Inspection on 21/05/07 for Barchester Tower

This inspection was carried out on 21st May 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Barchester Tower 30/06/06

Barchester Tower 24/11/05

Barchester Tower 21/07/05

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 Key Unannounced Inspection 21st May 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Barchester Tower DS0000021038.V337155.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Barchester Tower DS0000021038.V337155.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Barchester Tower Address 31 De Cham Road St Leonards-on-sea East Sussex TN37 6JA 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) 01424 435398 Mr Paul Hughes Mrs Indra Hughes Mrs Indra Hughes Care Home 22 Category(ies) of Dementia (22) registration, with number of places Barchester Tower DS0000021038.V337155.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is twenty two (22) Service users must be aged sixty-five (65) years or over on admission Service users with a dementia type of illness only to be accommodated Date of last inspection 30th June 2006 Brief Description of the Service: Barchester Tower is a large detached property situated in St Leonards-on-Sea approximately 1 mile from 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 offer a large garden and parking area. An alarmed gate separates the property from 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. 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 stair-lift, which some residents can safely access. 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. This is subject to a risk assessment and safety considerations. Information on the range of fees charged was confirmed in the pre-inspection questionnaire prior to the last inspection with fees approximately ranging from around £366 to £410[private rate] per week with extra changes for personal items. Copies of recent Inspection reports are kept in the reception area of the home as part of the Service User [Residents ] guide. Barchester Tower DS0000021038.V337155.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an Unannounced key Inspection, which included a visit to the home which took place between 10.00am and 3.30 pm on 21 May 2007. The inspection visit was carried out by two inspectors based on the Commission’s own risk assessment. The planning of this visit was unable to take account of the homes Annual Quality Assurance Assessment [AQAA] form sent to the home by the Commission 4 weeks before the inspection visit. This information was not received by the day of the inspection or by the time of writing this report. This QAAA when received will be used to inform the next inspection. It is noted that this Inspection identified areas for improvements in how the home measures quality During the inspection 8 of the 17 residents [some new] were spoken with and others observed along with speaking with staff, and observing carepractices. The inspector spoke at length with 4 relatives following the inspection visit and received survey comment cards from others. The focus of this inspection report is based on three main areas; comments from relatives and professionals [after the inspection visit]; how the home is dealing with areas of improvements identified on previous inspections such as those relating to the environment, activities, health and safety, management, and staff. The visit also focused on newer Residents, those with higher needs, and those who had accidents since the last inspection. This included looking at Care records, health and medication needs and the diversity of activities. All communal areas of the home along with some bedrooms were toured. Meal arrangements were examined. A record of complaints was inspected. Staffing and management was looked at in detail including measures to ensure quality for Residents. Discussion with management looked at progress since the last inspection on 30 June, 2006 and agreements with the proprietors [providers] in a meeting with the Commission in April 2006. Three [3] outcome areas are assessed as Good and four [4] assessed as Adequate [ok] and in need of improvement. What the service does well: A calm and friendly atmosphere continues to be maintained by the home. Visitors are also impressed by the care and attention given to their needs. There is a trained and knowledgeable staff team, supported by an effective manager to meet general care needs of residents. Staff were observed providing sensitive and dignified support. The home makes a good effort to Barchester Tower DS0000021038.V337155.R01.S.doc Version 5.2 Page 6 assist new Residents to settle in to the home. Residents are afforded flexible routines and other freedoms based on their needs and preferences such as bedroom keys and access in and out of the home. What has improved since the last inspection? What they could do better: The key area identified for improvement by relatives and as observed during the inspection, is activities and opportunities for all Residents for mental stimulation based on their individual needs. There has been some improvement since the last Inspection but more pro-active work is needed especially for those who are less able. This improvement will be aided by fuller recording of hobbies and interests when people move into the home. A repeated feature of successive inspections has been the home’s difficulties in meeting higher mobility needs and respond to falls and changing needs. Although Care-planning has improved in general, further work is needed to confirm that