Inspection on 18/10/07 for Barley Close

This inspection was carried out on 18th October 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Barley Close 09/11/06

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 Barley Close Axminster Road Musbury Axminster Devon EX13 8AQ Lead Inspector Clare Medlock Key Unannounced Inspection 18th October 2007 10:00 Barley Close DS0000063867.V344558.R01.S.doc Version 5.2 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 Barley Close DS0000063867.V344558.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 Adults 18-65. 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. Barley Close DS0000063867.V344558.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Barley Close Address Axminster Road Musbury Axminster Devon EX13 8AQ 01297 552913 01297 553973 barleyclose1@tiscali.co.uk 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) Voyage Ltd Mr Nicholas John Phipps Care Home 10 Category(ies) of Learning disability (10), Physical disability (10) registration, with number of places Barley Close DS0000063867.V344558.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Learning disability, aged between 16 to 45 years on admission- Code LD 2. Physical disability, aged between 16 to 45 years on admission- Code PD The maximum number of service users who can be accommodated is 10. 9th November 2006 Date of last inspection Brief Description of the Service: Barley Close is registered to provide personal and supportive care for up to ten service users with a learning and or physical disability. The home is run by Voyage Ltd, which has a number of similar homes throughout the region. Barley Close is a large detached house situated just outside the village of Musbury, close to the town of Axminster. The home has extensive views of the countryside and hills and has large gardens and ample parking. The home is on two levels; the ground level has five en-suite bedrooms, a large conservatory, a lounge, dining room, kitchen, laundry room and sensory room. The second floor, which can only be accessed by people without mobility problems, has five en-suite bedrooms and two offices. Information received from the manager at the inspection indicates that current fees are from £1400 to £1950. Additional charges are made for transport and personal items. The previous inspection report is kept within the office and is available at request. Barley Close DS0000063867.V344558.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over six and a half hours during a weekday, starting at 9.30am. The registered manager was present throughout the time. Some of the people living at Barley Close have limited verbal communication skills. They were therefore unable to contribute verbally to the inspection process. Time was spent with all people at the home and observations were made during the inspection. We took an ‘expert by experience’ to this inspection. An ‘expert by experience’ is a person who, because of their experience of either using services or their ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The ‘expert’ spent time, spoke with and had lunch with the people living in the home. Prior to the inspection the manager completed a questionnaire, called an AQAA (Annual quality assurance assessment), which provides information about service users, staffing, fees and confirms that necessary policies and procedures are in place. Before the inspection we also sent out questionnaires to the people living in the home, their families and health care professionals. We received 6 questionnaires from people who use the service. Three questionnaires from relatives, two from health care professionals and five from staff. A small number of staff and relatives also chose to speak with us before the inspection. All this information gives us a picture of what it may be like at the inspection and helps focus the inspection on what matters to the people who use the service. On the day of inspection we “case tracked” two people who use the service. This means the inspector spoke with staff about individual care, read the persons records and made observations if the person was unable to speak with us. We looked around the building and other records were inspected. These included, fire safety logbook, maintenance records, staff files, medicine records, complaint records, care plans, communication books and other work books. Barley Close DS0000063867.V344558.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The information (Statement of Purpose & Service User Guide) provided to people who are thinking of moving into the home and their relatives has been updated to ensure the information is accurate. There is now information to say that more suitable locks to a person’s room will be provided if necessary. Barley Close DS0000063867.V344558.R01.S.doc Version 5.2 Page 7 The manager now ensures that all staff read all information prior to a person being admitted to the home. This means they understand the needs and risks of people before and during admission to the home. Information on a persons care plan & risk assessments are more detailed to ensure staff are provided with clear guidelines on how to meet needs safely and consistently. The care plans are now beginning to reflect or encourage a more independent approach. Any decisions made on behalf of a person that may infringe on their freedom of movement, choice or privacy are now discussed and agreed within a multi-disciplinary setting. This now shows that such decisions are made in the best interests of the person and are recorded, monitored and reviewed regularly. The medication system has also been improved with the introduction of a policy relating to “over the counter” medicines. Handwritten entries on medication administration sheets are now checked and signed by two people to ensure entries are recorded correctly and further