Inspection on 27/09/05 for Barclay Gardens

This inspection was carried out on 27th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

Barclay Gardens 07/08/09

Barclay Gardens 21/08/07

Barclay Gardens 05/10/06

Barclay Gardens 16/01/06

Barclay Gardens 09/12/04

Barclay Gardens 06/07/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Barclay Gardens Barclay Gardens Wellington Road Telford Shropshire TF2 8AB Lead Inspector Pat Scott Unannounced Inspection 27th September 2005 09:50 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 Barclay Gardens DS0000044626.V253990.R01.S.doc Version 5.0 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. Barclay Gardens DS0000044626.V253990.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Barclay Gardens Address Barclay Gardens Wellington Road Telford Shropshire TF2 8AB 01952 605321 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) Coverage Care Shropshire Limited Mrs Carol Margaret Jones Care Home 40 Category(ies) of Dementia (20), Old age, not falling within any registration, with number other category (20) of places Barclay Gardens DS0000044626.V253990.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home may accommodate 40 Older People, of whom 20 may be suffering from dementia. Mrs Jones undertakes appropriate training to demonstrate she has qualifications in dementia as part of her continuing professional development. 9th December 2004 Date of last inspection Brief Description of the Service: Barclay Gardens is a purpose built care home for older people located in Donnington, Telford. The home became operational on 9th April 2003. The home can accommodate a maximum of 40 older people, 20 of whom may have Alzheimers related illnesses. The home is owned by Bromford and Carinthia Housing Association and leased to Coverage Care Shropshire Limited who provide the management and staff. The building also accommodates a large day centre and 24 independent living flats also for older people. The restaurant accommodates all residents (if they choose) and non-residents attending the site. Barclay Gardens DS0000044626.V253990.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 27th September 2005 commencing at 09.50 hrs. The National Minimum Standards for Care Homes for Older People focus on achievable outcomes for service users – that is the impact on the individual of the facilities and services of the home. Evidence was looked for that the standards were being met and a good quality of life enjoyed by service users through: • Discussions with service users, families and friends, staff and managers. • Observation of daily life in the home • Scrutiny of written records (including care plans for 4 service users). The statement of purpose was used to assess how far the home’s claims to be able to meet service user requirements and expectations were being fulfilled. Reports regarding an overview of the conduct of the home are sent to CSCI on a monthly basis by the Head of Operations for Coverage Care. These, as well as the risk assessment from the last inspection were taken into account to determine the core standards focused on and depth of inspection. This inspection concentrated on the care provided in the elderly care units. The Commission does not currently have any concerns regarding this home. What the service does well: The home provides for the needs of elderly people through small group living. Service users were seen to be treated in a respectful and dignified way and some of those spoken with stated that they were well looked after by staff and that they were “in charge of their own life still”. The corridors in the units are quite long but the staff demonstrated person centred care by delivering the morning drinks a few at a time on a tray rather than by trolley. After appropriate risk assessment, service users are not discouraged or unduly restrained from undertaking activities solely for fear that for example, they may hurt themselves. The building is used for a number of purposes as it also incorporates day care facilities and is attached to the independent living flats. The way in which this Barclay Gardens DS0000044626.V253990.R01.S.doc Version 5.0 Page 6 is managed protects the privacy of service users whilst allowing the building to be used in other ways. The quality of meals and the way they are provided is very good. For instance; a key worker for one service user spoke of how that person could not manage meat but could eat all the vegetables. So the kitchen had been informed to blend the meat only and serve the vegetables as usual. Coverage Care provides training to a level that creates a trained and experienced staff team. Health care needs are well attended to with information in care plans being precise and up to date. What has improved since the last inspection? 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. Barclay Gardens DS0000044626.V253990.R01.S.doc Version 5.0 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 Barclay Gardens DS0000044626.V253990.R01.S.doc Version 5.0 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): 1,3 The homes statement of purpose and service user guide are good providing service users and prospective users with details of the services the home provides, enabling an informed decision about admission to the home. EVIDENCE: The information provided to service users gives details of needs assessment to be conducted prior to admission and examination of care plans on the units confirmed that this process had been carried out. The philosophy of the home is such that the service is tailored around the needs of individuals. The statement of purpose and service users guide were on display in the foyer. Barclay Gardens DS0000044626.V253990.R01.S.doc Version 5.0 Page 9 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): 7,8,10 There is a clear, consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet service users needs. Personal support in this home is offered in such a way as to promote and protect service users’ dignity and privacy in their daily life. EVIDENCE: Care plans looked at for 4 service users were consistently completed and had all the useful information in them that is necessary to enable a care worker to provide the right care for that individual in a way that meets their wishes and preferences. Care staff spoken with were aware of the plan’s existence and content and demonstrated how they were involved in any changes these records. Ascertaining information can be time consuming when an individual is admitted with complex problems and records provide evidence of consultation/communication with families and other supporters. The information that was read showed that individuals receive the level of care Barclay Gardens DS0000044626.V253990.R01.S.doc Version 5.0 Page 10 which their own situation requires. All care plans seen had been signed by the service user. Visits by other health care professionals are documented e.g. GP. Regular monitoring and review of a service user’s condition takes place to ensure that the correct treatment and care is being given. As an example; although the care plans seen were for those service users on the elderly care units, there was evidence of monitoring of mental health deterioration and of referral on for re-assessment to the CPN (Community Psychiatric Nurse). Staff were heard talking with service users in a respectful manner and of noting their movement about the home in a discreet way. The mid-morning drinks were taken to service users who were in their rooms on a tray from the kitchenette. The care assistant knew exactly what they liked which showed they were treated as individuals. This carer always knocked before entering. There