the home can still meet the needs of those who are more vulnerable. The home needs to ensure better written documentation to confirm that staff are aware of changing care practices and that all incidents such as falls and accidents are reported to the Commission, and without unnecessary delay. Many Residents due to dementia type illness are unable to make informed comment about the quality of the service and what needs to improve. Those who are currently more able may deteriorate over time. It is therefore useful to have quality assurance surveys carried out by the home that involve relatives and other advocates/stakeholders so that Residents have someone speaking on their behalf and in order to promote a formal link between visitor’s views and the home. Barchester Tower DS0000021038.V337155.R01.S.doc Version 5.2 Page 7 There has clearly been an improvement in the health and safety practices by the home although more attention is still required to ensure that residents are not placed at an unnecessary risk such as the risk of scolding from excessively hot water. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Barchester Tower DS0000021038.V337155.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Barchester Tower DS0000021038.V337155.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 6. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Prospective new Residents and their advocates are supplied with good information and opportunities to visit before deciding upon the home. The home has improved the quality of information it obtains prior to deciding if it can offer a service to prospective Residents EVIDENCE: The inspector found that the home’s copy of its Residents guide kept in reception, which also contains the Statement of Purpose, has been updated during 2006 and contains useful information such as the names and qualifications of key staff. Visitors are attracted to the guide and supporting colour brochure for the home by a sign in the reception area. Relatives spoken with especially those who chosen the home over the last year for their relatives spoke positively about how the home gave them information and opportunities Barchester Tower DS0000021038.V337155.R01.S.doc Version 5.2 Page 10 to visit before deciding on the home. They remarked positively on relaxed and friendly atmosphere where they had ample opportunities to ask questions. One relative remarked positively upon the homely and relatively small nature of the home, which helps his relative to have ownership. The guide also contains previous inspection reports and a brief report on survey of Residents views in May 2006 with a suggestion by 2 Residents for table- tennis. The homes complaints procedure along with sample contracts are also contained. The name of the new Commission and its new local office location needed updating in the guide with the home advised to do this during the inspection. The inspector looked at a sample contract for a newer Resident which showed full adherence to the main aspects of the new regulations effective from September 2006.This contract was signed near to admittance [18 April 2007] showed the fee and room number along with who is responsible for paying. The difference between what self funders and those funded by East Sussex socials services is slight £366 versus £410. it was recommended to the home that they insert a section into the contract to indicate whether the fee would be different depending on the funding arrangements in line wit the transparency indicated in the new regulations. Residents receive the same service whatever the funding arrangements. The inspector sampled written assessments on two of the most recently admitted Residents and found information to be full and improved with the minor exception of diversity and equality needs, such as hobbies, social aspects, cultural, and spiritual interests. Fuller information in this respect will support activity planning to assist some continuity. One relative indicated that they were disappointed that a drawing activity one Resident enjoyed prior to moving in had not been picked up upon although they were pleased with everything else and so did not want to raise this themselves. In one instance the home as seen in records reassessed a prospective new Residents twice, due to a lengthy delay in the admittance process. Newer Residents who could offer an opinion indicated that they had been offered the opportunity for trial visits although they had relied on their advocates to make the right choice of home. One newer Resident remarked on how they enjoyed maintaining some of their existing independence and had a room key with the home supporting them to obtain a working television. Another new Resident remarked positively on the freedoms they enjoyed, along with a another who stated “I eat and drink well, I am very happy staff are nice and other Residents keep themselves to themselves” relatives remarked positively on how the home supports Residents to settle in. Staff who spoke with the Inspector indicated some good knowledge of newer Residents and their key support needs. Barchester Tower DS0000021038.V337155.