Inspection on 19/10/06 for Barking Hall Nursing Home

This inspection was carried out on 19th October 2006.

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 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

Barking Hall Nursing Home 13/10/08

Barking Hall Nursing Home 06/03/06

Barking Hall Nursing Home 19/12/05

Barking Hall Nursing Home 08/02/05

Barking Hall Nursing Home 25/05/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Barking Hall Nursing Home Barking Nr. Needham Market Suffolk IP6 8HJ Lead Inspector Jill Clarke Key Unannounced Inspection 19th October 2006 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 Barking Hall Nursing Home DS0000037085.V316538.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. Barking Hall Nursing Home DS0000037085.V316538.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Barking Hall Nursing Home Address Barking Nr. Needham Market Suffolk IP6 8HJ 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) 01449 720793 01449 722977 Pri-Med Group Ltd. Patricia Ellen Smaldon Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places Barking Hall Nursing Home DS0000037085.V316538.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th March 2006 Brief Description of the Service: Barking Hall is registered to provide care with nursing for 41 Older People. It is owned by the Pri-Med Group Ltd, who were taken over by Healthcare Homes Ltd in March 2006; a private company with a number of care homes in Suffolk. The home is situated a short distance away from Needham Market, a small rural town with amenities such as shops, public house, Doctors general practice and Post Office. The home over looks the countryside and adjacent to the local parish Church. The building is set in its own extensive grounds with car parking at the front. The accommodation is partly in a converted domestic dwelling and in a new extension, which is linked via an enclosed, glass walkway. All the bedrooms are single occupancy, and have their own en-suite facilities including either a shower or bath. Bedrooms sizes vary from 11.10 square meters in the old part of the home, to 15 and 17.5 square meters in the new part. Communal spaces include a large lounge/diner with views of the new courtyard, with its raised flowerbeds and seating areas in the new extension, and separate dining room and lounge in the original part of the home. The second phase of the building works is currently being undertaken in the main part of the home. Work being carried out includes laying new corridor carpets, decorating resident’s bedrooms as needed, and a new larger kitchen, and staff training room. Fees range from £555.00 to £655.00 per week plus the determined Registered Nursing Care Contribution (RNCC). Prices include a television, and in the new extension, plasma screen televisions and facilities for Sky digital television and the internet. Mrs Patricia Smaldon manages the home. Barking Hall Nursing Home DS0000037085.V316538.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection, undertaken over 8¼ hours, which focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to, and during the inspection. Commission for Social Care Inspection (CSCI) feedback cards were sent to the home in September. This gave an opportunity for relatives, visitors and staff to give feedback on how they thought the service was run. Comments from the completed residents (16), joint relative/visitor (13), feedback cards have been included in this report. No staff feedback cards were returned. Staff, management and owners were helpful and cooperated fully throughout the inspection. Time was spent with 4 Residents, and 1 relative in private, to hear their views on the level of service provide. A tour of the building, took in all the communal rooms and a sample of 3 bedrooms (in the new extension), laundry, kitchen and medical room. Records viewed, included care plans, staff recruitment, supervision and training records, Fire Risk Assessment, Statement of Purpose, Service Users Guide, Quality Assurance questionnaires, Menus and medication records. Previous visits to the home identified that people living at Barking Hall preferred to be known as residents, this report respects their wishes. What the service does well: The home is well managed, and staff receive training and support to enable them to provide a good level of service, within a homely, safe environment. All residents are fully assessed, by an experienced Nurse who will answer any questions about the service, and give information on the home, including fees. Prospective residents and families said that staff made them “feel welcome, and were happy to answer any questions they had”. One resident described staff as being “very considerate and understanding’” saying that “they don’t pretend to know it all and will listen”. Other comments on staff included ‘very professional’, ‘there are some excellent members of staff who really show an interest in me’, I am ‘very happy with the care and support at Barking Hall’ and a ‘very good home with excellent staff and facilities’. Barking Hall Nursing Home DS0000037085.V316538.R01.S.doc Version 5.2 Page 6 Relatives, completing CSCI feedback questionnaires also spoke highly of the home, which included ‘the home is fresh, clean and most of all a happy friendly place …a brilliant place’. 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. The summary of this inspection report can be made available in other formats on request. Barking Hall Nursing Home DS0000037085.V316538.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 Barking Hall Nursing Home DS0000037085.V316538.