Inspection on 29/08/07 for Barleycombe Residential Home

This inspection was carried out on 29th August 2007.

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

The inspector 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

Barleycombe Residential Home 14/01/08

Barleycombe Residential Home 11/10/05

Barleycombe Residential Home 27/06/05

Barleycombe Residential Home 23/05/05

Barleycombe Residential Home 04/11/04

Barleycombe Residential Home 19/05/04

Barleycombe Residential Home 13/02/04

Barleycombe Residential Home 14/08/03

Barleycombe Residential Home 28/11/02

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

CARE HOME ADULTS 18-65 Barleycombe Residential Home Sudbury Road Long Melford Sudbury Suffolk CO10 9HE Lead Inspector Claire Hutton Key Unannounced Inspection 29th August 2007 10:45 Barleycombe Residential Home DS0000024331.V349914.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 Barleycombe Residential Home DS0000024331.V349914.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. Barleycombe Residential Home DS0000024331.V349914.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Barleycombe Residential Home Address Sudbury Road Long Melford Sudbury Suffolk CO10 9HE 01787 880203 01787 310809 barleycombe@activecarepartnerships.co.uk www.schealthcare.co.uk West Regent Ltd 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) Mrs Joanne Woodhead Care Home 14 Category(ies) of Learning disability (14) registration, with number of places Barleycombe Residential Home DS0000024331.V349914.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th October 2005 Brief Description of the Service: Barleycombe is a care home for adults with a learning disability and currently only has male residents. The home consists of a two-storey building situated in extensive grounds, which had been cultivated to produce vegetables and maintain livestock. The home was set back from the main road running between Sudbury and Long Melford. Both towns were accessible via public transport, with Long Melford within reasonable walking distance. The owners of the home had produced plans to extend the service by providing a five-bedroom moving on facility. Copies of the plans were submitted to the National Care Standards Commission in 2003, these have since been revised. Fees for this home range from £407.00 to £969.00 per week. More information about fees can be obtained from The Statement of Purpose and Service Users Guide. Barleycombe Residential Home DS0000024331.V349914.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 that focused upon the core standards relating to Adults (18 – 65). It took place over two days. The inspection team was made up of an Inspector, an Expert by Experience and his supporter. Darren Cunningham (Expert by Experience) and his supporter came from ‘Barking and Dagenham centre for Independent Living Consortium’ As a service user Darren Cunningham has an expert opinion on what it is like to receive services for people who have a learning disability. His comments are included throughout this report where he is referred to as an ‘Expert by Experience’. The inspection process included visiting communal areas of the home, discussions with residents and staff, observations of staff and resident interaction, and the examination of a number of documents including residents care plans and associated documents, medication records, the staff rota, recruitment, training records, menus and records relating to health and safety. The report has been written using accumulated evidence gathered before and during the inspection. The Commission had received an Annual Quality Assurance Assessment (AQAA) completed by the registered manager. The Commission had received information relating to several concerns about choice, decision making, risk taking and privileges being denied as well as matters about restraint. These had previously been sent to the home therefore the matters were looked at through the inspection and assessment of key standards. The findings are to be found throughout this report. Three matters not resolved were passed back to the home to examine using their complaints procedure. Seven completed residents surveys were received, four surveys were received back from relatives/visitors, all of which were generally complimentary. No surveys were received back from staff, even though nine had been sent to individual staff at the home. A random inspection visit was conducted at the home on 5th December primarily to note progress made on the six requirements made at the key inspection in June 2006. That inspection found all the requirements had been actioned. What the service does well: There is information available about the home, contracts are issued and care needs will be assessed and kept under review. Therefore an informed choice can be made about Barleycombe. Barleycombe Residential Home DS0000024331.V349914.R01.S.doc Version 5.2 Page 6 Assessed needs are set out in an individual care plan. Residents are able to contribute to the development and review of their care plans, with their views and needs taken into account, to ensure they receive the appropriate personal, health, and social care. The management of medication is good thereby protecting residents. People who use this service will