Inspection on 10/11/05 for Barford Court

This inspection was carried out on 10th November 2005.

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

Barford Court 12/11/08

Barford Court 15/11/06

Barford Court 02/06/05

Barford Court 08/02/05

Barford Court 01/09/04

Barford Court 25/11/03

Barford Court 06/06/03

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

CARE HOMES FOR OLDER PEOPLE Barford Court 157 Kingsway Hove East Sussex BN3 4GR Lead Inspector Jennie Williams Unannounced Inspection 10th November 2005 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 Barford Court DS0000013959.V265314.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. Barford Court DS0000013959.V265314.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Barford Court Address 157 Kingsway Hove East Sussex BN3 4GR 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) 01273-777736 01273-777633 Royal Masonic Benevolent Institution Mrs Susan Hale Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Barford Court DS0000013959.V265314.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. That service users accommodated must be aged sixty-five (65) or over on admission. That the home may admit two (2) named service users who are under the age of sixty-five (65). That the maximum of twenty-five (25) service users accommodated will be in receipt of personal care only. That a maximum of fifteen (15) service users accommodated will be in receipt of nursing care. That the named service user who now requires nursing care may continue to be accommodated. No additional service user requiring nursing care to be admitted until service user numbers in receipt of nursing care returns to fifteen (15). That the maximum number of service users to be accommodated is forty (40). 2nd June 2005 6. Date of last inspection Brief Description of the Service: Barford Court is a care home registered to provide accommodation for forty (40) residents. The home provides nursing care for a maximum of fifteen (15) residents and personal care to a maximum of twenty-five (25) residents. The home is part of the Royal Masonic Benevolent Institution (RMBI) and there are a number of care homes within the company. The home is located in Hove and is within walking distance of the seafront and local amenities. There is nearby access to public transport. Barford Court is a grade 2 listed building. It was built in 1931 as the home of a British film tycoon, and has its original art deco features. An extension has been built which is constructed to the 1930s style. The home is a large building and is separated into four units. There is a large indoor garden/communal sitting area that residents have access to. There are easily accessible, well maintained gardens to the front and rear of the home. Car parking is available at the home. Rooms are located over two floors and a passenger shaft lift is available for those requiring assistance to access the first floor. Barford Court DS0000013959.V265314.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001, uses the term ‘service user’ to describe those living in care home settings. For the purpose of this report, those living at Barford Court will be referred to as ‘residents’. This unannounced inspection took place over seven hours on the 10 November 2005. The registered manager was not available on this day. Staff files and some policies and procedures were spot-checked. Care plans were spotchecked and some areas of the environment were looked at. Medication procedures were spot-checked on one of the units. Discussions took place with staff and residents throughout the inspection process. The Inspector would like to thank staff and residents for their assistance throughout the inspection process. A telephone discussion took place with the registered manager on changes that are currently being implemented. What the service does well: 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. Barford Court DS0000013959.V265314.R01.S.doc Version 5.0 Page 6 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 Barford Court DS0000013959.V265314.R01.S.doc Version 5.0 Page 7 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, 4 & 5 All prospective residents are assessed prior to moving into the home. Standard 6 is not applicable as the home does not have dedicated accommodation to provide intermediate care. EVIDENCE: All prospective residents are assessed prior to moving into the home. There was evidence that a pre assessment had been completed on a newly admitted resident. The manager or trained nurse will undertake the initial assessment of any prospective resident. The person undertaking this assessment must ensure that they sign the assessments forms. Prospective residents are invited to visit the home prior to moving in. A resident spoken with confirmed that the registered manager visited them in their own environment to undertake the assessment. They then visited the home prior to admission. Other residents confirmed that family members visited the home on their behalf. The home does not admit any resident whose needs cannot be met with the skill mix of staff and services provided at the home. The home does not have dedicated accommodation to provide intermediate care. Respite care is available at the home if there is a spare room available. Barford Court DS0000013959.V265314.R01.S.doc Version 5.0 Page 8 