storage cupboards are available which could be used for controlled drug storage. What they could do better: People who use the service must be safe at all times and must have their needs met. The Provider and Manager must ensure there are enough staff on duty to meet the ratios agreed before someone moves into the home. In addition to this, ratios must be sufficient enough that other people’s needs are not neglected when the acceptable number of staff are caring for another person. The manager should keep the Commission for Social Care Inspection informed if staffing levels have the potential to affect the well being of people at the home. The organisation needs to investigate this issue further. Staffing levels must be such that means people who use the service are not restricted in making decisions about their lives, choices about what they do or attending preferred leisure activities. The manager should also make sure enough staff are provided so in house activities can be provided whilst maintaining safe staffing levels. The Provider must ensure that managers have sufficient time to perform administration duties and complete records within the working day. This will help the smooth running of the business and mean that care needs can be communicated more effectively. Care Plans must reflect the care that is given and be used as a working document to help communication and promote consistency for the people who receive care. Communication can also be improved by providing opportunities for staff and resident meetings where people and staff can voice their concerns and Barley Close DS0000063867.V344558.R01.S.doc Version 5.2 Page 8 communicate new ideas, which may improve the quality of life for people at the home. The manager must remember that it is his responsibility as registered manager to ensure evidence is kept in the home of pre employment checks performed on staff. Keeping evidence in the home will show that staff employed have had all the necessary checks performed. This must include two written references and details of the level the police check that has been performed. The manager should continue with the planned programme of changes, which will improve information for new people moving to the home and protect them. This should include changes to the Statement of Purpose and Service User Guide to include details of what people can expect from the home if they are under the age of 18. The manager should also continue performing additional child police checks on staff now people under the age of 18 are cared for. Work on information regarding the needs of people and how to safely care for them should also continue so staff have enough information in an emergency or if a person is admitted to hospital. 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. Barley Close DS0000063867.V344558.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Barley Close DS0000063867.V344558.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 4 and 5. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Good admission practices means that people can be assured that their needs can be met by the home. EVIDENCE: The home has a Statement of Purpose, which sets out what services the home provides. A summarised and easier to read version is produced people who use the service (Service User Guide). Improvements to the Statement of Purpose have been made and now include details that suitable locks would be provided if coded keypads were not suitable to meet someone’s needs. The manager told us he is also planning to change the Statement of Purpose and Service User Guide to include information for people in the home who are under 18 years old. The process of a person moving into the home is a gradual process. Information is gathered prior to moving to the home. Staff take time to visit the person in the setting where they spend most time. This can be their home or current work or day care placement. Staff get information from parents, health care professionals and other sources before agreeing to offer the person Barley Close DS0000063867.V344558.R01.S.doc Version 5.2 Page 11 with ‘transitional visits’ where they can get to know other people living at the home. Staff at Barley Close then complete their own assessment which covers all areas of need, ranging from health, emotional, mobility, dietary, spiritual, likes and dislikes and much more. Staff then sign to say they have read this assessment. All three relative surveys stated that enough information is received to help make decisions. People who use the service completed questionnaires before this inspection took place. Of the seven questionnaires four said they were asked if they wanted to move to the home. One person had been unwell, one had moved to the home quickly, one person could not answer the question and another said the care manager had found the place at Barley Close. Five of the people who filled in the questionnaire said they received enough information before moving into the home. Comments included ‘My mum had lots of information and I came to stay several times before I moved in’. Staff told us about the transitional work that is completed before someone moves to the home. The Manager explained that the move is kept under review and gave specific examples of this. One comment from a relative read ‘I would like you to thank the staff for making my daughters transition to a residential home so smooth and their friendliness to me in making me worry less about my daughter.’ Barley Close DS0000063867.V344558.