CARE HOMES FOR OLDER PEOPLE
Barking Hall Nursing Home Barking Nr. Needham Market Suffolk IP6 8HJ Lead Inspector
Helen Fontaine Unannounced Inspection 6th March 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.V285871.R01.S.doc Version 5.1 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.V285871.R01.S.doc Version 5.1 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 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Barking Hall Nursing Home DS0000037085.V285871.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 19th December 2005 Brief Description of the Service: Barking Hall is registered to provide care with nursing to 26 Older People. It is owned by the Pri-Med Group Ltd, 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 and a patio area between the original house and the next extension. The accommodation is partly in a converted domestic dwelling and an extension nearly completed right across the back. All the existing rooms are en-suite as are the new rooms, all of which comprise of a shower, toilet and washbasin. The communal spaces are still in the process of being developed, but currently there is an entrance hall, dining room and a lounge. The extension will include a walkway to link the home, enclosed courtyard and a new kitchen. Once the development and refurbishment has been completed, the home will be able to offer care for up to 40 service users. Barking Hall Nursing Home DS0000037085.V285871.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection of Barking Hall Nursing Home took place over five hours and was the second statutory inspection visit in the inspection programme for 2005/6. Over the course of the two visits, all core standards have now been assessed. One requirement was set at the previous inspection and was evidenced as being met. No new requirements or recommendation were given at this inspection. The Matron and the Responsible Individual were present during the inspection and their assistance with the inspection was very much appreciated. A number of residents were visited in their rooms, during the monitoring of medication and visitors were spoken to. A number of records were looked at and during the inspection staff were observed interacting with residents. What the service does well: What has improved since the last inspection?
At the last inspection the home received a requirement around the homes pre admission assessment. Files of the newest resident to the home were looked at and found that the homes form had been fully completed and documented with it was additional information from the hospital ward. This information does allow the home to identify that they can meet the needs of the proposed resident. Barking Hall Nursing Home DS0000037085.V285871.R01.S.doc Version 5.1 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. Barking Hall Nursing Home DS0000037085.V285871.R01.S.doc Version 5.1 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.V285871.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 People who use this service can expect to have their needs assessed before moving into the home. EVIDENCE: At the last inspection the home was given a requirement around the initial assessment and information being obtained before the resident moved into the home. At this inspection the files of three of the newest residents were looked at and found do be fully documented. The assessment looked at gave the home adequate information to indicate that they would be able to meet the needs of proposed resident. The initial assessment covered areas of basic information such as full name, date of birth, address, social history and health treatment history. The assessment had a dependency score, date of introductory visit and signature by the homes staff. Another section covered the nursing dependency, safe environment, able to maintain own safety, with four headings scoring 1-4. Mobility, personal hygiene, elimination, eating and drinking were scored as, 18 as high, 10-18 medium and 0-10 low. In addition to this information, the home had information from other professionals and one file had documentation from the hospital. Included in this information
Barking Hall Nursing Home DS0000037085.V285871.R01.S.doc Version 5.1 Page 9 was the daily record of the resident, for the whole time that they were in hospital prior to moving into the home. Barking Hall Nursing Home DS0000037085.V285871.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 Residents can expect to be protected by the home’s policies, procedures and practices for dealing with medication. EVIDENCE: During the inspection issues around medication were looked at, documentation around dependency levels showed that three residents were able to self medicate. Also seen were the risk assessments for these residents, it was noted that these are regularly reviewed. The inspector observed the member of staff during the lunchtime medication round. The home have a fully adapted medication room and all medication is taken round the home in a locked medication trolley. The member of staff had gone through the Medication Administration Records (MAR), to identify which residents needed medication. The bubble packs for the lunchtime medication were placed in the trolley, alongside any bottles of liquid and medication kept in the fridge. The medication room was then very carefully locked and the trolley was taken to residents who were in their rooms. The MAR sheet was then checked and it was noted that it documented the name of the resident, the room number and had a photo of the resident. The member of staff closed the trolley and then took the dispensed medication into the resident. The