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 A new care plan format is currently being implemented. Health needs are being met. Residents are treated with dignity and respect. EVIDENCE: Care plans were not thoroughly inspected on this occasion. There is a deputy manager commencing employment at the end of November 2005, who will be involved in and co-ordinating clinical issues within the home. A new shift leader has just commenced employment, who will oversee the care for residential residents. It was confirmed that the care plan format is in the process of being amended. Care plans will be thoroughly inspected at the next inspection. The Inspector briefly spot-checked some care plans. A daily care record sheet has been developed and implemented for all residents. The documentation of wounds and treatment has improved. Body charts are used and there is a wound communication sheet. It was confirmed that specialist advice is being sought more often in regards to wounds. An assessment tool used as part of the care planning was not dated or signed. It is important that it is reiterated to staff the importance of signing and dating all assessments forms/tools used as part of the care planning process. Barford Court DS0000013959.V265314.R01.S.doc Version 5.0 Page 9 Residents spoken with were complimentary about the staff working at the home and felt that their needs were being met. Residents’ health needs are being met at the home. One resident observed to be wearing glasses confirmed that they received new glasses recently and has their eyes checked when required. There is pressure-relieving equipment available at the home. The registered manager confirmed that the home is currently in the process of upgrading beds on two of the units, with advice from a tissue viability nurse. Quotes have been obtained and this will be a rolling programme. These beds will assist in reducing manual handling tasks for staff. There is evidence that residents are being weighed on a monthly basis. A weight chart demonstrated that within nearly a month period an individual had lost nearly a kilogram. There was no record to show if any action was taken to see why there was a sudden loss in weight. This was discussed with the new team leader on the day of the inspection. It was stated that this resident is well and the weight may have been written incorrectly. Staff need to ensure accurate records are maintained. Medication procedures were spot-checked on one of the units. There are policies and procedures in place for aspects of dealing with medication. The content of these were not read. MAR charts were inspected, but new ones had just been implemented so there were limited entries to inspect. A hand written MAR chart was not signed. It remains an outstanding recommendation that all handwritten MAR charts are signed and double-checked by staff who have been trained in medication procedures. Staff spoken with confirmed that they have received training for administration of medication. There was evidence that medication is being signed for at the time of administration. Controlled drugs spot-checked demonstrated that there are clear records being maintained. Most residents spoken with felt that their privacy and dignity are respected. One resident commented that ‘staff provide care in a subtle way’. This resident requires assistance when going down stairs. Staff say to them “‘I’m going down, come down with me’ and not I’ll take you down.” Barford Court DS0000013959.V265314.R01.S.doc Version 5.0 Page 10 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 & 15 Residents are provided with opportunities to be involved in activities. Routines of daily living are flexible. Some residents bathing preferences are not being met. EVIDENCE: The home employs an activities co-ordinator four days a week. Most residents spoken with felt that there were enough activities on offer if they chose to be involved. Comments were made to the Inspector that a lot of activities are more suited for the women. The activities programme showed that there is a variety of activities provided. The home has a bus on site that is used for outings. There are facilities for two wheelchairs to be able to be clamped securely into the bus. It is recommended that the activities co-ordinator ascertain from the males residing at the home their preferences in regards to provision of activities. Residents confirmed that most routines of daily living were flexible and their own choice. Some residents informed the Inspector that there was still not a lot of flexible in the choice of bathing times. This was commented on at the last inspection. It was confirmed that the new care plan format will have more detailed information regarding an individuals’ bathing preferences. This remains an outstanding requirement. Barford Court DS0000013959.V265314.R01.S.doc Version 5.0 Page 11 Visitors are welcomed at the home. A resident confirmed that visitors can be seen in private. There is a visitor’s book at the entrance to the home that all people visiting must sign. There were mixed feelings regarding the provision of meals. Comments ranged from ‘generally good’ to ‘not enthusiastic’. All residents confirmed that there is always a choice of meals. One resident commented that the menu has brussels spouts on it, they stated they have never had them. The registered manager had previously implemented steps to address this