Inspection on 26/11/07 for Barham House Nursing Home

This inspection was carried out on 26th November 2007.

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

The inspector 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

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Barham House Nursing Home The Street Barham Canterbury Kent CT4 6PA Lead Inspector Elizabeth Baker Key Unannounced Inspection 26th November 2007 09:40 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 Barham House Nursing Home DS0000070163.V350448.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. Barham House Nursing Home DS0000070163.V350448.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Barham House Nursing Home Address The Street Barham Canterbury Kent CT4 6PA 01227 833400 01227 833419 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) Care and Residential Homes Ltd Mrs Sheralyn Kelly Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places Barham House Nursing Home DS0000070163.V350448.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing only - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category (OP). The maximum number of service users to be accommodated is 23. Date of last inspection N/A Brief Description of the Service: Barham House is registered to provide nursing care for up to 23 residents aged 65 and over. Barham House, which has been a registered care home for many years, changed ownership on the 25 June 2007. The home is a grade II listed Georgian detached house, set in its own grounds. Parking is not available on site. The home is situated in the rural village of Barham. There is a shop with a post office, two churches and a public house in the village. The A2 is half a mile away, providing links to Canterbury and Folkstone. Residents’ accommodation currently consists of 13 single bedrooms and five doubles bedrooms. Seven single bedrooms have ensuite facilities. A 5-person passenger lift accesses bedrooms on the first floor. A wheelchair platform lift accesses three bedrooms on the mezzine floor. Day space consists of a large lounge and small quiet room. An upgrading programme has just commenced. Information about the home including inspection reports by the CSCI is available on request at the home. Current fees range from £394.00 per week to £550.00 per week, exclusive of the Registered Nurse Contribution. Additional charges are payable for chiropody, hairdressing, barber, newspapers, toiletries, and trips to external venues. Available current activities include make up and manicuring sessions, quizzes, bingo, art and crafts, including making Christmas cards, shopping and theatre trips. The Commission has not received any complaints about the home. Barham House Nursing Home DS0000070163.V350448.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first key unannounced visit to the home following the change of ownership for the inspection period 2007/08. Allocated inspector Elizabeth Baker carried out the visit on 26 November 2007. The visit lasted eight hours. As well as briefly touring the premises, the visit consisted of talking with some residents and staff. Five residents, one visitor and five members of staff were interviewed. Verbal feedback of the visit was provided to the home manager throughout the visit. Unfortunately at the time of compiling the report the Commission had not received any responses to surveys/comment cards distributed in support of the visit. At the Commission’s request the home manager completed and returned on time the home’s first Annual Quality Assurance Assessment (AQAA). Some of the information contained in the AQAA has been incorporated into the report. At the time of the visit 21 residents requiring nursing and personal care were residing at the home. What the service does well: What has improved since the last inspection? The inspector has not visited the home for many years so it was difficult to establish. However the new provider is committed to improving the home’s environment to make it a nicer place for residents to live in. According to the AQAA improvements since the last visit include staff having been provided with person centred care training to improve the quality of individual care and the home now provides a key worker system with skilled senior carers owning their own team, motivating the carers to ensure good practice. Barham House Nursing Home DS0000070163.V350448.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. The summary of this inspection report can be made available in other formats on request. Barham House Nursing Home DS0000070163.V350448.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 Barham House Nursing Home DS0000070163.V350448.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 and 6. Residents who use the service experience adequate outcomes. This judgement has been made using a range of evidence including a site visit to this service. Although prospective residents are provided with information about the home, the Statement of Purpose and Service User Guide must be reviewed to ensure they provide up to date and precise information about the home. Not all residents are treated equally in that only privately funded residents are currently provided with a contract or terms and conditions of staying at the home. EVIDENCE: The home has a Statement of Purpose and Service User Guide. These are intended to inform prospective residents and or their advocates of the care, services and facilities provided at the home. The information contained in the documents generally follows the Commission’s guidance to providers for the composition of such documents. However details of the home’s actual environment does not wholly comply. Bedrooms vary in shape and size. The documents do not include precise bedroom sizes but refer to meeting and Barham House Nursing Home DS0000070163.V350448.R01.S.doc Version 5.2 Page 9 exceeding National Minimum Standards. However not all prospective residents and members of the public may be aware of or have access to this document. It has not been the home’s