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, & 10. Quality in this outcome area is, Adequate. This judgement has been made using available evidence including a visit to this service. Care-plans are good for some Residents but not for those with more complex and changing needs. Risk Assessments on Residents need to be updated to ensure that individuals are not placed at risk to confirm that changing needs can still be met. Medication arrangements have improved with only minor improvements now needed. EVIDENCE: The inspector looked at the care-plans relating to three of the newest Residents of two established Residents who have either been involved in accidents/ falls since the last inspection or who were observed to have mobility needs during the inspection visit. The inspector found a good amount of information and useful profiles. The care-planning books use an accessible and Barchester Tower DS0000021038.V337155.R01.S.doc Version 5.2 Page 12 user-friendly format, which allows for regular reviews. It is noticeable that all experienced staff are involved in the care-planning process which assists them to have up to date knowledge. Care-plans contained good information and recording around health needs such as fluid and food intake and how best to support this. The plans also contain information about Residents preferred routines and interests such as bed and waking up times. Guidelines for personal care were found to be good and based on supporting Residents to maintain their independence. Some care-pans lacked detail around social and activity interests, and where these were recorded , lacked a plan as to how these wishes would be carried out. The main concern was around how care-plans are reviewed and adapt to changing needs. The plans have monthly review sections, which were found not to be in line with the changing needs of two Residents with changing mobility needs. Daily records, accident reports, records of falls and observation of the two Residents concerned and care practices were not reflected in these plans. It was therefore not possible to evidence whether the home understood their changing needs or could meet them. One of these Residents had a Fall on 25/01/07 face downwards with arm and wrist badly bruised at 10.45pm with the home waiting until 9am next morning to organise her to go to hospital where a broken wrist was diagnosed. The accident report stated fully ambulant before fall but a care plan evaluation of27.12.06 states “walks about the home with some difficulty as she has always done”. A further fall took place on 26/01/07 where the person was found on the floor. The home responded by putting down a mattress on the floor. A X ray showed further damage done to the wrist which needed to be put in plaster. Further falls occurred in February with two in April, with most resulting in injury Following these falls there was no evidence of a falls risk assessment being updated. The last falls risk assessment in the care- plan is dated 22/08/06, which states “ fully mobile, shuffles, low risk”. There has been no change to care-plan despite regular falls after the first one in 25/01 07 and no reference to these in monthly evaluation with reference to the falls in April. The Residents concern was observed to require two staff to mobilise throughout the inspection. A Pre assessment of a Resident dated 17/06/06 and observed to be a wheelchair user throughout the inspection, which was confirmed by her relatives as spending their day in a wheelchair, described her as walking with a Zimmer frame. On admission a care plan entry dated 17.6.06 indicted that they were unable to stand on scales without support indicating high mobility needs on admission in a home not registered to provide nursing and which Barchester Tower DS0000021038.V337155.R01.S.doc Version 5.2 Page 13 lacks level access. The Mobility Risk assessment of 16.12.06 states only walks with 2 carers wheelchair is just for going out with a History of falls. There was no information in subsequent monthly reviews to show how she has moved to being a permanent wheelchair user.. Staff were observed to respond promptly to care needs in a sensitive manner. Staff were observed to be confident with Residents with the exception of one Resident with a facial injury [high mobility needs] where discussion between staff was unclear about its origin or when it would be looked at by a specialist. Relatives who spoke with the inspector described the care as good with just an query as to whether staff were fully aware of some finer points relating to the care of those with advanced mobility needs such as the risk attached to a someone permanently being in a wheelchair all day. One relative indicated that they had obtained a particular item for their relative at the request of the home to improve a care, but had not seen this item being used . Social services and the local contracts department contacted during the inspection process expressed no concerns about the care of Residents. This also included discussion with the district nurse team who indicated no concerns about any current Residents. The team visit one resident who was not looked at as part of this inspection. The team indicated that they found the staff team cooperative and helpful and able to give some basic support such as dressings. The inspector observed medication being dispensed along with stocks, which were found to be good. All outstanding matters form the last Inspection were found to have been sorted with accurate recording and risk assessments for anyone who can self medicate. Two recommendations were made in relation to best practice. A number of Residents are on a range of medication and it will be useful for staff to know why arte they giving these drugs and what side effects to monitor. The manager identified that she is organising information sheets in relation to this. Where a Resident may request occasional pain relief is its preferable if this is as a PRN as opposed to having monthly prescriptive supplies when most are not used. The inspector observed that 5 of the Residents who were in the lounge during the morning from around 10.15 to 11.45 am mainly slept although there was no evidence of anyone being over-sedated, as staff confirmed. Barchester Tower DS0000021038.V337155.