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 and 5. (Standard 6 not assessed as do not offer a intermediate care service) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People wishing to move into the home, will be given information on the level of care provided, and can expect their needs to be fully assessed. This supports the prospective resident in identifying if the home is suitable, and ensures the home only admits residents whose care needs they can meet. EVIDENCE: Since the last inspection, Healthcare Homes Group Ltd have purchased the PriMed Group homes, which included Barking Hall Nursing home. Inline with the changes they have updated their Statement of Purpose and Service User (Residents) Guide, which covers all the required information. Views on the new brochures were mixed, with 1 resident saying they were aware that the owners have to sell the place’ but it bears ‘little relation to what it is actually like, where another resident described the brochure as being ‘really nice’. The brochure, which has a photograph of Barking Hall, comes with, ‘Health Care homes’, supplement which shows pictures of their other establishments, and Barking Hall Nursing Home DS0000037085.V316538.R01.S.doc Version 5.2 Page 9 includes an ‘Activities’ sheet, which does not fully relate to work currently being undertaken (see Daily Life and Socail Activities section of this report), but will in the future. When the home first receives enquiries from prospective residents, or their representative, they complete an enquiry form and obtain a brief outline of the person’s needs. Based on this information, a provisional weekly fee is given. One resident, said they had ‘asked to inspect the home’ and was told ‘they could come at any time - to just report to the reception and someone would show them around’. Staff said they always encourage the prospective residents and/or if unable their family to visit. One family had recently taken a video of the home, to help them give feedback to their relative. On the day of the inspection, an experienced Nurse had just arrived back from visiting a prospective resident, to undertake their pre-assessment. The completed assessment was comprehensive and gave a good, initial insight, into the resident’s physical, mental and social health needs. Arrangements had been for the resident to visit the home later in the day. Comments seen by a member of staff showed, that although the home has vacant rooms, there is no pressure on them to fill the rooms. They felt it was important that residents only moved in when they felt ready. This was further evidenced in a note made on a resident’s file, which stated ‘family/resident still unsure about placement – told to go away and think about it - - no pressure I will hold the room for 3 weeks’. All admissions are subject to a 1 month’s trial period. All residents are given a copy of ‘Terms and Conditions of Admission and Terms of Business’, which gives a good level of information. This includes what is included in the fees, and what residents are required to pay for themselves, for example transport and escort to and from hospital, hairdressing and chiropody. Records seen showed that residents had been sent a letter giving information on costs, date of admission and room to be occupied. Residents completing the CSCI surveys confirmed that they had been given a contract. Records viewed showed that residents had been made aware of the costs involved, before making the decision to more into the home. Feedback both verbally and from completed residents CSCI surveys, evidenced that staff were able to meet resident’s individual assessed needs. This was also reflected in relatives/visitors surveys, with a 100 stating that they were satisfied with the overall care provided. One relative commented that their next-of-kin, who had only been living at the home for a few weeks, but as far as they could tell, they had ‘settled in and is being well cared for’. Barking Hall Nursing Home DS0000037085.V316538.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 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service can expect staff to monitor their care, based on their individual needs, and take appropriate action to support their changing physical and mental health. The principles of respect, dignity and privacy are put into practice. Residents cannot be assured that their medication records are always being completed accurately. EVIDENCE: This inspection coincided with staff changing the current residents care plans to the new Healthcare Homes format, which the managers from their homes had helped develop. All new residents are using this format, whilst existing residents will have their information transferred from old to new formats over a period of time. The care of 3 new residents was tracked, which included viewing the new care plan format, and spending time with the residents, to hear their views on the level of service provided. Time was also spent discussing with staff, their understanding of the resident’s physical, medical and social care needs. Barking Hall Nursing Home DS0000037085.V316538.R01.S.doc Version 5.2 Page 11 Care plans seen, gave a good level of information, showing work undertaken to monitor residents physical (nursing and personal care, nutrition, pressure areas, continence), safety (manual handling, falls and environmental risk assessments) and social interests and activities. The home had purchased new weighing scales, which enable residents to be weighed sitting in their wheelchair. Care needs assessments focused on supporting the resident to maintain their