find they are supported to maintain family relationships. The catering provides a varied menu with choices including healthy options available. There are opportunities presented to access the community and engage in leisure activities. Holidays had been taken and others were planned. People who use this service will find a comfortable home that is clean. The procedures for the recruitment of staff are stringent, training offered to staff is good and both provide the safeguards to offer protection to people living in the home. What has improved since the last inspection? What they could do better: Staff must help and support all residents in their lifestyle aspirations to take part in valued and fulfilling activities. An example that the expert by experience reported was: ‘Clients expressed a wish to do more hobbies and activities such as watching football or going to the local steam railway’. People who use this service may not have their concerns listened to, taken seriously and acted upon. Evidence suggests that concerns are raised, but not taken seriously as they are not systematically recorded, investigated and responded too. Barleycombe Residential Home DS0000024331.V349914.R01.S.doc Version 5.2 Page 7 Outcomes of safeguarding investigations must be implemented promptly to ensure the protection of residents. Also the recording of physical interventions by staff must be in line with the homes policy and procedure. To ensure that the premises are suitable to meet the needs of the residents the bath in the flat must be replaced and the washing machine installed. The staff toilet also needs repairing. The independence of residents should be encouraged by the provision of the listed equipment but also staff need to support resident with using the new equipment. Residents must not be placed at risk due to the lack of permanent night staff and staff who know their needs therefore consideration must be given to resolving the current lack of night staff available at the home. This report also contains recommendations around further improvements that should be considered by the home. Good practice suggestions include development of independence and living skills for the residents around areas of domestic skills, and retaining and controlling their own medication. Also around developing a culture of autonomy and choice with regard to when the communal TV can be watched, inviting fellow residents into each others room and going to the pub in smaller numbers. 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. Barleycombe Residential Home DS0000024331.V349914.R01.S.doc Version 5.2 Page 8 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 Barleycombe Residential Home DS0000024331.V349914.R01.S.doc Version 5.2 Page 9 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 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service can be confident that there is information available about the home, contracts are issued and that their needs will be assessed and kept under review. EVIDENCE: At the last inspection the manager had updated the Statement of Purpose and Service Users Guide. Records relating to three individuals were examined. Each individual had an assessment in place or a recent reassessment completed by the registered manager. Each individual had a contract in place and this could be examined. One individual had a licence to occupy in his file. The completed AQQA states ‘ARRANGE HOME VISITS PRIOR TO ADMISSION AND A FULL ASSESSMENT PRIOR TO ADMISSION BY 2 SENIOR STAFF MEMBER’. The home also say they are ‘OFFERING A COMPREHENSIVE TRANSITION PERIOD TO ENSURE PROSPECTIVE SERVICE USERS HAVE EVERY OPPORTUNITY TO MAKE AN INFORMED DECISION OF WANTING TO LIVE AT BARLEYCOMBE’. Barleycombe Residential Home DS0000024331.V349914.R01.S.doc Version 5.2 Page 10 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 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be assured that their assessed needs are set out in an individual care plan. They are able to contribute to the development and review of their care plans, with needs taken into account, to ensure they receive the appropriate personal, health, and social care. EVIDENCE: Care plans and associated records were examined for three individual residents. The care plans have developed since the last inspection at the home. There were assessments by other professionals as well as reassessments by the manager. This formed the basis of care plans. These were developed in an individual way based upon the needs presented. One resident with complex care needs had the following: a plan around nutrition – this showed that choice was promoted around food. There was a plan around home care skills and the support required by staff to enable the resident to complete tasks that promoted independence. There was a plan around the individuals’ specific learning disability and autism and how staff were best Barleycombe Residential Home DS0000024331.V349914.R01.S.doc Version 5.2 Page 11 placed to communicate with the person. There was a plan in place to inform staff how best to manage and support the individual when they displayed behaviour that was challenging. (In relation to recording of incidents of behaviour that challenge please see standard 23) This was accompanied with a list of