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, & 15. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Stimulating activities have improved for some but more work is needed to show that the home is proactively meeting Residents needs and preferences on a regular basis. Routines and meals meet Residents needs and preferences. Residents are encouraged to maintain safe levels of independence and freedoms based on their abilities. EVIDENCE: The key area for improvement identified by relatives and some Residents is in relation to activities and opportunities for mental stimulation. The inspector observed that there has been some improvement over recent inspections based partly on some Residents and staff being more proactive. The inspection took place on a Monday where there is some structure to the afternoon. During the morning some Residents received there 6 weekly chiropody treatment and four of the 17 Residents played scrabble. The inspector observed that in the Barchester Tower DS0000021038.V337155.R01.S.doc Version 5.2 Page 15 lounge 6 of the Residents between 10 and 12 noon apart from being offered drinks were left to themselves elected to sleep during or most of this period without any stimulation while some others sat passively. Some residents made reference to mini bus outings, which are scheduled for Tuesdays but indicated as confirmed by records and talking with relatives that this does not occur every week and is affected by reliability issues. Some Residents and relatives indicated that more outings should be organised. The Extend exercise and music class on a Monday afternoon is popular with some Residents and occurs once a week. Other than Mondays and Tuesdays there is no regular structured plan for activities and whilst it is recognised that staff may initiate in house activities at other times, this is not predictable. Activity participation records examined for 5 Residents indicated a lack of regular or diverse opportunities for mental stimulation. There was also no evidence of any review of whether current arrangements to check these are working. Some Residents had a number of interests recorded such as gardening or artwork without any plan evidenced on how these could be supported by the home. Some sections of the care-plans and initial assessments pro-forma have sections dealing with equality and diversity questions such as cultural and social, and special interest with the information recorded being patchy. One relative indicated a concern that a Residents favourite hobby in their last placement [drawing] had not been continued by the home and they were unsure if the home had this information. Another relative indicated concern that those Residents with mobility needs and, or may spend more time in their rooms as consequence were in danger of being isolated. The relative indicated that on most of their visits they find their relative alone in their room. This person’s care-plan indicates a range of activity interests. It is positively noted that the home recently organised a Theatre trip for some Residents with relatives indicating plan for another. It is recognised that there are difficulties with activities and motivation for some Residents with advancing dementia but the home is required to demonstrate that all reasonable steps have been taken to address this area. The home is therefore requested to carry out another survey of Residents interests and include relatives in this process with the intention of developing a more comprehensive activity schedules. Some plan should also be developed to direct staff as to how much time they can spend with each Resident especially those less able and proactive. To help exercise choice and control over resident’s it will be helpful if the home develops picture/signage around the home which can reduced confusion for the need for staff to be there to direct Residents. A recommendation has been made in the environment section of this report. For the same reason of promoting control it is recommended that a Re-orientation board, should be introduced and include information such as day, date, menu, today’s activity and other relevant information Barchester Tower DS0000021038.V337155.R01.S.doc Version 5.2 Page 16 Visitors indicated to the inspector that they find the same good welcome and care whether they visit unannounced, or, announced. They also indicated that staff make special efforts to accommodate them. Food and menus was found to be good with people’s likes and dislikes recorded. Relatives and Residents confirmed that they liked the food. There was one Resident who has expressed concerns about the food based partly on their special requirements and associated frustrations with the persons relatives indicting that this was also the case when they lived at home. Choices are communicated to Residents verbally with the home therefore advised about how they could also signpost this information. The inspector observed the meal being served which offered a healthy choice with good preparation and in good portions with staff communicating to the cook a range of special instructions depending on individual needs. Residents were observed to eat their meals over a flexible 2 hour lunchtime period. All food was appropriately prepared and served. Staff gave support to those who required it within a calm atmosphere. Barchester Tower DS0000021038.V337155.