Barking Hall Nursing Home DS0000037085.V285871.R01.S.doc Version 5.1 Page 11 member of staff stayed with the resident, checking that they had taken it and supported and encouraged them. It was noted that during this process the member of staff checked that each resident was well and in one case asked a member of staff help a resident to have a drink. Information was passed to residents during the process, one resident had been unwell and had their medication changed. They had finished the course of medication and the member of staff was able to inform the resident that the Doctor would be visiting that day. The member of staff encouraged all residents to be as independent as possible with their medication and it was noted how this member of staff gave each resident the time they needed. Barking Hall Nursing Home DS0000037085.V285871.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): This area will be examined in more detail in future inspections. These standards have been previously assessed as well met, and during the inspection no concerns were raised or noted. EVIDENCE: Although this area was not specifically inspected, it was noted during the inspection that there was a notice near the dining room that there was to be a resident/family homes meeting. During the inspection of staff files, it was also noted that home does have a volunteer working with residents in the home. Barking Hall Nursing Home DS0000037085.V285871.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Service users felt confident that the home’s management would take concerns or complaints seriously. EVIDENCE: This standard was explored quite thoroughly at the last inspection, however the complaints documentation was looked at again during this inspection. There were no more complaints documented in the complaints document and from the documentation around the quality assurance, there has been no documented complaints since 2004. During the inspection of one of the newest residents file, it was noted that there was a verbal complaint. The complaints were fully recorded and were investigated, with documentation about the contact with the family. It documented that staff had been spoken to and also some clarification from the conversation with the family. It was recorded that the resident was happy with the outcome. The inspector bought this recording to the notice of both the matron and the responsible person, who felt that it did not need to go through the complaints process. Residents spoken to all said that they felt that they did not have any complaints, one resident said there are always little moans but the staff would respond quickly to anything else. Barking Hall Nursing Home DS0000037085.V285871.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): This area will be examined in more detail in future inspections. These standards have been previously assessed as well met, and during the inspection no concerns were raised or noted. EVIDENCE: During this inspection some areas of the home were visited and found to be clean and hygienic. There was only one small area, where there was a slight stain on the floor. The matron indicated that medication was spilled and despite efforts to clean it off, it had left this stain. The matron said that this corridor was due to have all the carpets renewed, it was felt that it did not warrant a recommendation. Barking Hall Nursing Home DS0000037085.V285871.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 29 The home recruitment practices are robust and staffing levels are satisfactory. EVIDENCE: During the inspection the homes dependency classification form was looked at, although the matron did comment that they were due to do the form for February the day of the inspection. The home had for the month looked at six residents that were very high dependency. Four residents who had high dependency and six with medium. There were another six who had low and one resident who only had residential care needs of a medium dependency. The matron indicated that there were five members of care staff and one qualified member of staff on duty in the morning and three carers and a qualified member of staff on duty in the afternoon. It was opinion of the matron that these staffing levels, which do not include the kitchen, cleaning, volunteer or handyman is more than adequate. Three of the newest members of staff files were looked at and one of these files were the files of the volunteer worker. Noted on the files were the application form, identification, Protection of Vulnerable Adults (POVA) first check and the documentation around the Criminal Records Bureau (CRB) check. Barking Hall Nursing Home DS0000037085.V285871.R01.S.doc Version 5.1 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 and 38 People who use this service can expect to live in a home that is well managed with policies and procedures that protect their health and safety. EVIDENCE: The homes manager has been working in the home for sometime and is qualified and registered. It was noted on the feed back comments on the quality assurance document that there was 100 satisfaction with the matron as well as the staff. The quality assurance document comes from the Registered Provider, the Registered Provider sends questionnaires directly to the residents, families/carers and other professionals. There is also a questionnaire that is sent to staff, it was noted that whilst looking at the quality assurance audit that there was a very low return of questionnaires from the staff. It documents that this issue is being taken up with the companies training section for resolution.
Barking Hall Nursing Home DS0000037085.V285871.R01.S.doc Version 5.1 Page 17 During the inspection all the homes documentation around the health and safety were looked at. The documentation covered all the fire precautions and maintenance of fire equipment, plus the fire evacuation training. It also covered electrical maintenance, boiler, all equipment like hoists maintenance and the water temperature tests. It was noted here that the water temperatures were quite high and varied between 39° C to 51°C, this was mentioned to the matron and the Responsible Individual. The inspector did test with a thermometer at random a bedroom basin hot water and this was found to be 40° C, which was appropriate. Also looked at during the inspection with regard to the resident’s health and safety were the homes risk assessments. The risk assessments seen were for bed rails, falls, hot water and for residents who might be physically or verbally aggressive. There was also documentation for employer’s liability, fire log, lifts/hoists, pest control, fridge and freezer temperatures, food handling, accident book and first aid. It was noted whilst checking the documentation around health and safety that the home maintains good records and makes sure that their residents are kept safe at all times. Barking Hall Nursing Home DS0000037085.V285871.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 3 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 3 Barking Hall Nursing Home DS0000037085.V285871.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Barking Hall Nursing Home DS0000037085.V285871.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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