Inspection on 02/06/05 for Barford Court

This inspection was carried out on 2nd June 2005.

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

The inspector 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 10/11/05

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 2 June 2005 10.00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Barford Court H59-H10 S13959 Barford Court V218823 020605 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Barford Court Address 157 Kingsway Hove East Sussex BN3 4GR 01273 777736 01273 777633 barford@rmbi.org.uk Royal Masonic Benevolent Institution Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) VACANT Care Home with nursing (N) 40 Category(ies) of Old age, not falling within any other category registration, with number (OP) 40 of places Barford Court H59-H10 S13959 Barford Court V218823 020605 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users should be over sixty-five (65) years on admission. Date of last inspection 8 February 2005 Brief Description of the Service: Barford Court is a care home registered to provide accommodation for 40 residents. The home provides nursing care for a maximum of 15 residents and personal care to a maximum of 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 1930’s style. The home is a large building and is seperated 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 availble for those requiring assistance to access the first floor. There were 35 residents living at the home on the day of the inspection. 15 in receipt of nursing care and 22 receiving residential care. Barford Court H59-H10 S13959 Barford Court V218823 020605 stage 4.doc Version 1.30 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 nine hours on the 2 June 2005. A tour of the home was provided. Staff files and some policies and procedures were spot-checked. Care plans were spot-checked. Residents and visitors spoken to were overall satisfied with the services provided at the home. Some staff members were interviewed. 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 H59-H10 S13959 Barford Court V218823 020605 stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Barford Court H59-H10 S13959 Barford Court V218823 020605 stage 4.doc Version 1.30 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 standard(s) 1, 3, 5 & 6 The home has information available to prospective residents and their representatives to make an informed decision if the home is suitable for their needs. 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: The home has a Statement of Purpose and Service User Guide that will need to be amended to include the recent change in management. This was a requirement in the last report. It is not reflected as outstanding in this report as there has been an additional change in management. 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. Prospective residents are invited to visit the home prior to moving in. A resident spoken with confirmed that they visited the home prior to admission. Respite care is available at the home if there is a spare room available. Barford Court H59-H10 S13959 Barford Court V218823 020605 stage 4.doc Version 1.30 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 standard(s) 7, 8, 9 & 10. Some needs are at risk of not being met due to insufficient information in the care plans. Residents’ privacy and dignity are respected. EVIDENCE: Care plans were only spot-checked. The newly appointed acting manager has already identified some shortfalls in the documentation. It was confirmed that the head office of the organisation is looking at amending and bringing in new paperwork throughout the organisation. There was evidence that care plans are being reviewed on a monthly basis. Care plans must be amended when there are changes within an individual’s needs. Some residents were observed to have dressings in place. These were not documented in the individuals’ care plan. Documentation needs to be improved to evidence that what is actually done can be evidenced when tracking care. Eg. Turning charts, (used for people who have limited movement and are at risk of developing pressure areas). Care plans need to reflect actual practice. There was evidence that monthly reviews are being done for some risk assessments. It is recommended that all risk assessments be reviewed when reviewing care plans. Barford Court H59-H10 S13959 Barford Court V218823 020605 stage 4.doc Version 1.30 Page 9 The acting manager confirmed that specialist advice is sought when the need arises. There was a chiropodist visiting the home on the day of the inspection. He confirmed that he found the home ‘very nice’ and visited the home on a regular basis. Medication was not thoroughly inspected on this occasion. The acting manager confirmed that they are looking at changing suppliers within the next month. The CSCI Pharmacist Inspector will inspect Standard 9 at a later date. The policies and procedures manual was read on one of the units, which demonstrated that there are shortfalls in the policies and procedures regarding medication practices. This remains an outstanding requirement. There was evidence that medication is being signed for at the time of administration. It is recommended as good practice that hand written MAR charts are double checked by staff who are trained to administer medications. This will reduce the risk of errors occurring. Residents spoken with felt that their privacy and dignity are respected. Barford Court H59-H10 S13959 Barford Court V218823 020605 stage 4.doc Version 1.30 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 standard(s) 12, 13, 14 & 15 Residents are provided with opportunities to be involved in activities. Some residents’ preference of lifestyle is not currently being fully met by the home. EVIDENCE: Residents spoken with confirmed that there were enough activities on offer at the home, if they choose to be involved. On the day of inspection there were residents being taken out for morning