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Staff are provided with information to help them to meet the needs of the people who use the service, but improvements to the care plans are needed to ensure their needs are met safely and consistently. The decisions made are not always those of the people who use the service. EVIDENCE: One person told us that daily records are written about them and that staff talk to them about their care. But that they cannot always do what it says or what they want to do because there are not enough staff. Barley Close DS0000063867.V344558.R01.S.doc Version 5.2 Page 13 Two people recently admitted to the home did not yet have a care plan written although pre admission assessments had been written and daily notes recorded. Two care plans that had been written described individual needs and provided some action that was necessary to meet the needs. Hazards to service users were assessed with action on how to reduce any risks. Not all people had a formal care plan although daily sheets, workbooks, handover books and communication books are used to communicate information. One member of staff said that when they come on duty the senior staff ‘fill them in’ on the changes and then it is up to them to read the rest of the daily sheets and communication books for the days that they have been away. This potentially has the risk that information relies on verbal communication and may not be accurately passed on. Staff told us that keeping records has not been the main priority in recent months because of lack of time. Senior staff told us they have had to work with the people who use the service, which means that some documentation, care plans and records have not been updated as much as they would like. All staff were very knowledgeable about the needs of the people they care for and the standard of care seen throughout the inspection was high. However the care plan is not a working document and it did not reflect the care that was seen. An example of this was that staff were aware that one person has a particular cup, which triggers their anticipation for bedtime. All staff were aware of this need but care plans did not clearly show this. Staff told us that on occasions they have not been supplied with enough information when escorting a person to hospital. The manager told us he has started to devise an information sheet, which could be used for this purpose. Health care professionals confirmed that the home communicate with care managers. One comment included ‘I have visited Barley Close to review the care needs of my client who had been placed there. I have received correspondence from the home which supports may clients care needs, which involves other healthcare professionals.’ Relative questionnaires told us that staff communicate well with families and keep them informed of changes in care and appointments. Care Plans did not reflect this, although parental communication sheets are used to record information shared with families or representatives. One comment included ‘They always inform me of any appointments and because she can’t talk they Barley Close DS0000063867.V344558.R01.S.doc Version 5.2 Page 14 let me know how she is’ Another comment read ‘They give a very high level of care and all staff seem very friendly and caring towards her’ and another comment read ‘The manager and deputy manager make a real effort with parents to make them feel that their opinion is important and a part of my daughters care plan.’ Seven people who use the service completed questionnaires, which stated that they could always make decisions about life at the home. One comment included ‘I can not always go out because there are not enough staff’ A relative told us that they were happy with the care their relative receives but the staffing had been so low that trips out had been limited which was not under their control. We saw that some care plans stated that some people needed two staff to care for them, and three in the event of seizures. Staff told us that, at times, when a third member of staff has not been available, some people were expected to wait outside the room to prevent them from harming other people at the home even though this would not be their decision. We looked around the home and saw that the kitchen door was propped open and freely accessible by all people living in the home. One person told us that he knows the code to his door but chooses not to use it. Other people were also seen to have free access to the home, although this depended on their mobility. Areas around the home had adaptations, which also supported people taking risks whilst being protected as much as possible. One example included promoting privacy and freedom of movement but providing padding for furniture edges in case of seizures. Barley Close DS0000063867.V344558.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 14, 15 16 and 17 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Opportunties for personal development and social activities are limited due to inadequate staffing arrangements. Dietary needs are managed well. EVIDENCE: The feedback we received from people who use the service, their families, care professionals and staff was that the home are not providing enough social activities in and out of the home and that sometimes daily routines are restricted purely because of low staffing levels. The expert spoke with one person who said that sometimes they were not able to make choices because of lack of staff. Barley Close DS0000063867.V344558.R01.S.doc Version 5.2 Page 16 Examples of good practice were shared regarding activities. One person told the expert that they go for hydrotherapy on a Monday and that when they have more staff he will do some voluntary work. The person told us they used to go horse riding which they enjoyed but had not been for ages as they do not have enough staff at the moment. We were also told people at then home also go to a local centre, which has day and evening activities. One person told our expert that they had a pen pal who lives up north and that they go to the pub to play pool, goes to the gym and also plays basketball and tennis. People at the home