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, & 18. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Complaints and concerns about the service have dropped sharply with improved satisfaction from stakeholders. Resident’s benefit from sensitive support from trained and mature staff. EVIDENCE: This area was found to be much improved with no complaints or concerns expressed to the Commission over the last 18 months. Relatives, Contracts and purchasing, and those other professionals the inspector was able to speak with, expressed no current concerns about the service. Some relatives indicated that they had some queries but most felt confident raising these questions with the home. Some felt that their views on the service should be routinely sought proactively by the home either in a meeting or via a questionnaire. In the reception area of the home there is a notice, which invites relatives or advocates to attend monthly reviews of Residents care. The home’s complaints procedure is also displayed which is just awaiting amendment to indicate the new address of the Commission’s nearest area office. Barchester Tower DS0000021038.V337155.R01.S.doc Version 5.2 Page 18 The manager confirmed, with reference to the homes own recording book, that there had been no complaints made to the service since the last Inspection. Staff spoken with indicated a good knowledge of how to both identify and report suspicions of alleged abuse. The home has its own policy and procedure in respect of protecting vulnerable adults and most staff have completed National Vocational Qualification in Care level 2 which covers this area. All Residents who could give an opinion felt that the care was good and respectful and that their rights were upheld, a view shared by relatives spoken with. Barchester Tower DS0000021038.V337155.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24, & 26 Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. The layout of the homes environment is not ideal for the needs of Residents but a number of reasonable adjustments have been made over the last year. Health and safety areas have improved with some further work still required. Residents benefit from an environment which is homely in character and which is kept clean. EVIDENCE: The Inspector toured all communal areas and a number of bedrooms finding the home to be clean and free from offensive odour with one exception, which the home is already working towards a solution. It was noticeable that carpets throughout the home were cleaner. Barchester Tower DS0000021038.V337155.R01.S.doc Version 5.2 Page 20 The manager confirmed by reference to an assessment of the home by an Occupational Therapist at the Commissions request that all recommendations had now been carried out such as creating safer access to the rear garden. The remaining recommendation for a loop system for the deaf was no felt necessary. Given that this is a home for those with a dementia type illness the following best practice advice from dementia specialists is recommended. To help exercise choice and control over resident’s it will be helpful if the home develops picture/signage around the home (toilets/bathrooms). Bedrooms may also benefit from having a photo of the user which can reduced confusion about rooms for Residents and reduce the need for staff to be there to direct Residents. The home does not have a passenger lift although a stair lift is in operation. Experience has shown that the stair lift is not suitable for all. The home is on two floors, with a stair-lift providing access to the upper floor. However, there are still some steps upstairs with this floor lacking level access, which affects the accessibly of the home for all Residents. The limitations of the building require those who develop mobility needs that originally have bedrooms on the first floor where most are based, to move downstairs. This often requires them to share rooms with others. A recent case of this was not shown to be recorded in the care-plan to show that this was based on a positive decision to share. One relative spoken with indicated no concerns with the principle of room sharing, except that their relative could not choose whom to share with and had varied relationships depending on how they had shared with. The environment health department carried out a visit in 2006 as evidenced in a report seen during the inspection visit. The Kitchen floor identified as needing prompt attention to reduce the risk of infection was still found to require repair. Other areas were found to have been adhered too. Fire safety measures have improved with all doors not having auto- closure devices, with none found to be wedged open. Barchester Tower DS0000021038.V337155.