independence. Staff were given guidance on what residents were able to do for themselves, and how much help staff should offer. The manual handling assessments, were comprehensive, however, where staff had written requires ‘minimal assistance’ more information should be given, to clearly identify what level of assistance is required. For example offering a guiding hand, or giving verbal support. Completed resident’s surveys, confirmed that medical support was available when they required it. Information held in care plans showed that nursing staff monitor resident’s changing physical and mental health needs. This includes completing a monthly ‘dependency assessment’, which supports them in identifying any changes over a period of time. One relative praised the standard of nursing care, describing the positive improvement seen in their next-of-kin, since they moved into the home. This was further reflected in a letter written by a General Practitioner (GP) to a colleague, who described a resident who was on respite care, showing signs of improvement and going from ‘strength to strength’. Care plans incorporated residents preferences, such as they would like a ‘cup of tea at 7.30’. Residents had signed to confirm that they had been given the ‘opportunity to discuss’ their care needs and wishes, and had read and signed to confirm that they agreed with the information written in their care plan. Time was spent with a resident reviewing the information written in their care plan, which the resident felt gave a true reflection of their needs. During the inspection, staff were observed to address residents politely, using their preferred first name, or surname. Residents, said that staff ensured their privacy and dignity was maintained whilst receiving personal care. However, 1 resident had commented on their survey that ‘carers should ensure that there is no loss of dignity to the residents’. No other information was given, including the name of the person completing the survey, so the inspector was unable to follow up the reason they felt this way. The home uses a commercial monitoring dosage system to dispense medication, which is supplied from the local pharmacist. The home has a good working relationship with the local pharmacist, who has been undertaking a review of all residents’ medications. This is to ensure that residents are on the most suitable medication for their ailment. Barking Hall Nursing Home DS0000037085.V316538.R01.S.doc Version 5.2 Page 12 Medication is held securely in a locked room, with restricted key access. Trained nurses are responsible for giving out medication. A random audit check of 3 resident’s medications identified shortfalls in 2 out of the 3 residents records, which had not been completed accurately. The home was asked to look into the situation, which they did, confirming that the residents concerned had been given or offered their medication. The error had occurred where staff had not signed, or entered the required code on the resident’s Medication Administration Records (MAR), to confirm the resident had been given, or refused the medication. The temperature of the drugs fridge was being checked daily. However, on inspection the fridge held an open yogurt pot. Once it was pointed out, staff removed the pot straight away. This led to discussions that although the resident may be taking yogurt with their medication, to stop cross infection it was good practice to store food and drug items separately. Time spent with 1 resident evidenced their concerns, that their medication was not always on time, and they discussed the physical side affects they felt if not given within the set time scale. Discussions with staff confirmed they were aware of the situation, however the delays may have been caused when using Agency staff who were not aware of the timings of the medication. The home has safe systems in place, backed by policies and procedures for the safe storage, administration, recording and disposal of medication. A random audit check of controlled drugs held, against the amounts listed in the control drugs register was found to be correct. Staff were aware that medicated skin patches, used for pain control had to be made ‘inactive’ after being used (by folding the sticky sides together), before being disposed of. Barking Hall Nursing Home DS0000037085.V316538.R01.S.doc Version 5.2 Page 13 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are offered a choice of nutritiously balanced home cooked meals, using fresh ingredients. People can expect to take part in a range of activities, which are being developed to meet individual residents requirements/interests. EVIDENCE: Residents completing CSCI surveys were asked if they felt there was enough activities arranged by the home, for them to take part in. Five replied ‘Always’, 5 ‘usually’ and 3 ‘sometimes’. However, 1 resident identified that ‘in the last few weeks the home has started to organise some very welcome activities –before this there was nothing’. Another resident said that an ‘activity programme for each patient, twice a week’ had recently been organised. The inspection identified that changes had recently taken place, as the home now had a dedicated activities co-ordinator, currently working 15 hours a week, but this will be increased as the home reaches full occupancy. The introduction of the activities co-coordinator (trained by Healthcare homes) is part of the new owners commitment to ‘provide activities linked to residents’ particular interests or life experiences’. Barking Hall Nursing Home DS0000037085.V316538.R01.S.doc Version 5.2 Page 14 As well