told our expert that inside the home one person likes to play DVD games. One person told us that they have voice coaching lessons and loves music and singing. A while ago the home organised a Stars in their Eyes evening and invited people from homes nearby. On the day of inspection people were preparing for a Halloween party by making paper mache masks. The deputy manager told us she is planning to look at work opportunities for some of the people living at the home and gave an example of dog walking for those people who love dogs. A person at the home told our expert that this was being arranged People who use the service told us in their questionnaires that they sometimes or never had a choice in their activity programme or support to maintain links with the community. One comment received was ‘There are not enough staff on and not enough drivers’. Another person told our expert that their privacy is respected and they are able to make decisions. This person showed the expert their new clothes and necklace they were wearing which they had chosen them self. Both people, when speaking with our expert were accompanied by staff. The expert confirmed that one person was hard to understand so the key worker stayed to explain what the person was saying. Our expert said the keyworker did not influence what he wanted to say. Another person wanted a staff member with him. The expert felt the staff member did not ‘but in’ or influence the persons answers to the questions asked. One person told the expert he was unhappy at the home because he had a specific interest and had not been helped to fulfil this interest since he had been at the home. The manager confirmed that this feeling was known and a review had been arranged to discuss the person’s feelings. Barley Close DS0000063867.V344558.R01.S.doc Version 5.2 Page 17 Staff told us that some daily routines had been affected because of low staffing. Examples of this included getting some people up earlier than they wanted to or got ready for bed earlier to ensure they were cared for safely by the right ratios of staff. All staff spoken to before and during the inspection told us that activities had been limited because of low staffing levels and inability to meet staffing ratios. Staff told us that this was beginning to change. People who use the service told us that they could keep in touch with their family. Care records had a section on family contact, where staff recorded, visits and telephone contacts. Relative questionnaires and relatives at the inspection told us that they are happy with the care, and pleased with the support provided to make sure people keep links with their family but that low staffing levels has meant that people can not go out as much as they would like. One comment was ‘I am not sure of the activities on offer to someone who is quiet and likes to stay indoors’ Staff questionnaires told us that the home needed ‘more drivers’, ‘more staff to do the things they should be doing’ ‘more in house activities’ and a new bus with a tail lift’. One comment read ‘We know that she would like to go out more because she stands by the door’ Senior staff gave specific examples how people are supported in relation to their preferred individual sexual preferences. Good examples were explained where staff are acting as advocate for the person providing appropriate support where needed. Records showed that the preferences and requests of the person are followed with appropriate involvement from the family. We joined people and staff for lunch this was chicken, mashed potato and peas, which everyone seemed to enjoy. Menus demonstrated a varied, healthy and balanced diet is provided. Fresh fruit was offered at lunchtime and plenty of bowls of fruit were seen in the kitchen. One person told us that alternative choices are available on request if they do not want what is on offer. The main meal tends to be at lunchtime although the staff and manager said this could be flexible to suit service users’ needs and activities. Our expert confirmed that both people they spoke with they could have drinks and food whenever they want. One person told us they could use the kitchen by them self and they know the code to get in if the door is shut. Barley Close DS0000063867.V344558.R01.S.doc Version 5.2 Page 18 At lunchtime our expert said that people who use the service were served first and if they needed anything the staff would see to them straight away. Staff were seen to interact very well with people who use the service. All staff emphasised that the recent staffing levels were having a detrimental impact for the people in the home and had worked hard to cover shortages. Barley Close DS0000063867.V344558.R01.S.doc Version 5.2 Page 19 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Persons’ dignity and privacy is respected and they benefit from their health needs being closely monitored and met. The excellent management of the medication practices protect the person’s health and welfare. EVIDENCE: People who use the service were observed receiving support in a respectful manner. One person told us that if they did not want a bath or shower staff did not force them to do this. Staff told us that sometimes gentle prompting was required to encourage people to keep clean. People are able to choose their own clothes and hairstyles and reflected their preferences and personalities. Senior staff were able to give specific examples of this, which showed they support all requests and needs. Care plans described the preferences of people in relation to being moved and supported. These are supported by manual handling assessments. This ensures Barley Close DS0000063867.V344558.R01.S.doc Version 5.2 Page 20 that staff are aware of how to move someone correctly, therefore protecting their safety. Staff at the home maintain good communication links with the