Inspection on 30/06/06 for Barchester Tower

This inspection was carried out on 30th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 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 Jon Wheeler Key Unannounced Inspection 30th June 2006 09:00 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.V294414.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.V294414.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.V294414.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 24th November 2005 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, or 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 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 inspection with fees approximately ranging from around £366 to £410 per week with extra changes for personal items. Barchester Tower DS0000021038.V294414.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 9am and 2pm on 30 June 2006. The Commission met with the proprietors at the office of CSCI in Eastbourne on 6th April 2006 to stress the importance of making the necessary improvements and changes, to ensure the home meets the Regulations and Standards. The inspection process involved talking to the two proprietors, one of whom is now the sole registered manager; three care staff, the cook and conversations with six service users. Written feedback was received from seven service users and two relatives. Staff generally supported the written feedback from service users. In addition, questionnaires were received from seven staff members. The inspection process also involved a tour of the premises, observing staff working with service users; reading care plans, records, policies and procedures. The storage, administration and recording of medication were viewed. The inspection found that there had been progress in meeting most of the requirements and recommendations from previous inspections. Some new requirements were made, which must be addressed by the service. What the service does well: What has improved since the last inspection? Pre-admission assessments and care plans have been improved, with more comprehensive information and detail about the needs of service users. Medical treatment is no longer provided to service users in the bedroom of another service user on the ground floor. Equally, confidential records and information is no longer stored in this room. Accidents were recorded appropriately in the accident book and in the daily recordings in care plans. Barchester Tower DS0000021038.V294414.R01.S.doc Version 5.2 Page 6 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 DS0000021038.V294414.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Barchester Tower DS0000021038.V294414.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 5, 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A satisfactory pre-admissions process ensures that prospective service users are able to make informed choices and the service is able to meet the needs of people living in the home. EVIDENCE: There was evidence that there has been an improvement in the quality of preadmission assessments since the last inspection. There was documentary evidence that a service user who recently moved in to the home had a comprehensive pre-admission assessment undertaken by the manager of the home, prior to moving in. The assessment contained background information, a hospital discharge plan, an assessment of needs and an action plan. The service user also had a number of visits to meet people already living in the home, have lunch and spend a day before finally choosing to move in. Barchester Tower DS0000021038.V294414.R01.S.doc Version 5.2 Page 9 There was a range of evidence that the home is able to identify and meet the needs of people who live there. The manager/proprietors and staff demonstrated a clear knowledge of the needs of people with dementia type illnesses and of each individual service user and also how those needs are met. The service does not provide intermediate care. Barchester Tower DS0000021038.V294414.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. 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 identify the needs and support required for each service user. Service users receive adequate health support from a range of services appropriate to their needs. The service could not ensure the health and safety of service users as not all medication had been dispensed and signed in line with the policies and procedures of the service. EVIDENCE: There was documentary evidence that the quality of pre-admission assessments and the format of care plans had improved since the last inspection. Staff had received training in care planning to ensure the new system is used effectively. Care plans included background information about service users; photographic identification; record of visits by health professionals; pressure area assessments; risk assessments and daily recordings and evidence of a basic monthly review. Barchester Tower DS0000021038.V294414.R01.S.doc Version 5.2 Page 11 There was documentary evidence that service users are supported to access a range of health services, such as a General Practitioner, Community Nursing, and Psychiatric nursing. Service users have also accessed hospital and inpatient services where required. Whilst generally dispensed medication had been recorded accurately, there were a number of gaps in the recording sheet on the day of the inspection. An immediate requirement was made for all dispensed medication to be accurately recorded. One service user was able to self-medicate, but the risk assessment to enable this to safely happen was brief and lacked sufficient detail. It was required that the risk assessment be reviewed to provide more comprehensive information to ensure the health and safety of the service user. Staff were observed treating service users with dignity and respect. One staff member in particular was observed resolving a difficult situation between two service users, with sensitivity and skill. Service users who responded in questionnaires all stated that the staff treated them well. Barchester Tower DS0000021038.V294414.R01.S.doc Version 5.2 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 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. A range of opportunities in the home and community provide a range of activities for the service users. Service users are enabled to maintain meaningful relationships with family and friends, with visitors being welcomed in to the home. Service users are encouraged and enabled to make choices about their care and all other aspects of their lives. Varied and nutritious meals are provided to meet the needs and preferences of the service users. EVIDENCE: There was evidence of a range of activities in the home, including dance; games; puzzles; an exercise class; reminiscence sessions; painting; songs and dance; watching films and a church service in the home. The Home has use of a minibus to take service users on trips out. During the inspection, generally service users watched television or listened to music. One staff member played a game of cards with a service user, whilst another staff member took time to sit and chat. However, it was not evident that there are regular activities offered on each day throughout the week. Barchester Tower DS0000021038.V294414.R01.S.doc Version 5.2 Page 13 It was reported that visitors are welcomed in the home, which was supported by feedback from family members. There was documentary evidence that family members were consulted as part of the pre-admissions assessment process for prospective new service users. Service users were observed being offered choices about a range of things, including activities, where they wanted to sit and the food they wanted to eat. Service user choices and preferences were recorded in their care plans. There was evidence of