practice to issue sponsored residents with a contract or terms and conditions of staying at the home. All residents should be provided with a document setting out the rights and responsibilities of both parties, for equality purposes. The home manager generally visits prospective residents in their current place of occupation to determine whether the home is suitable to meet their assessed needs. Not all prospective residents are able to visit the home prior to admission. Where this is the case, their relatives or advocates do so on their behalf. Information is also sought from other agencies, where a sponsor is involved in the placement. To make new residents feel more at ease on admission, flowers are put in their bedrooms as a welcoming gesture. According to the AQAA relatives/potential residents are informed that the placement is not permanent if funded by social services until the resident has had their review at 4-6 weeks. If the resident is self-funding they would have a trial period. Residents are informed that all parties must be satisfied that needs are being meet and resident and family are happy. This is good practice. However when the pre admission process is complete the home manager verbally confirms to the resident or their representative that the home can meet the assessed needs. However to prevent any misunderstandings this needs to be confirmed in writing. Although the home is registered for nursing care, where the assessed needs of residents determine there has been a change in the resident’s condition, which the home can no longer meet, the home assists residents, with support from multi-disciplinary team members, in transferring to more appropriate homes. The home is not registered for intermediate care. Standard 6 is not applicable. Barham House Nursing Home DS0000070163.V350448.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Residents who use the service experience adequate outcomes. This judgement has been made using a range of evidence including a site visit to this service. Although the health and personal care needs of residents are generally met with evidence of multi-disciplinary working taking place when required, not all care records evidence this. Tighter medicine practices would reduce potential risks to residents. EVIDENCE: Care records of three residents were inspected. Records contained a care plan and a range of supporting clinical and health and safety risk assessments, including moving and handling, skin integrity, falls, nutrition, mental health abbreviated test and catheter care. Observation charts are maintained and reviewed monthly. Residents’ weights are included. Residents receive input from specialist clinicians where there is an assessed need. Daily records are maintained and give a brief picture of the individual resident’s quality of day experiences. In the main they were signed and dated. However some practitioners record night entries by the use of “nocte”. This should be discouraged, as it could be difficult in the event of an investigation being carried out to track the actual night care delivered. Care plans were dated as Barham House Nursing Home DS0000070163.V350448.R01.S.doc Version 5.2 Page 11 having been reviewed monthly. However, not all new problems trigger an update or generate a new plan to reflect the resident’s actual condition. For one resident this concerned pain and continence. Risk assessments are undertaken on residents in respect of the use of bed rails. The form used refers to known contra indications. This is good practice. However a recorded incident for one resident had not triggered a meaningful re-assessment of the form to reflect the behaviour change, although the bedrail assessment was dated as being regularly reviewed. The nutrition plan for the resident instructed staff to undertake daily blood sugar levels. The accompanying chart had unexplained gaps. It was difficult to establish from the care records how the pain control treatment for a particular resident was being managed. Although the medicine administration chart (MAR) indicated regular dose medicine must be administered four times a day, comments on the chart indicated the resident had not been administered this medication because they “cannot swallow”. The MAR chart indicated the medicine dosage had recently been increased from 3 times a day. There was no indication on the chart when the change was effected or on whose authority. Pain charts are maintained to monitor pain control treatment plans. However the resident’s plan had not been updated to reflect the most recent situation. Medicines, some nursing aids and sundry equipment are stored in a designated room for safety purposes. The room contained three oxygen cylinders. Only one was secured. To ensure the home conforms to current waste medicines disposal regulations, the home has an appropriate contract. Registered nurses administer medications to residents. A drug trolley is used for this purpose. However the trolley on one occasion was seen left unlocked and unattended. A resident described occasions when they do not get their medicines at the prescribed times leaving them wondering whether they are getting the intended benefit. Residents spoken with said staff assist them with their personal hygiene needs in a manner protecting their privacy and dignity. Fixed screen curtains are provided in the double rooms and used for residents’ protection when assistance with personal care is carried out. In the main residents admitted into the home stay there for the rest of their lives. The care records inspected contained family contact and funeral details. A relative described the “wonderful treatment” his mother and the family are receiving from the home during her end of life stage. Staff should be complimented on this. However care plans do not specifically record details of residents’ spiritual and cultural preferences and wishes in the event of death and dying. This is an important aspect of care and must be addressed. Barham House Nursing Home DS0000070163.V350448.