local General Practice, who acknowledge that not all people living at the home are able to attend the surgery. The GP attends the home when requested to reduce distress fro the person. Feedback from a GP was good. Comments included ‘This seems a first class home’ Care Plans detail the healthcare needs for the person and contain correspondence with healthcare professionals. Feedback from relatives told us that they are informed of changes in healthcare where appropriate. Care plans also showed that specialist needs are discussed with other healthcare professionals and in some cases good practice committees where parental agreement is not approved. None of the people living at the home were able to self medicate although staff told us they could adapt their service to provide this if appropriate. The majority of people at the home are not able to provide obvious consent to their medication, however staff were knowledgeable about the ‘triggers’ that mean people are aware that they are taking their medicines. An example of this was knowing that one person only took their medications with a cup of tea. The management of medication at the home was excellent. Records of medicines entering and leaving the home are kept on medication administration records and separately. Copies of repeat prescriptions, patient information leaflets and homely remedies are stored but have easy access for quick reference. The administration of medication is well controlled with each person having an emergency prescription and a named box of medications already prepared to administer in the event of any predicted emergency. Storage and stock control was very good with one person being responsible for the storage of medications. There are cupboards provided for suitable controlled drugs storage. New cupboards had been purchased since the last inspection. The medication supplier has also changed because of the ability to provide monitored dosage systems, which are more appropriate for the people who use the service. Staff who are responsible for the administration have received medication training. In addition to this the majority of staff have been trained in the specialist administration of sedatives in the event of seizures. Barley Close DS0000063867.V344558.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Good systems are in place to make sure people and their relatives will have their complaints dealt with appropriately. Systems are in place at the home to protect people from potential abuse. EVIDENCE: The majority of the people we spoke with told us they like living at Barley Close, are well cared for and that staff treat them well. One person told us that although they did like living at Barley Close and that they were well cared for, he did not always feel safe because of other people in the home. This person gave us a specific reason why this was. The Manager told us this was being dealt with. The questionnaires people completed either stated that staff always treated them well. Where people were helped filing in the questionnaires this was left blank. One comment read ‘I do think she is treated well but am not sure this is her opinion’. Barley Close DS0000063867.V344558.R01.S.doc Version 5.2 Page 22 Relative questionnaires stated that staff were very friendly and caring. One comment included ‘Staff at the home try hard to find time to chat to us and show great concern for the well being of the residents’ All relatives spoken to knew how to make a complaint. All felt confident that it would be dealt with properly. People who use the service told us that they would speak to someone if they were unhappy. Staff told us of ‘signs’ they used if someone was unhappy. All staff spoken to said they knew who to report allegations of abuse to. All staff knew of the different types of abuse and had received training in the protection of vulnerable adults. The manager told us that they are caring for a person under the age of 18 and are in the process of repeating police checks to include the protection of vulnerable children register and have been arranging child protection training. The Commission for Social Care Inspection have not received any formal complaints regarding Barley Close since the last inspection. However, two members of staff and one relative contacted us prior to the inspection to communicate their concerns about poor staffing and the impact it has had upon the people who use the service. Examples of this were getting people up earlier than they wanted because of staffing numbers. The manager and deputy manager confirmed that staff had informally and formally raised concerns about inadequate staffing and the unsafe practices in the home. Records showed that the manager was able to raise these shortfalls with the operations manager who has now authorised the use of agency staff. Discussion with staff on the day of inspection confirmed routines of getting people up earlier than they wanted is improving with the introduction of appropriate staff numbers. The Manager and deputy manager have received two complaints. One from a relative was dealt with appropriately and had a summary, which would be useful to monitor any trends. The other was from a member of staff, which highlighted staffing levels, which did not meet the needs of the people at the home. The manager showed letters he had sent to the operations manager highlighting the inadequate staffing levels. The finances of people at the home are well managed. Some relatives maintain apointeeship and provide the home with monies when necessary. Voyagers Ltd are appointees for some of the people at the home. Fees are paid directly to the company and personal monies are managed through individual service Barley Close DS0000063867.V344558.R01.S.doc Version 5.2 Page 23 users’ bank accounts. Staff told us that records of all financial transactions are kept