whenever the home is meeting expectations. The home ensures that all appliances are regularly serviced and maintained to help ensure a safe environment. This is aided by staff training. Residents and staff will benefit from more regular fire drills. EVIDENCE: The home verified at the last inspection [February 2005] that it requires the manager to have the appropriate qualification namely an NVQ level 4 in Care. The home has 2 registered managers one of whom predominantly works shifts Barchester Tower H59-H10 S21038 Barchester Tower V231324 210705 Stage 4.doc Version 1.40 Page 20 with a couple of hour’s admin time per week, although it was explained that this can stretch to 7 hours. The other manager is the Owner. It was noted that additional time is needed to develop care-plans more promptly. The manager on the care-side was on shift and participated in the first half of the inspection. She completed an advanced City and Guilds in the Management of Care in 1998. The Commission’s expectation is that the home moves to having one registered manager in line with the expectations of the National Minimum Standards which were effective from 2002. The owner/manager confirmed that it would be the other registered manager who will be doing the National Vocational Qualification level 4 in Care. She also showed research into local colleges, finding a part-time course starting in September. The owner/manager is a Registered Mental Health Nurse. Her role alongside the other owner involves managing the business and offering specialist clinical advice including the development of care-plans and assessments. Staff indicated that they are well supported and supervised by the home’s management. The home has developed its own questionnaire for surveying residents and their representative’s views. The inspector found that 7 residents and 1 visitor on the 140705 had filled these in. All indicated happiness with the home. All suggestions were carried out as indicated in a report on these findings. An annual development plan produced on the same day indicated that a bedroom opposite the lounge would be decorated. All equipment was found to have been serviced such as the boiler and fire equipment. Most staff continue to undertake health and safety training such as Moving and Handling carried out on September 04, and food hygiene, and first aid training. Those residents observed in the inspection to have minor facial injuries had their falls clearly recorded in the homes accident book. There was no pattern of any residents having a higher number of accidents. Since the last inspection 6 months ago there has been 14-recorded accidents, which is not considered high given the number and frailty of residents. The home is advised to ensure that visitors record the purpose of the visit in the book, which the home maintains in reception. A bath was found to be delivering hot water at 48 degrees centigrade. All hot water outlets have safety valves fitted and staff test water before residents have baths. The engineer was found to check the outlets annually with the manager stating that the engineer will be called back in. Barchester Tower H59-H10 S21038 Barchester Tower V231324 210705 Stage 4.doc Version 1.40 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 2 x x x x 3 x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 x 3 x x x x 2 Barchester Tower H59-H10 S21038 Barchester Tower V231324 210705 Stage 4.doc Version 1.40 Page 22 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 3 Regulation 14[1] Requirement Timescale for action 28/07/05 2. 7 15[1] 3. 38 23[4][e] That the registered person must carry out a full written assessmnent on any service user [resident] before they are admitted, or re-admitted into the home. That this assessment shows evidence that all necessary areas have been assessed with all relevant parties involved. That the service user and, or, their representative is written to confirming that the home is suitable to meet needs. That the Service User [Resident] 21/11/05 Care Plans must outline individual’s assessed needs and show how these will be met in practice. That preferences and choices are fully recorded. That all section of the Plans are completed and reflect information contained in assessments. That information in the plans is Clear And noncontradictory. That information in the plans shows the persons holistic needs such as social and leisure, and how these needs will be met. That Regular Fire Drills must be 21/08/05 carried out. That an evaluation Version 1.40 Barchester Tower H59-H10 S21038 Barchester Tower V231324 210705 Stage 4.doc Page 23 of these drills is also carried out. 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. 3. 4. Refer to Standard 24 27 28 31 Good Practice Recommendations That the decision behind service users [residents] having the location of their bedrooms changed, is clearly recorded and agreed. That the managers hours devoted to the administration and management of the home is clearly recorded on the Rota. That 50 of all care staff in the home achieve at least NVQ Level 2 by December 2005. That the registered manager[s] Commences and completes a NVQ Level 4 in Care, without delay. Barchester Tower H59-H10 S21038 Barchester Tower V231324 210705 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Ivy House 3 Ivy Terrace Eastbourne East Susssex BN21 4QT National Enquiry Line: 0845 015 0120 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 Barchester Tower H59-H10 S21038 Barchester Tower V231324 210705 Stage 4.doc Version 1.40 Page 25 - 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. 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