a varied and nutritious diet being offered for service users. Care plans recorded any preferences or dietary requirements of the service users. There was evidence of service users having choice of food for breakfast, which was being served when the inspection started. The cook was knowledgeable about the dietary requirements of the service users and said she was able to cater for those requirements. Barchester Tower DS0000021038.V294414.R01.S.doc Version 5.2 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 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. Service users are able to raise complaints and concerns and are protected by robust policies and procedures for complaints and adult protection. EVIDENCE: The home has a complaints policy and a book to record complaints, with one complaint having been received at the home in December 2005. There was documentary evidence that this complaint was substantiated and resolved effectively. Of those who responded, service users said they were able to raise any issues or concerns they had with the manager or staff. There is an adult protection policy in the home. The staff spoken with had a clear knowledge and understanding of the adult protection policy and procedure. Barchester Tower DS0000021038.V294414.R01.S.doc Version 5.2 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 the following standard(s): 19, 20, 21, 23, 24, 25, 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home offers a friendly and relaxed environment. There are sufficient bathroom and toilet facilities that meet the needs of the service users. The home is kept clean and tidy. The environment is not wholly accessible to all service users. Service users are able to personalise their rooms to meet their individual needs. EVIDENCE: The home provides a friendly and relaxed environment and is kept clean, tidy and hygienic. Service users are able to personalise their own bedrooms to suit their needs and preferences. There is sufficient communal space with a lounge and a dining room. During the inspection, service users were able to listen to music in the dining room or watch television in the lounge. There are extensive gardens around the home, which are generally kept secure to enable some service users to use them. Barchester Tower DS0000021038.V294414.R01.S.doc Version 5.2 Page 16 The home is on two floors, with a stair-lift providing access to the upper floor. However, there are still some steps upstairs, meaning the home is not wholly accessible for all service users. The home is kept safe and secure for service users, with all radiators being covered and water temperatures regulated in areas accessed by service users. There is an alarmed front door and gate to ensure service users are safe inside and in the grounds. There was documentary evidence that the service had commissioned an independent Occupational Therapy report to assess the environment within the home. The owners had addressed some of the recommendations of the Occupational Therapy report with others being kept under review, should they be required to enable the service to more effectively meet the needs of the service users. Barchester Tower DS0000021038.V294414.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Service users receive appropriate care and have their individual needs met by a dedicated, knowledgeable and trained staff team. EVIDENCE: There was documentary evidence that there are sufficient staff on each shift. Staff were observed providing sensitive, thoughtful and skilled care. Of note was one staff member who sensitively and effectively supported two service users to resolve an argument and enable them both to have their needs met. There are generally three care staff on each shift, with two waking night staff. In addition, there is a cook and a cleaner each day. Staff spoken with were clear about their roles and responsibilities and those of their colleagues. Staff demonstrated a clear knowledge and understanding of the individual needs of the service users. There is a stable staff team, who have all worked in the home for many years. It was not possible to review the employment procedures of the home as no new staff had been employed in the home recently. There was documentary evidence of a range of training courses for staff, including training on care planning; infection control; health and safety; Barchester Tower DS0000021038.V294414.R01.S.doc Version 5.2 Page 18 administering medication; and food hygiene. Six of the thirteen care staff have an NVQ in care at level 2 or above. Barchester Tower DS0000021038.V294414.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 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. There is a clear sense of direction within the Home, with the home generally being run for the benefit of service users. Service users finances are safeguarded in the home. Staff are appropriately supervised and there are a range of health and safety checks to ensure the safety and well-being of service users. EVIDENCE: Since the last inspection, one of the proprietors has taken over the role of registered manager. Since that time, there is a clearer sense of direction and responsibilities within the home. The manager needs to complete relevant management training. Barchester Tower DS0000021038.V294414.R01.S.doc Version 5.2 Page 20 Staff reported that the manager is approachable and supportive. The manager/proprietors are knowledgeable about the needs of people with dementia type illnesses. These comments were supported by written feedback from seven staff members. The manager of Barchester Tower has been able to portray a relaxed and caring atmosphere, where with a settled staff team, service users are respected and generally have their needs identified and met. The manager is financial appointee for four service users. There was documentary evidence of service user money being stored securely and all transactions being receipted and recorded. There was evidence of a range of support systems for staff. Staff have regular supervision as well as attending monthly meetings. The staff spoken to also reported that they were able to get informal support from the manager whenever they needed it. The service has a range of regular health and safety checks, including taking the temperature of water outlets, the fridges and freezers and ensuring fire safety systems are working. There was documentary evidence of regular fire drills for all staff. Staff had received health and safety and fire safety training. Barchester Tower DS0000021038.V294414.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 3 X 3 Barchester Tower DS0000021038.V294414.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? 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 2 3 Standard OP9 OP9 OP12 Regulation 13 (2) 13 (2) 16[m]& [n] Requirement Timescale for action 30/06/06 4 OP31 9 (2) (b) (i) All medication dispensed is accurately recorded. There is a more detailed risk 07/07/06 assessment for the service user who self-medicates. That the Registered Person must 01/08/06 ensure that service users are regularly consulted as to their activity interests. That a regular programme of stimulating activities is made available. That participation is recorded to assess that such a programme continues to meets needs. That the Registered Manager 01/12/07 Commences and Completes a relevant management qualification. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Barchester Tower DS0000021038.V294414.R01.S.doc Version 5.2 Page 23 1. OP28 That 50 of all care staff in the home achieve at least NVQ Level 2 as soon as possible Barchester Tower DS0000021038.V294414.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex 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 DS0000021038.V294414.R01.S.doc Version 5.2 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!