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Residents who use the service experience good outcomes. This judgement has been made using a range of evidence including a site visit to this service. Despite having a range of activities and choice of meals not all residents experience what they really want or desire. EVIDENCE: The current service user guide records regular activities at the home include exercise activities, music events, individual and group games, arts and crafts and trips to local towns or areas of interest. One resident said how much she enjoys going out for a ride home’s vehicle to the local village and other places. A full time activities coordinator is employed. The AQAA states that the activities coordinator documents life stories with the help of residents and families. The care records inspected contained this. Residents can generally choose where they wish to spend their day. Some residents were seen in their rooms reading, watching television or resting. While some residents expressed satisfaction with this provision others did not. One resident stated they were “bored stiff” and another said they are unable to get around the home or indeed out into the gardens as often as they wished to because they required support and staff were not always available to provide this. The activities coordinator provides one to one support to residents in the privacy of Barham House Nursing Home DS0000070163.V350448.R01.S.doc Version 5.2 Page 13 their bedrooms or in the day rooms. This includes reading newspapers and or having general chats. Visitors are welcome at any time and offered refreshments. Residents’ special occasions are celebrated. Despite the service user guide recording church services take place this is no longer the case. However the close proximity of a church enables residents to attend services if they wish to. The home arranges for lay people from various religious denominations to visit particular residents and provide spiritual support as required. Although meals were not sampled on this visit, comments about them were generally good. However one resident said that despite being asked on admission for likes and dislikes, they occasionally get meals not of their liking or should not really eat. The home’s menus include a hot choice at lunchtime. Full cooked breakfasts are available on request. Menus are devised between the home manager and cook. The home does not have a designated dining room. However residents currently have the choice of eating their meals in the lounge or quiet room, or in the privacy of their own room if that is their wish. The Commission’s publications Highlight of the day? – improving meals for older people in care homes (March 2006) and Real Voices, Real Choice – the qualities people expect from care services, which are available from the Commission’s website may prove useful to the home when reviewing future menus and activities. Barham House Nursing Home DS0000070163.V350448.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 and 18. Residents who use the service experience good outcomes. This judgement has been made using a range of evidence including a site visit to this service. The home has a complaints procedure although its currency and availability may confuse or deter some residents and members of the public using it as intended. EVIDENCE: A complaints notice is displayed in the entrance conservatory. It contains current contact details of the Commission. However the notice does not comprehensively set out details of the new provider’s actual complaints route and contact details. The Service User Guide refers to the home’s complaints procedure in that it is available on request. Including the actual details within the documents may assist residents or advocates in making their views known without having to ask how they should go about it. Residents are supported in voting in elections if that is their wish. The Commission has not received any complaints about the home. The home manager refers matters to the appropriate agencies where she feels an adult alert must be raised for residents’ protection. The home maintains a record of formal complaints. Complainants are provided with a written response of the investigation. However it has not been the home’s practice to record centrally all “informal complaints and or niggles”. Having such a system may provide the home with a more effective way of auditing trends for quality assurance purposes. Barham House Nursing Home DS0000070163.V350448.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 25 and 26. Residents who use the service experience adequate outcomes. This judgement has been made using a range of evidence including a site visit to this service. The provider’s commitment to improving the environment should provide a more comfortable place for residents to live. Some of the current fire safety arrangements and practices potentially place residents at risk. EVIDENCE: The home changed ownership in June 2007. The new owner is committed to improving the home’s environment. This includes converting four of the five double bedrooms into singles. It is intended that all bedrooms will be refurbished. This includes replacing the old hospital type beds and renewing carpets. This is good news, as with the passage of time and continuous wear and tear the home is looking tired, worn and institutional. So far the dishwasher has been replaced, the ground floor woodwork has been repainted, the stair and ground floor carpet has been replaced, as have the carpets in two bedrooms. However during the visit an uneven carpet was seen Barham House Nursing Home DS0000070163.V350448.R01.S.doc Version 5.2 Page 16 in a particular bedroom, presenting possible trip hazards to the residents and staff. Some residents like to keep their bedroom doors open to enable them to see people coming and going or to go in and out of their rooms independently. However to accommodate this preference many doors had been propped open by fancy doorstops and in one case a chair. However technology has moved on with