problem. It is required that the home reviews the meals that are provided. Residents confirmed that mealtimes are now unhurried, as required at the last inspection. Barford Court DS0000013959.V265314.R01.S.doc Version 5.0 Page 12 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 Residents are provided with opportunities to air their views/concerns. Staff are provided with sufficient information to inform them of the correct procedures if an allegation of abuse is made. EVIDENCE: The complaints policy has been amended as required at the last inspection. A clear record of complaints and action taken is maintained. The home has received three complaints since the last inspection. One was substantiated and one unresolved. One complaint was investigated under the Protection of Vulnerable Adults (POVA) procedures. This involved an incident between two residents. This was resolved and no further action was required. There are clear guidelines for staff to follow in the event of an allegation of abuse being made. A recent incident demonstrated that staff at the home are aware of the correct procedures to follow. The POVA policy and procedure has space for contact details of the investigating authorities, but this information was not completed. Barford Court DS0000013959.V265314.R01.S.doc Version 5.0 Page 13 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, 24 & 26 The location of the home provides opportunities for residents and visitors to access local amenities and transport. Residents live in a clean and wellmaintained environment. EVIDENCE: The home is located in a residential area of Hove and is within walking distance to the seafront and local amenities. There is also a small shop opened at the home on Thursday mornings that sells sweets and toiletries etc. This enables residents to purchase items themselves if they are unable to access local shops. The home is spread over a large area and rooms are located over two floors. Residents live in a well-maintained environment. There is a passenger shaft lift available for residents who require assistance to access first floor. There are well-maintained gardens to the front and rear of the home that residents have access to. There is an enclosed fishpond within the grounds. There is suitable communal space for residents living at the home. There are small sitting areas throughout the home and a large indoor garden/communal Barford Court DS0000013959.V265314.R01.S.doc Version 5.0 Page 14 area that provides residents with a relaxing atmosphere. All rooms are for single occupancy. A full environment inspection was not done on this occasion. Rooms that were spot-checked were of a good standard and some were observed to be personalised to reflect the individuals’ choice and personality. There are new assisted baths currently being installed, which has proved positive with staff and residents. The home was clean and free from offensive odours. Barford Court DS0000013959.V265314.R01.S.doc Version 5.0 Page 15 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 The skill mix of staff meets residents’ needs. The number of staff working in the mornings needs reviewing. Residents are safeguarded by the homes recruitment procedures. EVIDENCE: Staff and residents spoken with felt that there were not enough staff on duty, particularly in the mornings. Residents were complimentary about the staff and felt ‘sorry for them having to rush all the time’. There is always a registered nurse on duty. The rota now reflects the working hours of the registered manager as required at the last inspection. The rota provided to the Inspector demonstrated that the same number of staff is not always on in the mornings. The Inspector noted on a couple of occasions, call bells appeared to be ringing for an extended period of time. Residents expressed that bathing preferences were not currently being met. The home is a large building and one unit may be left up to one hour without a staff member being there due to assisting on another unit. One staff member commented that the medication round could take a long time if one staff member has to do the medication round on the three residential units. Staff also assist in the serving of meals. Staff commented that this could also be time consuming. One unit may have one carer working on it. One residents’ manual handling risk assessments demonstrated that this individual may sometimes require two staff to transfer. The home must ensure that there are sufficient staff on duty at all times, especially at peak times, taking into account the design and layout of the home. This remains an outstanding requirement. Barford Court DS0000013959.V265314.R01.S.doc Version 5.0 Page 16 The registered manager informed the Inspector that new rota times will be implemented after Christmas. These changes have been agreed with the staff working at the home. All relevant checks are undertaken on all staff. All staff complete medical questionnaires. These are seen by the company’s Occupational Health Physician, who provides the home with a report on the individuals’ suitability to work. These reports are stored in the individuals staff file. The reports also contain names of other staff members. It is recommended that a separate report be provided for each individual to ensure confidentiality. This is remains an outstanding recommendation. Management must ensure that a full employment