tea to Worthing. The home has a bus on site that is used for outings. The bus can carry three staff and eleven residents. There are facilities for two wheelchairs to be able to be clamped securely into the bus. The home employs an activities co-ordinator four days a week. One to one sessions are also provided for those residents who remain in their rooms. The RMBI also has a home in Kent and residents in both homes will meet up with each other every couple of months on arranged outings. Some residents spoken to identified that their daily routine is flexible to meet their needs. Some residents informed the Inspector that they are provided with a bath/shower once a week. Some mentioned they would like one every day and some would like one twice a week. It is required that the home undertakes a survey to ascertain residents bathing preferences and ensure care plans are amended to reflect this. Action must be taken to ensure Barford Court H59-H10 S13959 Barford Court V218823 020605 stage 4.doc Version 1.30 Page 11 residents’ preference in lifestyle is met. Residents confirmed that other routines of daily living were flexible and their own choice. Visitors are welcomed at the home. There are private sitting areas throughout the home or within the individuals’ room should privacy be required. Visitors spoken to were overall satisfied with the care and services provided at the home. Residents are encouraged to maintain their own finances for as long as they wish and are capable to do so. Information is stored securely at the home and used in accordance with the Data Protection Act 1998. There were mixed views regarding the standard of the meals provided. The general comments were ‘some days are good and some days not so good’. Residents spoken with did confirm that there is a choice of meals available. The acting manager has requested that the chef visits residents to obtain direct feedback regarding the quality of the meals provided. On the day of the inspection, residents were observed to be enjoying the lunch provided to them. As the home is aware of the food issues and taking action to address this, it has not been reflected as a requirement. Some residents stated that lunchtime is sometimes rushed due to the change of staff and shift times. Action must be taken to ensure lunch times are unhurried and residents be given sufficient time to eat. Barford Court H59-H10 S13959 Barford Court V218823 020605 stage 4.doc Version 1.30 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 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 policies and procedures manual on one of the units demonstrated that the contact details of the CSCI are still not included in the complaint procedure as required in the last inspection report. Some residents spoken with confirmed that they knew who to speak to in the event of having to make a complaint. It was confirmed that staff have received adult protection training, provided by an outside agency. Staff spoken with also confirmed that they have undertaken this training. Adult Protection training is also provided in the induction process. There has been one allegation of verbal abuse by a staff member towards a resident since the last inspection. This allegation was found to be substantiated. This was investigated and resolved following adult protection procedures. The acting manager stated that she proposes to provide a suggestion box so compliments/complaint/suggestions can be made anonymously at any time. Barford Court H59-H10 S13959 Barford Court V218823 020605 stage 4.doc Version 1.30 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 standard(s) 19, 20, 22 & 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. The acting manager confirmed that arrangements are currently being made to install ramps so residents have direct access to the front garden. There is an enclosed fishpond within the grounds. Barford Court H59-H10 S13959 Barford Court V218823 020605 stage 4.doc Version 1.30 Page 14 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 area that provides residents with a relaxing atmosphere. All rooms are for single occupancy. Two rooms are offered to couples that choose to live together. One for a bedroom and one for a lounge room. It is not always possible for the home to provide the two rooms near each other. 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. Some residents spoken to were happy with their rooms. There was evidence that some rooms are currently being refurbished/redecorated. A few residents were observed to be in their room without being able to access their call bells. One resident spoken with confirmed that staff sometimes forget to leave the call bell within reach. It must be reiterated to staff to ensure call bells are within reach at all times, unless a risk assessment identifies it is unsafe for a resident to be issued with one. The home was clean and free from offensive odours. Visitors spoken with confirmed that they always found the home to be clean when visiting. Barford Court H59-H10 S13959 Barford Court V218823 020605 stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, & 30 The skill mix of staff meets residents’ needs. Residents are safeguarded by the homes recruitment procedure. There is a feeling of low morale amongst some staff members. EVIDENCE: The rota provided to the Inspector demonstrated that the home complies with the Residential Forum for Care Homes for Older People. There is always a registered nurse on duty at all times. The rota needs to reflect the hours of the acting manager. Some staff and residents spoken with felt that there were not enough staff on duty at all times. Some residents commented that staff appear rushed and don’t have time to sit and talk. One comment was ‘they have too much to do and too many people to look after’. Staff also commented on not being able to spend time with the residents. They stated that some residents are becoming more dependent. Staff commented that the layout of the home poses some difficulties in providing care. Comments received by staff and residents were discussed with the acting manager and suggested that this issue is discussed at the next staff meeting. The home must ensure that there are sufficient staff on duty at all times, especially at peak times. The bathing needs of residents and hurried lunch times is evidence that some changes are required. Barford Court H59-H10 S13959 Barford Court V218823 020605 stage 4.doc Version 1.30 Page 16 The Inspector was informed of some staff leaving employment at the home. There has been a couple of changes in management recently and this can be unsettling for staff. All concerns were discussed with the acting manager to address. The morale of staff should improve once this transitional period in management has completed. 