with receipts, but these were not inspected on this visit. Barley Close DS0000063867.V344558.R01.S.doc Version 5.2 Page 24 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,29,30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People live in clean, safe and comfortable surroundings that meet their needs. EVIDENCE: The people who use the service appeared comfortable in their home. The people at the home on the day of inspection had access to all areas of the home. Appropriate door openers were available on fire doors that were propped open. Track hoists were available for all ground floor rooms. These would be able to transfer a person from bed to bathroom whilst maintaining privacy. Equipment was seen in rooms that provide privacy but ensure safety for the person. This equipment included pressure mats and movement sensitive mats to ensure a person can stay in their room alone but have facilities to alert staff if the person has a seizure. All bedroom doors are fitted with coded keypad locks. One person told us he knows how to use the door pad but other people at the home would probably Barley Close DS0000063867.V344558.R01.S.doc Version 5.2 Page 25 be unable to operate these small keypads. The manager told us the Statement of Purpose now states that suitable locks would be fitted if necessary. The home has a large lounge with a sensory room, a large dining room and a large conservatory. The lounge and conservatory have a TV and music system. This enables people to get away from each other if they choose but still have the same facilities. The kitchen area is of medium size and has a “training” kitchen to the side of it. There is a keypad lock to the kitchen but this is propped open with an appropriate device. The standard of decorations and furnishings throughout is excellent, creating a warm, friendly and homely atmosphere. There is a large paved area outside and ramps to all entrances of the home and gardens to enable people who use wheelchairs or those with poor mobility easy access. The manager told us there are no current sleeping facilities for staff, as both staff are awake for the night shift. The manager told us there would be space for this if it were needed. On the day of the inspection the home was warm, bright and clean. A separate laundry room is provided with hand washing facilities. Barley Close DS0000063867.V344558.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Although people who use services have confidence in the quality of staff that care for them, staffing levels are poor and mean that people are sometimes at risk. Recruitment procedures are sometimes inadequate which means that people may potentially be placed at risk. EVIDENCE: The people and relatives we spoke with all said staff were kind and caring. Comments included ‘The staff are very experienced, friendly and caring’ and ‘the staff really understand the needs of my daughter’ One person told our expert that the staff are good but there are not enough of them. Staff seen on the inspection were professional and provided appropriate support. The expert noted that one person had to be with a member of staff Barley Close DS0000063867.V344558.R01.S.doc Version 5.2 Page 27 at all times. The staff member didn’t make it obvious they were always with this person. The person and the staff member seemed to be relaxed in each other company. Staffing levels do not meet the needs of the people using the service, with the health and welfare of people sometimes being affected. Records showed that at one stage staffing levels were approximately half of those that were required. Staff told us that the impact of low staffing levels has meant that routines for people at the home have been restricted. In addition to this, activities outside the home have been stopped and often the day-to-day routines places people at risk. Examples seen include the need for some people needing 2:1 or 1:1 care which means that when 2 staff are caring for one person other residents have been left alone or placed at risk. All staff told us that poor staffing was their main cause of stress in the workplace and all shared ways in which the lives of people who use the service were affected. One person said their frustration had caused her to consider leaving the home. Staff told us they had tried to cover shifts for each other and that many had done overtime but staff were now tired which was reflected in sickness levels and the numbers of staff leaving. The expert said there seemed to be a big problem with not enough staff and were told that the manager is working to get more staff. The staff told the expert that they have a lot of ideas for the people who use the service and that when more staff are available there will be more choice and more places for the residents to visit. Staff spoken to all knew what their roles were and told us they had received an induction which involved reading documents, being shown around and working with another member of staff. Staff also told us that the induction covers subjects that are included in the Learning Disability Award Framework (LDAF). These are standards expected within homes that provide services for people with a learning disability. Additional training is provided by the home. This includes total communication, autism awareness, epilepsy and specialist medication administration. The deputy manager confirmed that all but three new staff have received this additional training. Barley Close DS0000063867.V344558.R01.S.doc Version 5.2 Page 28 Staff also told us they have not had a staff meeting for a long time. Some staff said they had received supervision but not all questionnaires stated they had had recent supervision. The manager confirmed that not all staff have got NVQ (formal training) qualifications. Six of the 21 staff have got NVQ 2 training. The Manager and deputy manager told us