as the residents, staff praised the new activities programme, and activities co-coordinator, saying “people we thought would never socialise” were attending the different activities now. These included a tea party which the local Brownies were invited, a talk from the RNLI, and a ‘sweet tasting’ session. Social sheets held in the care plans, evidenced what in-house activities residents had attended. The manager confirmed, that although the activities coordinator was an excarer, they would not be removed from their role to cover care shifts. The leaflet supplied to residents by the new owners, gives an insight to how the home’s activities will develop, and what will be on offer. This included ‘Pamper days’, Musical concerts, exercise, reminiscence, arts and crafts, poetry sessions, games and quizzes, In-House clubs, and exhibiting local artists work at the home. Feedback from residents also identified work undertaken by staff to enable residents to keep in contact with relatives at other care establishments. Residents are encouraged to bring in their personal belongings and make their room their own. Lockable facilities in the bedrooms, encourages residents to look after their own money. Residents asked through the CSCI surveys if they liked the meals provided by the home, 3 replied ‘always’, 8 ‘usually’ and 1 ‘sometimes’. One relative also praised the standard of food saying that they could ‘hardly stop’ their next-ofkin ‘from eating’. One resident had mixed feelings over the standard of food, their comments included ‘cooks are always helpful, especially over diet, but the vegetables are often hard. There are a lot of packaged things – cabbage every day for months. Frequently run out of bananas – there are too many sweet things and not enough fruit’ ‘vegetables so monotonous’. Time spent with the Cook and a look at the food stocks held, showed that the home cooks their food from fresh, and had fresh fruit and vegetables delivered twice a week. The only vegetable not to be purchased fresh was peas, which were frozen. The Cook confirmed that they did not get too many bananas in at a time, “as they go off too quickly”. However, if they did run out before the next delivery they would “go out and buy some”. Menus seen, showed that residents are offered a fresh fruit salad daily, as 1 of the alternatives to the other desserts, and a bowl of fresh fruit is kept at reception, which residents can help themselves. The menu showed that cabbage was quite regularly on the menu, but not every day, and there was also other choices including cauliflower, leeks, swede, peas and parsnips. The home’s own quality assurance questionnaire, which is to be carried out during November, also asks residents about the catering at the home, which will enable staff to monitor if the resident’s concerns have been/or still need to be addressed. Barking Hall Nursing Home DS0000037085.V316538.R01.S.doc Version 5.2 Page 15 To obtain residents choices for lunch, the Cook goes around and visits each resident during the morning, and if they do not like the main choice that is on offer, they will discuss an alternative. The main choice for lunch on the day of the inspection was Chicken and Mushroom Casserole. Residents were given a choice of wine or fruit juice with their lunch. The atmosphere in the dining room, was relaxed, with staff offering assistance discreetly as required. Residents were offered homemade cakes with their afternoon tea at 3pm. One resident said that they liked to “keep theirs back for supper time”. Relatives also commented that staff always provided tea and biscuits for the resident’s visitors, which was appreciated. For the evening meal, residents were seen to be served, Asparagus soup, Tuna Pasta Bake, and/or sandwiches, with a choice of dessert. Trays were seen to be taken to the bedroom, which were well presented and looked appetising. The meal is served from 5.30 to 7pm, depending on the resident’s wishes. Residents are asked to select their choice for breakfast during the afternoon, which can includes a “full English Breakfast and Kippers on request”. Residents spoken with said they “enjoyed the food” and had no complaints. Barking Hall Nursing Home DS0000037085.V316538.R01.S.doc Version 5.2 Page 16 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have access to a robust, effective complaints procedure, are protected from abuse and have their legal rights protected. EVIDENCE: All but 1 of the residents surveyed, knew who to talk to if they were not happy and wanted to complain. Residents spoken with during the inspection, said they would raise any concerns with the staff or Matron direct. The new Statement of Purpose and Residents guide gives information on the home’s complaint procedure, including who to contact, and that all complaints will be dealt within 28 days. The Residents Guide also gives information on ‘Civil rights’, and that the manager can supply information on advocacy services. Residents are informed that they are able to inspect records relating to them at any time. The guide does not give information on how residents will be able to vote in political elections, however previous inspections identified residents can undertake this through a postal vote or in person. Training records seen, confirm that staff undertake ‘Abuse awareness’ training as part of their induction, and attend further refresher training on a yearly basis. Staff had obtained the written consent from residents, or if unable to understand what is being asked their representative, before using safety aids which can restrict freedom, such as bed sides. Care plans also