positive reinforcements that were to be used by staff. For this individual there was evidence of regular reviews of care given as information was collated on a weekly basis then used in a monthly review of matters concerns the individual. This same individual had recently had an assessment by a psychologist. The report was on file, but the recommendations were not transferred into the care plan for staff to implement. Two other residents care plans and associated records were examined and found to be individual, up to date with regular reviews. Care plans also included risk assessments. These had been completed, were recent and signed by the manager. They covered matters such as advice to staff in case of heat waves; what staff should do for specific individuals if there was a fire and the resident needed help to understand what was expected; accessing the community in activities such as swimming; and access to the kitchen when residents had less understanding of keeping themselves safe. There was also good information, complete with photograph on individual files should they go missing. Decision making was discussed with the deputy manager at the home. There was an understanding around respecting residents’ decisions and that this could only be limited through the assessment process and a residents care plan. Therefore staff gave advice on matters such as alcohol or healthy eating but no restrictions were said to be put in place. An example seen on the day at lunchtime was a resident who was given advice by a staff member reminding him if he ate too much he may be sick. There are advocates involved at Barleycombe and one was visiting on the day of inspection. There was evidence that they are involved in the review process to help support the resident. Residents meetings are held at the home and minutes of these were seen. The expert by experience reported ‘Clients had the opportunity to speak at residents meetings, but some find this difficult to speak up in front of a group to express their concerns or wishes’. In the AQQA the manager reported that the home does well in the following: ‘ALL SERVICE USERS ARE ENCOURAGED TO MAKE CHOICES IN THEIR LIVES, THIS IS ACHIEVED THROUGH 6 MONTHLY REVIEWS, REGULAR SERVICE USERS MEETINGS AND THE KEY WORKER SYSTEM. SERVICE USERS ARE INCLUDED IN SETTING OF MENUS, IDENTIFYING PREFERRED SOCIAL ACTVITIES AND CHANGES IN THE ENVIRONMENT’. Barleycombe Residential Home DS0000024331.V349914.R01.S.doc Version 5.2 Page 12 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 good. This judgement has been made using available evidence including a visit to this service. People who use this service will find they are supported to maintain family relationships. The catering provides a varied menu with choices including healthy options. There are opportunities presented to access the community and engage in leisure activities. However there are some residents who may find that there are insufficient daytime activity opportunities presented to develop a fulfilling lifestyle. EVIDENCE: Residents at Barleycombe each have a varied program during the day. Some of the residents were not there due to being out at day services or work placement but a number were at the home. One person did not come out of their room for the four hours the expert by experience was visiting. Other residents did spend time in their rooms. The individual activites for one individual showed that usually during the day nothing was planned for them to participate in. However they did have a planned shopping day once a week Barleycombe Residential Home DS0000024331.V349914.R01.S.doc Version 5.2 Page 13 and a pub and a swimming visit at a weekend. In the same persons records it showed that for the month of June they participated in three activities. The inhouse activites had been suspended for the two days as staff were receiving training at the home in the residents dining room. In house activites begin each day with animals/horticulture. Other activites listed include basic skills in money, writing and reading twice a week and other activites include woodwork, painting, music, art and craft and nature study. There is a once a week befriender meeting held outside the home. In the AQQA the manager states that one of the things the home could do better is: ‘CONTINUE TO BUILD UP THE SERVICE WE PROVIDE, INCREASE THE IN HOUSE DAY FACILITIES’. At the inspection the deputy manager stated that the development of the activites co-ordinator post was one of the key aims for the future. The expert by experience reported the following: ‘Although the home has extensive grounds, allotments and animals some residents felt they could not always access these areas and that the care of the animals and the grounds was by a member of staff rather than them. On the day of our visit one staff member had been carrying out training and the client could not understand why they could not feed the animals whilst he was carrying out this duty. If the staff designed a chart (feeding/cleaning schedule) including pictures to support the text, possibly residents could take some further control over this area and be given the chance to be included more in this activity. We observed tomatoes being grown in the green house but that was all. One resident was clearing