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, & 30 Quality in this outcome area is, Good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a stable mature staff team, which has been supported by improved training opportunities, which has increased their awareness of Residents needs. EVIDENCE: There are currently 17 residents supported by 3 care staff during the day and 2 waking night staff. A cook and a dedicated cleaner complement these levels along with the manager who is available and visible to Residents. A clear rota confirmed staffing levels. These levels were found to be satisfactory for staff, relatives, and Residents who could offer an opinion. A small minority of residents requires 2 staff to mobilise but this was found to be managed well. Having two walking night carers is also helpful. Given that the home have been asked to review the range of activities and attention given to Residents, then a review of staffing resources might be necessary. Similarly, necessary improvements to care-plans may require more administration hours. The manager confirmed that half [5 of 10] of the care staff now have the National Vocational Qualification in Care at level 2 or above with some staff Barchester Tower DS0000021038.V337155.R01.S.doc Version 5.2 Page 22 having passed at level 3. The manager and staff confirmed that all other staff are either on this course or are shortly to be enrolled. Staffing files were not examined as the manager confirmed that no new staff have been employed since the last inspection and that a single record of training can be evidenced via a matrix format. The manager/owner has also updated their understanding as to changing recruitment procedures and legislation following inspections of their other home. The manager indicated that she has obtained the new style 12- week induction books compulsory from September 2006 and will use these in the event of any staff joining the home. Some staff spoken with indicated that training has significantly improved over the last 2 years and was more relevant to the needs of Residents, which helped them to do a better job. One staff member discussed the importance of attending an Understanding Dementia course over the last year as this had help them better understand what the world looks like from the Residents point of view. Staff also indicated how the Moving and Handling course they now do are more practically useful in the care of their Residents. Relatives and professionals identified staffing as the key strength of the home notably the maturity, friendlessness, and settled nature of the staff team. Throughout the inspection staff demonstrated that they had developed good team working practices, and good relationships with residents based on a commitment to there needs. Barchester Tower DS0000021038.V337155.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, & 38. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. The management of the home has improved with some future work needed in relation to developing more robust quality assurance measures. Further attention is necessary in relation to some important health and safety matters to protect Residents from potential harm. The reporting of incidents, which affect Residents wellbeing, needs to improve to promote transparency and confirm actions taken to support individuals. EVIDENCE: Barchester Tower DS0000021038.V337155.R01.S.doc Version 5.2 Page 24 The manager verbally confirmed that since the last Inspection, she had commenced and completed the necessary management course. The manager agreed to conform this in writing to the Commission with supporting evidence. Staff described the manager who is also the homes joint owner, as supportive. The manager demonstrated through discussions a good understanding of Residents needs. The further improvement of the service has been driven by the manager who is based in the home. The manager has range of experience and training relevant to the care of people with dementia type illness. The inspector found a brief one page report within the home Residents [service users ] guide which described a survey of 15 Residents dated May 2006 the result being that 2 recommended a table tennis as an activity. The manager indicated during discussion that she has been working on a business plan for 2007 to cover some planned changes to the environment. The manager was advised to develop an Annual Development Plan for 2007 which was holistic and took into account Residents needs and looked at the outcome areas within the standards such as activities. Moreover that this plan needs to be based on a wider survey of stakeholder views such as relatives and other professionals given the limitations of many Residents with dementia type illness to express their views. The home is therefore asked to conduct this survey and send the action plan to the Commission within the next 4 months. This plan may need to stretch into 2008 given that we are nearing the half waypoint of 2007. It was evident from talking with relatives that if the home develops a formal and proactive way of regularly seeking stakeholder’s views then outcomes for Residents could improve further. The Commissions own Annual Quality Assurance Assessment format sent the home for completion was not received within the designated 28 days or in the period following the Inspection where this report was written. This document will be used to inform the next inspection. Financial matters and records managed by the home have been inspected on previous visits without concern and therefore not looked at during this visit. Both the manager and relatives spoken with indicated no issues in relation to these affairs. The home attempts to avoid handling any actual Residents monies and prefers to invoice advocates/ relatives for any extra costs as itemised in the contract. Staff and the manager confirmed that written supervision for staff takes place on a regular basis. Staff confirmed that found this supportive especially in relation to identifying training needs and discussing new Residents. Good communication and team work is maintained within the staff team who regularly meet. Barchester Tower DS0000021038.V337155.R01.S.doc