regard to door props, and such items are not approved safety methods and the practice must cease. The practice also presents trip hazards. During the visit it was established that despite being required to do so under the Regulatory Reform (Fire Safety) Order 2005 the home has not carried out a proper fire risk assessment of the establishment. It was also noted during the visit that a number of fire exit signs were not of the pictorial type and fire detection in one of the sluice rooms containing a mechanical sluice could not been seen. The door to this room could not be shut as the handle had been removed. Day space includes a large sitting room and small quiet room. Lighting seen around the home is generally of a domestic type. However in one particular double bedroom the central light did not provide one of the two residents using the room with sufficient light, to carry on their activity. Sadly the matter was compounded by one of the bulbs having blown. The home has a range of assisted bathing and showering facilities to meet the assessed needs of residents. The home has two designated sluice rooms in which clinical waste is safely stored or disposed of. Neither room is lockable presenting potential risks to residents and young visitors. The home has a range of lifting and transferring equipment so staff can assist residents in a safe manner. As expected of care home providing nursing care, the home has a range of pressure relief and preventative equipment and this was seen in use. Residents spoken with said the home is always nice and warm. The home has a central heating system. To protect residents from burns, covers have been acquired for the radiators. However an uncovered hot radiator was identified in a particular bedroom, potentially placing the resident at risk. The window in this room cannot be used as intended because of its poor condition and has to be kept shut. This prevents the resident getting the air they wish but receiving draughts they do not want. The home has a nurse call system fitted throughout, as is expected of care home providing nursing care. The statement of purpose informs prospective residents and their advocates of this. However the document requests residents not to use this call system unless there is a need to do so and to use the internal phone system for non-urgent calls. The document does not describe what constitutes non-urgent. However not all residents may have the Barham House Nursing Home DS0000070163.V350448.R01.S.doc Version 5.2 Page 17 dexterity or capacity to be able to use an internal phone system to summon support from care staff. Barham House Nursing Home DS0000070163.V350448.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Residents who use the service experience adequate outcomes. This judgement has been made using a range of evidence including a site visit to this service. Staff morale is good resulting in an enthusiastic workforce that works positively with residents to help improve their quality of life. Not all staff have been appropriately vetted posing potential risks to residents. EVIDENCE: As well as care staff, staff are employed for cooking, activities, cleaning, laundry and maintenance. Staff rotas are maintained and indicate the home is staffed 24 hours a day. Staff were seen carrying out their duties in an unhurried manner. However not all residents are of the opinion that the home has sufficient staff. One resident inferred they have to wait sometimes for a response to the call bell or they continually have to repeat care instructions to staff despite the information already being known and recorded in the care records. The AQAA records that over 50 percent of unregistered care staff are currently trained to NVQ II in care and other staff are working towards this. Indeed two staff have completed their NVQ 3 training. The home’s induction now follows the Skills for Care training programme, which should equip newly appointed staff to better understand and meet the health and personal care needs of residents. Staff interviewed said they had received training on subjects relevant to their roles and responsibilities including infection control, Barham House Nursing Home DS0000070163.V350448.R01.S.doc Version 5.2 Page 19 fire safety, COSHH, food hygiene, adult abuse, wound care and the Mental Capacity Act. Although systems are in place for the recruitment and appointment of staff, on this occasion it was identified they had not been rigorously followed. Not all the three files inspected contained evidence that new staff had been vetted against POVAFirst, only one contained CRB clearance and only one contained two references. The Commission’s publications Safe and Sound? Checking the suitability of new care staff in regulated social care services (June 2006) and Better safe than sorry – improving the system that safeguards adults living in care homes (November 2006) may provide the manager with useful guidance about staff recruitment. Barham House Nursing Home DS0000070163.V350448.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 37 and 38. Residents who use the service experience adequate outcomes. This judgement has been made using a range of evidence including a site visit to this service. Despite best efforts, the recent change of ownership has undoubtedly impacted on the home manager’s ability to fully achieve what is expected of her. However the manager and provider have a good understanding of what needs to be done to improve the home and are committed to do so. EVIDENCE: The home manager is a registered nurse, has a Diploma in Management for Nursing Home Care and has almost completed the Registered Managers Award Course. She has worked at the home for about 20 years and has been the home manager for about three years. The AQAA records that the home now has a deputy manager and that it is intended the deputy undertakes further training to support management skills. The provider intends to install IT Barham House Nursing Home DS0000070163.V350448.R01.S.doc Version 5.2 Page 21 equipment and systems into the