weeds from the allotments and when asked what was he going to grow, he said he wanted to grow leeks and other vegetables but would have to wait till next year. Clients expressed a wish to do more hobbies and activities such as watching football or going to the local steam railway. Some residents are permitted to leave the grounds to go to the town, shops and travel on the buses. Some clients operate a car wash with members of the public driving into the grounds. This is a good idea for social interaction with others but this would be better if supervised by staff as cars arrive to ensure the safety of the residents. Most clients go to the local pubs at least once a week accompanied by staff members but they feel they are not given the freedom when out of the home to explore their independence and are viewed by some other customers in the pub as those people from the local home rather than just normal customers. Clients are only allowed to watch TV in the main building after 4pm and staff switches this off when it gets dark. Before 4pm and after the set is turned off residents can then watch their own TV’s in their rooms but only alone or with Barleycombe Residential Home DS0000024331.V349914.R01.S.doc Version 5.2 Page 14 other staff and not just with residents. Some clients felt this was unfair that they could not play computer games or listen to music with other people living at the home’. In the AQQA the manager states that one of the aims of the home is to ‘ACTIVELY PROMOTE ADMISSION OF FEMALE SERVICE USERS’. In the report from the expert by experience they reported that Barleycombe is ‘All men living together in a very male dominated atmosphere’. The home has a policy on relationships and sexuality and staff have received recent training in this area. The deputy manager spoke about holidays that had been arranged for residents, these were in small groups or as individuals and included destinations such as Pontins, Brighton, Devon and Scotland as well as Centre Parcs which was the one residents were talking about during the inspection. From the resident questionnaires six residents said they can do what they want during the day one said they could not. All seven said they could do what they wanted in the evening and at a weekend. Four positive responses were received from the relatives/carers/advocate questionnaires in relation to the questions about keeping in touch and updating on important issues. One person wrote ‘ I do receive weekly telephone calls, information magazine and invitations to birthday and Christmas parties.’ A meal was eaten at the inspection and this was found to be satisfactory. There is now a greater understanding of healthy eating, with a mixed berry fresh fruit salad on offer at lunchtime as well as fruit and yogurts. The menus were examined and the newly appointed chef spoken to. The home is developing menu choices based around green, amber and red choices to help the residents understand what healthy food choices are. There is no restriction placed upon the chef in terms of budgeting for meals and he is able to purchase fresh foods from local suppliers. He was preparing a fresh strawberry flan for supper. Food stocks were good. There was a record of choices of food offered to residents and food eaten with a column containing the residents’ comments about the food. Barleycombe Residential Home DS0000024331.V349914.R01.S.doc Version 5.2 Page 15 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 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Health needs are assessed and reviewed regularly to ensure that residents are properly cared for. The medication procedures in place ensure that residents are safe. EVIDENCE: Three care plans inspected contained specific information about personal support. Two residents had specific care needs around continence issues – their care needs were set out in the plan and the detailed daily recording showed these needs were met routinely to ensure the dignity of residents. Four positive feedback comments were received from relatives about the question ‘does the home give the support or care to your relative that you expect or agreed?’ The expert by experience reported: ‘Clients can have baths/ showers when they wish after advising staff’. In care plans there was evidence of good use of health professionals. There was access to standard health services such as GP, chiropody, dentist and Barleycombe Residential Home DS0000024331.V349914.R01.S.doc Version 5.2 Page 16 opticians. There was also good access and use made of more specialist healthcare services such as the wheel chair service, the continence advice service, community learning disability nurses and clinical psychologists. The management of medication at the home was examined. Currently there are no residents who self medicate – not even the two residents who live in the flat where independence is said to be encouraged. The security of medication is good. There is a locked medication fridge for medication as well as a steel medication cupboard. The system in use is a Boots monitored dosage system. There was a policy and procedure available for staff to follow. There was evidence of staff training. Three staff were planning to do advanced medication training in the near future. The medication administration records were examined and found to be correctly completed. There were sample signatures and initials that clearly identified who had administered medication. There was a clear audit trail that showed medication prescribed had been administered and by whom. When staff administered medication they wore a red tabard that said ‘Do not disturb medication administration in process’. Barleycombe Residential Home DS0000024331.V349914.R01.S.doc Version 5.2 Page 17 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 and 23. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents and their representatives cannot be assured that their views will be listened to, taken seriously and acted upon. Safeguarding of residents is currently compromised and therefore residents cannot be said to be robustly protected. EVIDENCE: As part of this inspection there were several issues of concern that had been sent to the Commission, which had previously been sent to the management within the home. However the complainant was not satisfied with the response, believing matters had not been listened too and taken seriously. The AQQA stated that there had been 2 complaints received within the last 12 months at the home. The majority of these concerns sent to the Commission were looked at through the key standards inspected and outcomes can be seen through the report. However some matters could not be adequately assessed during the inspection and they were handed back to the home to investigate under their procedure once again and report back to the Commission on their findings. The concerns were all put in writing to the management of the home, however there was not adequate recording of investigations or responses given to the person with concerns. There was inadequate recording of these matters in the complaints log and no formal response was seen in the majority of cases. Barleycombe Residential Home DS0000024331.V349914.R01.S.doc Version 5.2 Page 18 One matter that was looked at during inspection was relating to an incident that occurred in February 2007 that led to the restraint of a resident and a visit to the GP and an x-ray to ascertain any injury. Documentation around this incident was not adequate as no clear trail could be found. The matter had been logged in the control and restraint record – but no incident report had been completed to follow the matter up. Also incident reports were found that recorded restraint, but were not recorded in the control and restraint log. Due to inadequate recording this matter could not be clearly evidenced and concluded to determine if the restraint was connected to the injury that required a GP visit. Therefore the matter has been referred back to the home to review all documentation around restraint and incidents of behaviour that challenges to ensure that the homes policy and procedure is followed in line with Department of Health Guidance on the matter. The training staff received on control and restraint was examined. This was found to be up to date for all staff. However the training provider was not accredited with BILD (British Institute of Learning Disability) as recommended in the Department of Health Guidance. Since the last inspection there had been one matter of protection of vulnerable adults that had been referred through the local safeguarding procedures. The AQQA states incorrectly there have been no incidences reported. There was evidence of a referral and conclusion through the safeguarding procedures with the local authority and police. The management of the home then looked into the matter and conclusions drawn and recommendations made. However the deputy manger confirmed that some months later these recommendations had not been followed up. The deputy manager was unaware of the newly revised local procedure relating to safeguarding adults, therefore the web address to access the procedure and training was given to the home. Staff have received training in the protection of vulnerable adults but this dates back to 2005. The deputy manager explained that she intended to schedule a refresher course for staff. From the resident surveys five out of seven resident said they knew how to make a complaint. However all seven said they knew who to speak to if they were unhappy. One relative who responded said they were unaware of how to make a complaint should they need to. The expert by experience reported: ‘Clients interacted well with each other and all staff, but felt when confrontation did occur this was not always taken seriously or dealt with and tended to be brushed under the carpet until it occurred again’. Barleycombe Residential Home DS0000024331.V349914.R01.S.doc Version 5.2 Page 19 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use this service will find a comfortable home that is clean. However repairs may not be promptly actioned and therefore can lead to long-term inconvenience to residents and staff. EVIDENCE: The Inspector undertook a tour of all the communal areas. The residents showed the expert by experience around more of the home. The expert by experience reported: ‘All clients are permitted to decorate their rooms in their chosen style and have an assortment of electrical items including, TV’s, DVD’s, computer games and music centres. One client