history is provided. Gaps in employment and reasons for leaving care jobs must be documented, as stated in Schedule 2. It remains an outstanding requirement that staff files comply with Schedule 2. Training records/schedules were not inspected on this occasion. Staff spoken with confirmed that they are provided with opportunities to attend training sessions and they are kept up-to-date with mandatory training. Barford Court DS0000013959.V265314.R01.S.doc Version 5.0 Page 17 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, 35 & 38 Residents live in a home that is managed by a suitably qualified person. Residents’ financial interests are safeguarded. The health, safety and welfare of residents and staff are promoted and protected so far as is reasonably practicable. EVIDENCE: The registered manager was approved registration with CSCI in September 2005 and has the relevant skills and experience to manage the home. She has had over 20 years of care experience in a variety of roles and settings. She has current registration with the Nursing and Midwifery Council. A deputy manager will be commencing employment at the end of November who will provide clinical support to staff. A newly appointed team leader will be overseeing the care of residential residents. This new management structure will assist in addressing shortfalls. Barford Court DS0000013959.V265314.R01.S.doc Version 5.0 Page 18 There were mixed feelings regarding the ethos within the home. The Inspector discussed these issues with the registered manager over the telephone a day after the inspection. The registered manager asked what was said to the Inspector on the day, as some residents told her they wished to retract some statements made. No requirement or recommendation has been made within this report. These issues will be addressed by the registered manager independently from the inspection process. The head office of the organisation deals with financial procedures. There is suitable insurance in place. The home has given no cause for concern regarding financial viability to date. The home holds minimum personal allowance for residents. Residents are aware that they must access this money during office hours as the home has safety measures in place to ensure minimal people have access to residents’ monies. Monies spot-checked demonstrated that there are suitable recording procedures in place. Some policies and procedures were spot-checked. It is recommended that a quick reference guide is developed to assist staff to quickly and easily access the relevant policy needed. The health, safety and welfare of staff and residents are promoted and protected so far as is reasonably practicable. The maintenance person confirmed that all relevant health and safety checks were undertaken. Records required to be kept for the health and safety of residents were not checked on this occasion. An inspection had been undertaken in February 2005 that identified this standard was fully met. Fire doors that require to be kept open are now all fitted with suitable door guards. Door wedges/furniture were not observed to be in use, as required from the last inspection. Barford Court DS0000013959.V265314.R01.S.doc Version 5.0 Page 19 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 3 X 3 STAFFING Standard No Score 27 2 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 3 Barford Court DS0000013959.V265314.R01.S.doc Version 5.0 Page 20 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. 2. Standard OP7 OP8 Regulation 14 17 Schedule3 (3)(m) 12.2 & 12.3 Requirement That all assessment forms/tools used as part of the care planning process are dated and signed. That accurate weights be recorded and document action taken to address any sudden loss in weight. That a survey is undertaken to ascertain service users bathing preferences and reflected in the care plans. Action must be taken to ensure service users preference in lifestyle is met. (Timescale 31.07.05 not met) That the home continues to review the meals that are provided. That the home reviews the staffing hours and numbers of staff on duty, particularly during peak working times. (Timescale 15.07.05 not met) That staff files contain all the information as stated in Schedule 2. (Timescale 31.07.05 not met) Timescale for action 31/01/06 31/01/06 3. OP12 31/01/06 4. 5. OP15 OP27 16(2)(i) 18.1(a) 31/01/06 31/12/05 6. OP29 Schedule 2 31/01/06 Barford Court DS0000013959.V265314.R01.S.doc Version 5.0 Page 21 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. Refer to Standard OP9 OP12 OP18 OP29 OP37 Good Practice Recommendations That hand written MAR charts are double-checked by staff who have been trained in medication administration. (Outstanding recommendation) That the activities co-ordinator ascertains from the males residing at the home their preferences in regards to provision of activities. That the relevant contact details are completed in the POVA procedure. That a separate medical report be provided for each individual. (Outstanding recommendation) That a quick reference guide is implemented for policies and procedures. Barford Court DS0000013959.V265314.R01.S.doc Version 5.0 Page 22 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 Barford Court DS0000013959.V265314.R01.S.doc Version 5.0 Page 23 - 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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