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. 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. Staff spoken with confirmed that they receive suitable training to carry out their duties safely and efficiently. There are three care staff with NVQ level 2 qualifications and two with NVQ level 3. Additional staff are currently undertaking these studies. The home is continuing to work towards achieving the 50 ratio of NVQ trained staff. Barford Court H59-H10 S13959 Barford Court V218823 020605 stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 35 & 38 Residents live in a home, which is run and managed by a suitably qualified person. Residents’ financial interests are safeguarded. EVIDENCE: The acting manager commenced employment at Barford Court on the 25 April 2005. The acting manager is currently going through the registration process with CSCI. The acting manager has had over 20 years of care experience in a variety of settings. The most recent job was managing a nursing home for approximately five years. The Inspector was informed that the home has a quality assurance and quality monitoring system in place. Questionnaires are provided to residents and visitors/relatives annually. There is no formal method to obtain staff feedback, but it was confirmed that staff are provided with opportunities to view concerns etc during staff meetings and handover sessions. The suggestion box, proposed to be installed, will provide an opportunity for all people to Barford Court H59-H10 S13959 Barford Court V218823 020605 stage 4.doc Version 1.30 Page 18 anonymously express concerns/complaints etc at any time. It is recommended that a formal questionnaire be developed for staff and completed on a regular basis. The home does not hold any monies for residents. Some are capable of managing their own finances. Representatives for individuals maintain the finances for those that are unable/unwilling to manage their own finances. Some doors were observed to be held open by furniture/wedges etc even though proper fire door guards have been installed. This practice must not continue. It must be reiterated to all staff that doors are not to be wedged open and to immediately report if there is problem with the proper device in use. 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. Barford Court H59-H10 S13959 Barford Court V218823 020605 stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 3 3 x 2 x x x 3 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 2 x 2 x 3 x x 2 Barford Court H59-H10 S13959 Barford Court V218823 020605 stage 4.doc Version 1.30 Page 20 YES 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. Standard OP1 Regulation 4&5 Requirement That the Statement of Purpose and Service User Guide is amended to reflect the change in management and staff. That a copy of this amended document be forwarded to CSCI. That care plans are updated when the needs of an individual changes. That care plans reflect actual current practice. (Timescale 01.03.05 not met) That current written policies around all aspects of medicine management are developed and implemented. (Timescale 31.03.05 not met) 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. That mealtimes are unhurried and service users be given sufficient time to eat. That the complaints policy in the units include the contact details for the CSCI. (Timescale 01.03.05 not met) That call bells are left within reach of service users, unless a Timescale for action 31.08.05 2. OP7 15 31.07.05 3. OP9 13.2 01.08.05 4. OP12 12.2 & 12.3 31.07.05 5. 6. OP15 OP16 12.1 22 15.07.05 31.07.05 7. OP22 16.2(c) 02.06.05 Page 21 Barford Court H59-H10 S13959 Barford Court V218823 020605 stage 4.doc Version 1.30 8. 9. OP27 OP27 Schedule 4 (7) 18.1(a) 10. 11. OP29 OP38 Schedule 2 13.4 risk assessment identifies it is unsafe for an individual to be issued with one. That the rota reflects the hours the acting manager is working. That the home reviews the staffing hours and numbers of staff on duty, particularly during peak working times. That staff files contain all the information as stated in Schedule 2. That it is reiterated to staff that doors are not to be wedged open. Any problems with the safety devices in place must be reported immediately. 30.06.05 15.07.05 31.07.05 02.06.05 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 OP7 OP9 OP28 OP29 OP33 Good Practice Recommendations That all risk assessments be reviewed when reviewing care plans. That hand written MAR charts are double checked by staff who have been trained in medication administration. That the home continues to work towards achieving the 50 ratio of NVQ trained staff. That a separate medical report be provided for each individual. That a formal questionnaire be developed for staff and completed on a regular basis. Barford Court H59-H10 S13959 Barford Court V218823 020605 stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 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 H59-H10 S13959 Barford Court V218823 020605 stage 4.doc Version 1.30 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. 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. 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