stated he had fallen over on the back steps of the home, as the slabs were broken. We inspected this area and they were all damaged the client said he had informed a member of staff about the damaged slabs, but they had not been replaced. Barleycombe Residential Home DS0000024331.V349914.R01.S.doc Version 5.2 Page 20 One client who lived in a self contained flat with another resident was unhappy because they wanted to develop more independence but this was being held back because their bath had been cracked for 11 months, their washing machine which had been delivered two months ago but had not been plumbed in and they were unable to cook lunches and meals as the cooker was not working. The client has advised staff on many occasions about these matters but nothing has changed. Thus the clients are not really independent, as they have to shower, wash and eat in the main house rather than in their own flat. Clients showed us around the bathrooms which were near their rooms, which were clean though one on the upper floor was excessively hot as the heating was on full blast. This made it difficult to breath in this room and a client said it was always like this’. These matters were discussed with the deputy manager. The bath in the flat had been out of order for 11 months and had been chased up by the area manager. It was agreed this was an unacceptable length of time and would be looked at again and followed up promptly. The washing machine was confirmed as needing to be plumbed in. The cooker was said to be working, but the residents were believed not to know how to operate it. In the main house the staff toilet had been out of order since April 2007 a total so far of four months. Residents were having to share their toilet with staff. The laundry room was inspected and found to have the appropriate equipment and was clean. Staff has access to a wash hand basin and paper towels. However in the toilet shared by staff and residents there were no paper towels for staff to dry their hands on. All communal areas were found to be clean and recently decorated. The AQQA stated: ‘NEW FURNITURE AND FLOOR COVERINGS/PRESENTATION OF THE HOME AND DECORATION PROGRAMME HAS IMPROVED THE QUALITY OF THE SERVICE OFFERED. REDECORATION OF ALL COMMUNAL AREAS HAS TAKEN PLACE AND 10 BEDROOMS HAVE BEEN COMPLETED’. Barleycombe Residential Home DS0000024331.V349914.R01.S.doc Version 5.2 Page 21 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): 32, 33, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The procedures for the recruitment of staff are stringent, training offered is good and both provide the safeguards to offer protection to people living in the home. The deployment and number of staff available at night may not always be sufficient to meet the assessed needs of residents. EVIDENCE: A board with a Perspex front has been positioned in the front entrance, this contains photographs of staff with their names. This is useful to residents and visitors to the home. Several staff were spoken with during the inspection. There was concerns expressed around the lack of night staff avaiable for the coming weeks. The home had found itself in a position where ther was only one permanent staff member available to do nights. Even with the use of agency this would be difficult for the home to cover. Staffing levels during the day were maintained at the usual levels. Six care staff have recently left the home (one had become the cook) another person had confirmed that they were not returning Barleycombe Residential Home DS0000024331.V349914.R01.S.doc Version 5.2 Page 22 from maternity leave. Evidence was seen that five new staff were being recruited. Recruitment records for four staff were examined and found to have all the required checks in place before the person started work at the home including a CRB. On the day of inspection staff were receiving training updates in basic food hygiene and fire training. Other training available to staff included health and safety with training in the use of chemicals. Manual handling, first aid, care ploanning – a small protion had training in person centered planning. A small portion of staff are trained in autism and a small portion were trained in total comminucation – but the majority of these people have left. Information provided by the home shows that five staff have NVQ three or above. Three staff were doing their NVQ 2. The expert by experience reported: ‘All staff and the management were friendly and willing to answer questions throughout the visit. Clients got on well with each other and staff during our visit’. Barleycombe Residential Home DS0000024331.V349914.R01.S.doc Version 5.2 Page 23 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, 39, 41 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents, and their representatives will find that qualified persons manage the home. The health and safety of people using this service is being promoted, but matters around recording have left residents and staff vulnerable. EVIDENCE: The registered manager was not part of the inspection process as she was not available, but the deputy manager was available to answer any questions. Both the registered manager and the deputy have the Registered Managers Award and have several years experience of working