Version 5.2 Page 25 One hot water outlet in a bathroom used by Residents was found to providing excessively hot water with no records of checks over the 3-week period leading up to the Inspection. The manager organised the repair during the Inspection visit and is advised to give such matters more attention. One Resident case tracked had a Fall on 25/01/07 at 10.45pm which was not reported to the Commission on 01/02/07[6 days later] where the person fell face downwards with their arm and wrist badly bruised with the home waiting until 9am next morning to organise her to go to hospital where a broken wrist was diagnosed. A further fall on 26/01/07 where the person was found on the floor was not reported to the Commission but found in records in the home Further falls not reported occurred on6/2/07 bruising upper arm found on floor,,17/04/07 found again on the floor from a fall, 20/04/07 found on floor 12.30am, with none of these accidents reported. This is also referred to in relation to the comments in the Health and Personal Care section of this report. When questioned the manager explained that these might not have been falls but was unable to account for why a Resident would be found on the floor. The home were advised that such incidents need to be reported and without delay to promote transparency. Evidence of written and effective action plans based on reducing falls are necessary to promote Resident safety. Barchester Tower DS0000021038.V337155.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 3 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 2 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 X 1 Barchester Tower DS0000021038.V337155.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES 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 OP7 Regulation 15[2][b] Requirement Timescale for action 21/07/07 2 OP7 14 [2][a] 3 OP12 16[m]& [n] That the Registered Person must ensure that the Residents Careplan is kept under review and appropriately updated in light of changing needs with a clear and appropriate plan to show how needs can be met. That the Registered Person must 21/07/07 ensure that the Residents risk assessment in relation to mobility after admission needs is kept under review and shows appropriate updates when mobility needs change, or falls increase. That the Registered Person must 21/09/07 ensure that Residents are regularly and fully consulted as to their activity interests and any diverse cultural or other needs such as hobbies they wish to continue. That a regular programme of stimulating activities is made available either group, or individually based, as appropriate. That participation is recorded to assess that such a programme continues to meets needs . DS0000021038.V337155.R01.S.doc Version 5.2 Barchester Tower Page 28 4 OP19 13[4][c] 5 OP31 18[1][c] 6 OP33 24 7 OP38 13[4][c] 8 OP38 37[1][e] & 37 [2] That the Registered Person must ensure that requirements from the last environmental health inspection are met such as the repair of floors. That the Registered Person must ensure that the manager confirms to the Commission, achievement of the necessary qualification by the date shown. That the Registered Person must ensure a system is established and maintained for reviewing and improving the quality of care, which involves stakeholders and those advocates who can speak on behalf of Residents who have dementia type illness. That a survey of stakeholder’s views is carried out with a report and action plan developed which is sent to the Commission by the date shown. That the Registered Person must ensure that Residents are not placed at an unnecessary and avoidable risk. That the temperature of hot water on delivery, which is accessible to Residents, is regularly monitored with remedial action promptly taken so that it does not exceed 42 degrees. That the Registered Person must ensure that any event which adversely affects the welfare or safety of Residents such as falls and accidents are reported to the Commission , and without unnecessary delay. 21/07/07 21/12/07 21/10/07 21/07/07 21/05/07 Barchester Tower DS0000021038.V337155.R01.S.doc Version 5.2 Page 29 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 5 6 7 8 Refer to Standard OP2 OP3 OP7 OP9 OP9 OP14 OP22 OP24 Good Practice Recommendations That the contract [terms and conditions] states whether the fee would be different depending on who is funding. That the homes pre assessment obtains fuller information as to prospective new Resident’s diverse interests and current activity needs That the home carries out written audits of falls for individual Residents as appropriate That the system of administering PRN medication designed for pain relief is reviewed. That staff that administer medication are aware of the rationale in respect of each individual, in order to monitor effectiveness and side effects. That the home explores a Reorientation board to communicate the day of the week, activities, and menu for the day and other information. That the home explores signage in relation to bathrooms communal rooms and bedrooms to assist Residents with dementia type illness that may become disorientated. That arrangements based around 2 Residents sharing a room is based on a positive decision to share and which is documented. Barchester Tower DS0000021038.V337155.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Barchester Tower DS0000021038.V337155.R01.S.doc Version 5.2 Page 31 - 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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