showed the use Barking Hall Nursing Home DS0000037085.V316538.R01.S.doc Version 5.2 Page 17 of ‘body charts’ where staff record any bruising, marks or wounds, as part of their protection policy. Any unaccounted bruising would be recorded, investigated, and if concerns were raised on how they sustained the injury they would contact the vulnerable adult team. Barking Hall Nursing Home DS0000037085.V316538.R01.S.doc Version 5.2 Page 18 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, 23, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service can expect a clean, safe, comfortable and homely environment to live in, which has been furnished and maintained to a good standard. EVIDENCE: The tour of the home identified that the new bedrooms and communal lounge/diner had been furnished and decorated to a high standard. However, the older part of the building’s décor was showing signs of wear and tear. Staff said this was being addressed as part of the ongoing refurbishment with bedrooms being redecorated, and new carpets fitted in the corridors. This reflected 1 resident’s comments who acknowledged that their bedroom was in need of redecoration, however this was shortly to be addressed. Since the last inspection, the home has increased their registration to allow for the upstairs bedrooms being completed, and made available for new residents. Barking Hall Nursing Home DS0000037085.V316538.R01.S.doc Version 5.2 Page 19 The new bedrooms have been furnished to a high standard, with matching wardrobe, chest of drawers, bedside table and over-bed table. Soft furnishings are co-ordinated and of a good quality. Plasma televisions and self-adjusting beds come as standard, and there is also Internet and telephone facilities. All bedrooms have en-suite facilities, including a shower, and storage facilities. It was noted that the mirror in the bathrooms are only suitable for use by residents when in a sitting position, however staff said that residents normally sit down to wash. They were asked to monitor the situation, to ensure the position of the mirrors suits individual residents needs. Residents spoken with, said that they liked the new bedrooms, which were light and airy. The first floor lounge/diner in the new build is comfortably furnished to a high standard, looking out onto the new courtyard, and glass walkway which links up the old, to the new build. The new build also has assisted bathrooms, medication room, laundry, hairdressers, and nurse’s station. At the time of the inspection, building works was still being completed, which when finished, will include a new kitchen, lounge, office and staff training room. All areas of the home visited, were found to be clean, and staff were observed to be following safe infection control procedures. Washing machines had a sluice cycle, and soiled clothing/bedding were washed in specialist bags. Disposable gloves, aprons, liquid soap and paper towels, also formed part of the staff’s infection control procedures. Where an unpleasant odour was detected, this was due to a resident’s physical health, and action was taken by staff to eliminate the smell, and to ensure the dignity of the person concerned. Residents completing the CSCI surveys were asked if the home is kept ‘fresh and clean?’, confirmed that the standard found during the inspection, was up to its usual standard. This was also reflected in relative’s comments’ saying it was ‘so good that relatives from abroad and numerous friends of (the resident) have commented on it’. During discussions with residents, no concerns were raised over the home’s hot water temperatures, heating or lighting. Residents were seen to freely move around the home, using the passenger lift as appropriate. Residents had access to the internal courtyard, which has raised sensory flowerbeds, seating areas and designed for wheelchair users. Barking Hall Nursing Home DS0000037085.V316538.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service can expect to be cared for by trained, skilled staff in sufficient numbers to fill the aims of the home and meet the changing needs of residents. EVIDENCE: The staffing levels for the home are being increased to reflect the rise in occupancy. The minimum staffing levels being maintained at the current time (as given in the Statement of Purpose) are: • • • 2 Registered Nurses, 1 senior and 6 Care Assistants in the morning 1 Registered Nurse, 1 senior and 4 Care Assistants during the afternoon/evening. 1 Registered Nurses, 1 senior and 2 Care Assistants covering the night shift. Residents completing the CSCI survey were asked if ‘staff were available when they need them?’ 33 replied ‘always’ and 67 felt there were ‘usually’ enough staff. One resident had written ‘never once has there been a shortage’ however, this was not the view shared by 2 other residents. They felt the home was ‘short of staff’ which had resulted in them having to be ‘very patient’ when long waits occurred especially during ‘peak’ times. They felt more staff was needed, especially taking into account the home was ‘increasing’ in Barking Hall Nursing Home DS0000037085.V316538.R01.S.doc Version 5.2 Page 21 numbers. This was fed back to the Manager who confirmed that they had increased the staffing levels, to match the increase in occupancy. It was also acknowledge that since the CSCI surveys were sent out, staffing levels had been increased. The manager said that they did not see maintaining staffing levels as a problem, as they would use agency staff to cover any shortfalls, such as on the day of the inspection. However, they did feel that some staff, when using agency