with adults with a learning disability. The AQQA stated the evidence the home has to show what they do well is: ‘QUALITY ASSURANCE AUDITS, REGULATION 26 VISITS, POSITIVE FEED BACK FROM EXTERNAL PROFESSIONS’. Barleycombe Residential Home DS0000024331.V349914.R01.S.doc Version 5.2 Page 24 The Commision does receive regular reports from senior managers with in the organisation who visit the home (Regulation 26 visits). During the inspection audits were seen in relation to care plans and medication. There are regular residents meetings and staff meetings held with records kept. The inspector is aware that residents and staff are surveyed from time to time. The AQQA evidenced that all services to the home had been serviced within the last year. Records relating to fire were examined and found to be in order. Window restrictors were in place and records relating to the safety of hot water were examined. In the kitchen records relating to food safety were kept and were available for examination. The AQQA confirmed that the home have a procedure to respond to emerencies and crisis within the home. The deputy confirmed that this was in place and was able to quote parts of the planning in place should it be needed. The residents best interests are not safeguarded by the homes record keeping and policies and procedures. This is a management responsibility. In the case of the management of complaints and restraint records were not adequatly maintained. The detail of this is in standards 23 and 24. Barleycombe Residential Home DS0000024331.V349914.R01.S.doc Version 5.2 Page 25 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 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 2 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X 2 3 X Barleycombe Residential Home DS0000024331.V349914.R01.S.doc Version 5.2 Page 26 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 YA12 Regulation 16 (2)(n) Requirement Timescale for action 11/10/07 2. YA22 YA41 17 (2) schedule 4 (11) 3. YA23 YA41 17 (1) (a) schedule 3(l) 4. YA24 23 (2) (a) (b)(c) Staff must help and support all residents in their lifestyle aspirations to take part in valued and fulfilling activities. Access to more opportunities must be developed. People who use this service must 11/10/07 have their concerns listened to, taken seriously and acted upon. A record of must be kept of every complaint received and action taken in response. Residents must be safeguarded 11/10/07 and adequate protection afforded to them. Outcomes of investigations must be implemented promptly. Recording of physical interventions by staff must be in line with the homes policy and procedure. The home’s premises must be 11/10/07 suitable for its stated purpose; safe and well maintained; The bath in the flat must be replaced and the washing machine installed. The staff toilet must be repaired. Barleycombe Residential Home DS0000024331.V349914.R01.S.doc Version 5.2 Page 27 5. YA33 18 (1)(a) The back steps must be made safe. Residents must not be placed at 11/10/07 risk due to the lack of permanent night staff and staff who know their needs. The current lack of night staff available at the home must be resolved. 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 YA13 Good Practice Recommendations Residents at this service are supported to access the community, but have expressed a wish for this to be on an individual basis and not as a group ‘from the local home’. Therefore reasonable consideration should be given to achieving this. Residents at this service should be able to choose who they see in private in their own bedrooms, if the matter has not been restricted through assessment and documented in their care plan. Residents at this service should have unrestricted access to the home and grounds unless specified through assessment and documented in their care plan. Residents should be encouraged to retain, administer and control their own medication, within a risk management framework and thereby develop independence. Residents can be further safeguarded and protected. The up to date local procedure should be accessed and staff trained in this. The trainer providing training in physical interventions should be accredited with BILD as recommended in the Department of Health Guidance. 6. YA16 Residents should be encouraged in their independence in line with the purpose of the home. Adequate working DS0000024331.V349914.R01.S.doc Version 5.2 Page 28 2. YA15 3. YA16 4. YA20 5. YA23 Barleycombe Residential Home equipment should be in place with supervision provided by staff on the use of equipment such as the cooker and washing machine. 7. YA30 Further consideration should be given to controlling potential spread of infection whilst the staff toilet is out of action. Paper towels should be provided as standard for staff to use. Staff should attend autism and total communication training if they are to work with residents with this specified condition and with residents who are unable to communicate verbally. 8. YA32 Barleycombe Residential Home DS0000024331.V349914.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Colchester Local Office Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Barleycombe Residential Home DS0000024331.V349914.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!