home with the intention of providing more administrative support for the manager. This should assist the home manager in keeping on top of administrative duties, which because of changes in some working practices, arrangements and systems, have started to slip. Residents, staff and the visitor spoke openly about their experiences at the home. Good interaction was seen between the manager, staff and visitors. The manager endeavours to ensure that regular residents, relatives and staff meetings take place. It had been the home’s practice to annually survey residents and relatives for their opinions on the home’s services and facilities. Unfortunately the last one coincided with the change of ownership and so did not prove to be as effective as intended. However as part of the home’s improvements for the future, the manager intends to increase the frequency of satisfaction surveys to at least twice a year. The AQAA indicates that the home’s policies and procedures are regularly reviewed. Staff spoken with indicated they receive regular supervision and are well supported by the manager. The home does not maintain monies on behalf of residents. If an item of importance is been handed over for safe custody, the information has not always been recorded. Accident records are maintained to enable the home to monitor trends and take appropriate action where this is identified. The home notifies the Commission of incidents and accidents affecting residents’ welfare as is required by regulation. Since the change of ownership the provider visits the home weekly. A report of such visits is completed on a monthly basis and left at the home for inspection. As stated previously the home’s sluice rooms are not lockable to prevent unauthorised access and potential accidents. The AQAA records the home’s equipment is serviced and tested as recommended by the manufacturer or other regulatory body. However as identified previously, the home has not produced a fire risk assessment as is required under the Regulatory Reform (Fire Safety) Order 2005. Other environmental risks were also identified during the visit. The situation poses potential risks to residents and staff. As stated throughout the report, not all records relating to residents and staff are completed as is required. Details of the provider’s public and employer liability cover were unavailable on site. However the home manager said appropriate cover is in place. Barham House Nursing Home DS0000070163.V350448.R01.S.doc Version 5.2 Page 22 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 2 2 3 2 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 3 2 2 3 3 X X 2 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 3 3 X 2 1 Barham House Nursing Home DS0000070163.V350448.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? N/A 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 OP1 OP2 Regulation 4(1)(c) sch 1, para 16 5 Requirement The actual number and size of bedrooms must be included in the Statement of Purpose All residents must be provided with a contract or terms and conditions of staying at the home All residents must be provided with written confirmation that the home is suitable for their assessed needs with regard to health and welfare Care plans must be reviewed and appropriately updated to reflect changes in residents’ assessed needs; Clear administration guidance must be recorded for all medicines that are prescribed on an as and when required basis; The home’s complaint procedure must be updated to reflect the new ownership The home must produce a fire assessment of the premises as is required under the Regulatory Reform (Fire Safety) Order 2005 Approved measures must be taken to ensure the protection of DS0000070163.V350448.R01.S.doc Timescale for action 31/03/08 31/08/08 3 OP4 14(1)(d) 31/01/08 4 OP7 15 15/12/07 5 OP9 13(2) 15/12/07 6 7 OP16 OP19 22 24 31/12/07 31/12/07 8 OP19 23(4) 31/12/07 Barham House Nursing Home Version 5.2 Page 24 9 OP25 13(4) 10 OP29 19 11 OP31 18 12 13 OP37 OP38 17 13(4) all residents in the case of fire Action must be taken to eliminate the risks posed to residents from the unguarded hot radiator and uneven carpet Appropriate references and vetting checks must be obtained on all staff prior to commencement The registered manager must have all the resources required to effectively run the home, including systems, administrative support and time. All records must be kept up to date for the protection of residents Appropriate action must be taken within the home to identify and minimise potential risks to residents 31/12/07 31/12/07 31/01/08 31/03/08 31/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 7 Refer to Standard OP1 OP8 OP8 OP9 OP9 OP11 OP12 Good Practice Recommendations It is strongly recommended that a copy of the home’s current complaints procedure is included with the Service User Guide, for ease of access. Bed rails assessments must be appropriately updated when an identified need in the residents’ behaviour is identified Clinical risk charts must be completed as is required. Full details of dose changes to the prescriber’s directions must be clearly recorded on the medication administration chart Oxygen cylinders must be securely stored Care records must contain information on residents; spiritual and cultural needs and wishes in respect of death and dying All residents must be provided with meaningful support, DS0000070163.V350448.R01.S.doc Version 5.2 Page 25 Barham House Nursing Home 8 9 10 11 OP15 OP16 OP38 OP37 stimulation and occupation as per their preferred choice All residents should be provided with meals of their choice It is strongly recommended that all types of concerns and niggles be recorded It is strongly recommended that locks are fitted to each sluice room to prevent unauthorised access Appropriate and up to date records must be maintained for items kept by the home for safe-keeping on behalf of residents Barham House Nursing Home DS0000070163.V350448.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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