that they sometimes take work home to complete. They also said that agency use has now been authorised and adverts placed in local press for new staff. Staff files did not show that recruitment is robust at the home. Not all files contained evidence of two written references although this evidence was obtained from the head office prior to the end of inspection. Not all files contained a photograph and evidence was not available to show what level of police check was performed, although this information was also found by the end of the inspection. All files contained evidence that staff had received a contract of employment, application form and forms of Identification. Barley Close DS0000063867.V344558.R01.S.doc Version 5.2 Page 29 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,and 42 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home is well managed but not always run in the best interests of service users. The safety and welfare of staff and people living at the home are not always well protected. EVIDENCE: The registered manager has many years of experience in care and previously to this post worked as a deputy manager in another of the organisation’s homes. He has almost completed the Registered Manager’s Award. Barley Close DS0000063867.V344558.R01.S.doc Version 5.2 Page 30 All staff, relatives and people who use the service spoke highly of the manager; staff said he and the deputy manager were supportive and provide clear leadership and direction. Questionnaires received from staff confirmed that the manager was supportive and was trying to change the staffing issues. The Manager and Deputy manager have continued to find it difficult to find time to perform management work and administration because of the need to work with the people who use the service. The Manager and deputy have worked all shifts to cover staff sickness and absences. Staff told us that there have been no recent meetings because of staff shortages and no group meetings for the same reason. Records showed that staff have systems in place to raise their concerns and have done this informally by communication book and by more formal letters. Provider visits still occur but have not raised low staffing levels as a problem. The staffing concerns have been fed back to the operations manager as part of the inspection process. The fire logbook was found to be up to date and accurate. Fire risk assessments and staff training were completed, therefore protecting service users’ safety and welfare. Prior to the inspection the Manager submitted an AQAA (annual quality assurance assessment), which requests information regarding maintenance records and policies and procedures. This information is used to help form a judgement as to whether the home has the correct policies to keep people safe. A spot check was performed of maintenance records, which showed that gas, electric, hoist and other equipment maintenance records were up to date. Staff showed us a training ‘box’ that was used for training staff in mandatory subjects which included food hygiene, health and safety, Protection of vulnerable adults, fire safety and moving and handling. Staff do question and answer sessions using an electronic learning box which assesses their knowledge. I addition to this staff attend practical 1st aid sessions, moving and handling training and fire safety sessions. The deputy manager confirmed that all but three staff have completed this training. Barley Close DS0000063867.V344558.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 2 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 1 34 1 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 2 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 1 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 4 x 3 3 3 X X 3 X Barley Close DS0000063867.V344558.R01.S.doc Version 5.2 Page 32 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. 1 Standard YA6 Regulation 15(1) Requirement The Manager must make sure that each person has a care plan written so staff are able to meet a persons needs in a consistent way The Manager must make sure that a persons decision making is not restricted The manager must make sure that leisure activities for people are not restricted The manager must make sure he has: • Enough staff on duty to meet the planned staff ratio needs for people at the home. The Manager must ensure staff meetings are held to enable staff to express their views and concerns The manager must ensure he has evidence at the home of all recruitment checks listed in schedule two. This will how that people are cared for by staff who have had all the necessary checks performed These must include: • Two written references DS0000063867.V344558.R01.S.doc Timescale for action 30/11/07 2 3 4 YA7 12(2,3) 16(2m) 18(1a) 30/11/07 30/11/07 30/11/07 YA14 YA33 5 YA33 21(1) 30/11/07 6 YA34 Schedule 2 30/11/07 Barley Close Version 5.2 Page 33 • Evidence of the level of CRB check 30/11/07 7 YA39 26 The Provider must send Regulation 26 notices to the Commission for Social Care Inspection to keep us informed about the service people receive at the home. 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 YA1 Good Practice Recommendations The information in the statement of purpose should reflect accurately the facilities provided. (This refers to children being cared for at the home) The Manager should provide staff with sufficient written information for staff to provide in emergency and hospital settings when a person goes out of the home. The manager should arrange resident meetings so people have an opportunity to express their views and concerns about the service they receive 2. 3. YA6 YA8 Barley Close DS0000063867.V344558.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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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