carers, viewed this as being short staffed, and may have expressed these comments in front of residents. They said this had been a discussion point during staff meetings. Feedback from relative surveys, showed that 7 felt that there was ‘alwayssufficient numbers of staff on duty’, 2 had written usually, and 1 relative did not feel there was enough staff. When it was raised that none of the staff had taken the opportunity to complete and return the CSCI comment cards, the management felt that this was because staff did not have any problems, or concerns that they needed to raise with the Commission. During the inspection staff were observed to answer the call bells within a short timescale, although 1 resident raised concerns that their medication was not given on time (see Health and Personal Care section). Other residents spoken with confirmed that they felt that there was sufficient staff, and they received the level of support they required. The home is in the process of undertaking their own Quality Assurance audit, which asks residents their views on staffing levels. Information gained from the survey will be used as part of the home’s on-going monitoring of staffing levels, and as stated in their Statement of Purpose ‘the numbers of full and part time staff will increase as the new floor becomes occupied and will be reviewed on a monthly basis’. At the time of the inspection, 12 out of the 25 Care Assistants had obtained a National Vocational Qualified (NVQ) award, 8 at level 2, and 4 at level 3. With a further 3 staff booked on a NVQ course, the home aims to ensure they keep above having the required 50 of their staff qualified to NVQ 2 or above, to allow for any changes in staff. Healthcare Homes group Ltd employ their own dedicated training staff, who keep in close contact with the home to monitor staff’s training needs. This supports the home in organising training, to ensure new staff receive a full induction, and all staff receive refresher training as required. Training records of new staff showed the training courses they had attended, and ongoing assessment of their work during their probationary period. Feedback on staff’s abilities and skills, both verbally and through surveys was positive. However, during discussions with 1 resident, they raised concerns that they felt 1 member of staff, did not have sufficient understanding in the needs of residents with Parkinson’s Disease. They felt that this was reflected in their care practice and attitude, which did not allow for their fluctuating, physical abilities, associated with Parkinson Disease. This was fed back to the Senior Nurse on duty, who said they would look into the situation, and take any appropriate action required. Barking Hall Nursing Home DS0000037085.V316538.R01.S.doc Version 5.2 Page 22 Training records covered the mandatory Health and Safety training, however specialist training such as on Parkinsons Disease was not seen on the list. Staff confirmed that although the on-going training plan did not show this training being undertaken, the manager can request this as part of individual staff development, and on-going training needs. To monitor that the home is following safe recruitment practices, 3 staff records were looked at. This showed that work was being undertaken to validate new staff’s identity, with Criminal Bureau Checks (CRB) being undertaken. Written references had been obtained for 2 of the 3 staff, before they commenced employment. One member of staff’s file showed that they had commenced employment with 1 written and 1 verbal reference. Staff said the delay had occurred, as the person giving the reference did not want to send the written one, until they had obtained the applicant’s sickness record. Records checked, identified that the home had not always been obtaining a full employment history, and validating reasons (where reasonably practicable) why staff had left previous employment which involved working with vulnerable adults. Good practice was seen with the use of recruitment checks lists, enabling staff to monitor all the required recruitment paper work had been received, and what paperwork had been sent to the applicant. This included offer of employment letter and a copy of the General Social Care Council code of conduct for care workers. Barking Hall Nursing Home DS0000037085.V316538.R01.S.doc Version 5.2 Page 23 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, 36, 37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service can expect a well managed home, were staff are committed to providing a safe environment and working in the best interests of the residents. EVIDENCE: The Registered Manager for the home is Mrs Patricia Smaldon. A qualified Registered General Nurse (RGN), Mrs Smaldon also holds a qualification in management. Discussions with staff throughout the inspection evidenced that they felt the home was well managed and they received a good level of support. Comments made included “very approachable, lovely, excellent – good manager”. Barking Hall Nursing Home DS0000037085.V316538.R01.S.doc Version 5.2 Page 24 This reflected comments made by residents and relatives, not only for the manager – but for all staff. Who they found were approachable and friendly, which enhanced the atmosphere of the home. Time spent with Nurses, catering and maintenance staff, identified that the home had a clear sense of direction and leadership. They felt comfortable to voice their opinions direct to the management who they said would listen. This was the reason staff felt that they had not completed the CSCI feedback cards, as they had no