was excellent rapport seen between staff and the people in their care. Barclay Gardens has scored a 4 for standard 10, the evidence for which is reflected throughout other standards in this report. Information is displayed on the notice board regarding healthcare advice. This included many advisory leaflets about falls, food labels, diet and healthy eating. The home has demonstrated that it exceeds standard 8. Barclay Gardens DS0000044626.V253990.R01.S.doc Version 5.0 Page 11 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 Staff have an excellent understanding of the service users support and leisure needs and use this to assist them to exercise choice and control in their lives. Dietary needs of service users are well catered for with a balanced and varied selection of food available that meets service users tastes and choices. EVIDENCE: There is no imposition of rules or routines within the home. For example; a regular church service was to be held on one of the units. Information about this was displayed in the foyer and on notice boards and staff were heard to inform service users verbally on the day. Those who wished to attend did so and no one was forced to go. A service user commented that she had wanted to spend the morning in her room and that staff had been respectful of this. Staff were seen to keep a check on her. Her call bell was the other side of the bed to where she was sitting but she stated that she was able to get up and use it. Service users were extremely complimentary about the quality and choice of food. Menus seen, dining areas visited and the food provided at the time of inspection demonstrated that the standard of catering at Barclay Gardens Barclay Gardens DS0000044626.V253990.R01.S.doc Version 5.0 Page 12 exceeds the minimum standards. A separate restaurant is available for all to use and service users said that it made a nice change when their family visited. The home has achieved the gold Healthy Eating Award. Many activities take place to meet individual needs and religious observance; there is an open visiting policy. The home has a therapy room used for massage and exercise. Care plans detailed social needs and preferences how they spend their day. Service users stated they spent their time as they wished and were not forced by staff to participate in events. Barclay Gardens DS0000044626.V253990.R01.S.doc Version 5.0 Page 13 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 The home has satisfactory complaints system with evidence that service users feel that their views are listened to and acted upon. Staff are provided with induction and on-going training regarding adult protection. This provides staff with the relevant knowledge to safeguard service users from many types of abuse. EVIDENCE: The complaint log was examined. Complaints since the last inspection have been appropriately dealt with, including one that the home failed to respond to properly which was addressed by senior management in coverage Care. On the whole, all service users spoken with were very happy with life at Barclay Gardens. They said they knew whom they could speak to if they were worried about anything. Staff training portfolios showed that regular training is provided on the subject of abuse. An induction folder for one new starter had complaint/abuse topics signed off as discussed. Barclay Gardens DS0000044626.V253990.R01.S.doc Version 5.0 Page 14 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): 19,26 The standard of the environment within this home is very good providing service users with an attractive and homely place to live. EVIDENCE: A general tour of the bedrooms and communal spaces demonstrated that the home is purposely designed into small group units each with its own lounge/kitchenette and dining area. These were all in a good state of repair and comfortably furnished. It is easy for elderly frail service users to find their way around their unit. A separate hairdressing facility and a shop are on site. The laundry room is well organised with equipment in place to meet he standards. Sluice rooms provided are situated away from areas used by service users Barclay Gardens DS0000044626.V253990.R01.S.doc Version 5.0 Page 15 Barclay Gardens DS0000044626.V253990.R01.S.doc Version 5.0 Page 16 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): 27,29,30 The arrangements for the induction and training of staff are good with the staff demonstrating a clear understanding of their roles. There is a good match of well-qualified staff offering consistency of care within the home. The standard of vetting and recruitment practices is good with appropriate checks being carried out. This ensures that suitable staff are employed to care for service users. EVIDENCE: A new staff member was on their induction period in the home. The recruitment file and induction portfolio were seen. This person totally supernumerary and was shadowing other staff. A current staff member was also on her induction period to train as a relief care manager. Relevant training has been provided as seen on some training portfolios. Staff spoken with confirmed this. Staff are offered financial support, subject to approval, for individual professional development. Staff also confirmed that supervision takes place on a regular basis. Staff observed carrying out their duties were seen to be responsive and understanding of individuals wishes and needs. Barclay Gardens DS0000044626.V253990.R01.S.doc Version 5.0 Page 17 There were enough care staff in numbers and skill mix to meet the needs of service users. Domestic and catering staff are employed to ensure the critical care role is not impeded. Barclay Gardens DS0000044626.V253990.R01.S.doc Version 5.0 Page 18 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): 35,38 The manager is supported well by the care managers in providing clear leadership in her absence and demonstrating an awareness of their roles and responsibilities. The awareness of health and safety responsibilities by staff is good ensuring that service users live in a safe environment. EVIDENCE: The safety of service users is covered by the Health and Safety at Work Act and by the general risk assessment requirements of the Management Regulations. Relevant risk assessments were seen on care plans. The fire risk assessment for the home had been reviewed march 2005. Records were seen Barclay Gardens DS0000044626.V253990.R01.S.doc Version 5.0 Page 19 that demonstrated the fire system and equipment was in order and training was up to date. Manual handling updates are provided and a first aider is on duty each shift. Accredited medication training is recorded has having been provided but with no certificates to prove this. The report into the conduct of the home for the month of August 2005 stated that all health and safety checks are in place and up to date. An accident sustained by a service user had the episode detailed in the care plan and the accident book. Service users personal monies are locked away and a system in place to manage them. One amount counted reconciled with the record. Barclay Gardens DS0000044626.V253990.R01.S.doc Version 5.0 Page 20 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 X 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X 3 Barclay Gardens DS0000044626.V253990.R01.S.doc Version 5.0 Page 21 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. Standard Regulation Requirement Timescale for action 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 Barclay Gardens DS0000044626.V253990.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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. 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