concerns – although the inspector informed staff that the cards are used to evidence positive work being undertaken, not just for staff to raise any issues, anonymously if they wished. Although the home had, had a complete change of Directors, the take over had not affected the atmosphere of the home or staff morale. None of the residents raised concerns over the new ownership, instead praised the continuous improvements being made to the décor, and the introduction of a new activities programme. At the time of the inspection the home was preparing to send out their quality assurance questionnaires, which are sent out to residents, external agencies and staff. Copies seen, showed that questions asked covered all parts of the service provided. Staff are asked to give feedback on the level of support they are given, and ‘could you explain to someone who doesn’t work here , what the home is trying to achieve?’. The questionnaires will be sent out in November, and once the completed surveys have been returned they will be analysed, and the results made available for residents to read. Staff view the audit as a means to see how well they are doing, and to take action to address any concerns or suggestions made, as part of their on-going improvement plan. The owners continue to invest money into the home, with any building work undertaken carried out to a high standard. Although the home’s financial accounts were not looked at during the inspections, there have been no concerns raised to the CSCI over the home’s financial viability. Residents are encouraged to look after their own money, using the lockable facilities provided in their bedrooms. However, the home has systems in place for residents who request staff to hold their money in ‘safe keeping’. The system ensures money held is held securely with deposits and withdrawals being signed by a witness, and where applicable include receipts. A check of 1 resident’s money against records held was found to be correct. Systems are in place at the home to ensure staff receive regular supervision to support them in their role. Records viewed showed that care staff receives 2 monthly supervision, plus a yearly appraisal. New staffs training records also identified that they receive an ‘induction appraisal’ which gives them feedback on their work during their probation period. Nures and ancillary staff do not receive such regular supervision, but all receive yearly appraisals. Discussions Barking Hall Nursing Home DS0000037085.V316538.R01.S.doc Version 5.2 Page 25 with the Nurses confirmed that they had developed good communications links with the manager, and felt well supported. Records seen throughout the inspection were generally of a good standard, with 1 shortfall identified in the completion of medication records (see Health & Personal Care section). Policies and procedures looked at showed that the staff are given clear guidelines and training to support them in having the knowledge and skills to maintain a safe environment for residents. All new staff receive Health and Safety training as part of their induction training, which includes knowledge on manual handling, infection control, fire awareness and food hygiene. Training notices showed which staff had been put on to refresher courses, to update their knowledge. All accidents, injuries and incidents are record, and a copy held on the residents care plan, confirming what action had been taken to eliminate/ minimise the risk of a further incident reoccurring. ` Barking Hall Nursing Home DS0000037085.V316538.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 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 3 3 3 3 3 3 3 3 Barking Hall Nursing Home DS0000037085.V316538.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Not Applicable 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 OP9 Regulation 13 (2) Requirement Staff must complete residents’ medication administration records accurately. The home must obtain 2 written references and full employment history for staff before they commence employment in the home. Timescale for action 19/10/06 2. OP29 19 (1) schedule 2 (4) (6) 19/10/06 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 Refer to Standard OP8 Good Practice Recommendations Where manual-handling assessments states offer ‘minimal assistance’ the home should give further information on what is meant by minimal assistance. The home should ensure, as part of their medication polices and procedures, that food is not stored in the drugs fridge. 2 OP9 Barking Hall Nursing Home DS0000037085.V316538.R01.S.doc Version 5.2 Page 28 3. OP9 The home should ensure that all new and agency staff, are made ware of residents requiring medication outside the normal breakfast, lunch, tea and night time periods. To be more informative to the reader, the home should include a list of names and contact numbers for residents in the Residents Guide, rather than having to ask staff for this information. To be more informative to the reader, the home should include information on support given to residents to enable them to vote in political elections. The home should look at undertaking training for all their staff in understanding Parkinson’s Disease and how it affects resident’s daily lives. 4. OP17 5. OP17 6. OP30 Barking Hall Nursing Home DS0000037085.V316538.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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. Extracts may not be used or reproduced without the express permission of CSCI Barking Hall Nursing Home DS0000037085.V316538.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!