Inspection on 18/04/07 for Barleycroft Care Home Ltd.

This inspection was carried out on 18th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Barleycroft Care Home Ltd. 18/03/09

Barleycroft Care Home Ltd. 20/12/06

Barleycroft Care Home Ltd. 02/06/06

Barleycroft Care Home Ltd. 26/08/05

Barleycroft Care Home Ltd. 11/05/05

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

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

CARE HOMES FOR OLDER PEOPLE Barleycroft Care Home Ltd. Spring Gardens Romford Essex RM7 9LD Lead Inspector Jackie Date Unannounced Inspection 18th April 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Barleycroft Care Home Ltd. DS0000062659.V336287.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Barleycroft Care Home Ltd. DS0000062659.V336287.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Barleycroft Care Home Ltd. Address Spring Gardens Romford Essex RM7 9LD 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) 01708 753476 joga@festivalcare.com Festival Care Homes Ltd Jemma Craig-Dressekie Care Home 80 Category(ies) of Dementia (0), Dementia - over 65 years of age registration, with number (0), Old age, not falling within any other of places category (0), Physical disability (0), Physical disability over 65 years of age (0) Barleycroft Care Home Ltd. DS0000062659.V336287.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Total number of beds 80 to be used flexibly amongst the various categories. With the following categories: Old age, not falling within any other category (OP) either sex Residents 50 years of age with a diagnosis of Dementia (DE) either sex Residents 65 years of age with a diagnosis of Dementia DE(E) either sex Residents 50 years of age with a Physical Disability (PD) either sex Residents 65 years of age with a Physical Disability PD(E) either sex One Resident 40 years of age with a Physical Disability (PD) 20th December 2006 Date of last inspection Brief Description of the Service: Barleycroft is an 80-bed home arranged over three floors and operated by Festival Care Ltd. The home is purpose built and is accessible throughout for people with physical disabilities and mobility problems. There is a lift to each floor. There are 80 single bedrooms all with en suite facilities. Each floor contains a separately staffed unit. These provide care for specific client groups. People over sixty-five years requiring nursing care and personal care due to frailty/ illness and people with dementia. One of the units caters for people that need nursing care due to their dementia. The home is situated near Romford and is on a good bus route to other local areas. Romford has a British Rail Station. The range of fees for the home is between £489.34 and £695.50 per week, this range is dependant on whether the resident requires residential or nursing care. This information was provided in the pre inspection questionnaire received on 11th April 2007. Information about the service provided is contained in the service user guide. A copy of the Statement of Purpose and Service User Guide to the home is made available to both the resident and the family. There is a copy of the guide and most recent inspection report in the reception area. Barleycroft Care Home Ltd. DS0000062659.V336287.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and started at 9.00am. It took place over eight hours. Three inspectors, namely the lead inspector Jackie Date and Gwen Lording and Sandra Parnell-Hopkinson undertook the inspection. The registered manager and deputy manager were available throughout the visit to aid the inspection process. This was a key inspection and all of the key inspection standards were tested. Discussion took place with the registered manager, deputy manager, several members of nursing and care staff, the person in charge of the kitchen and the person in charge of the laundry on the day of the visit. Nursing and care staff were asked about the care that residents receive, and were also observed carrying out their duties. The inspectors spoke to a number of residents and relatives. Where possible residents were asked to give their views on the service and their experience of living in the home. In order to gain additional information about the quality of the service feedback questionnaires were sent to the home prior to the inspection. Written feedback surveys were received from 12 relatives, 8 residents and 10 staff, Prior to this inspection, an additional random unannounced visit took place on 12th March 2007. The reason for this inspection was to look into concerns raised in an anonymous letter sent to the Commission. The concerns were related to insufficient staffing to meet residents needs and staff working excessive hours and having insufficient breaks between shifts. We also took the opportunity to receive an update on the progress towards meeting the requirements from the previous inspection. Information with regard to these subjects can be found in the main body of the report. As a result of these concerns meetings have also taken place with the provider, to discuss their plans to improve the quality of the service. All parts of the home were visited and a number of staff, care and home records were looked at. The inspectors would like to thank the staff and residents for their input and assistance during the inspection. What the service does well: Since the last key inspection in December 2006, there has been a very marked improvement in the quality of the care being delivered to those residents living with dementia through, activities, Barleycroft Care Home Ltd. DS0000062659.V336287.R01.S.doc Version 5.2 Page 6 staff attitudes and interaction with residents, signage and décor and care plans. This has been due to the hard work and commitment of both the management and the staff at Barleycroft nursing home. In discussions with the manager and some staff it was evident that they are very aware of equality and diversity issues and were very clear that these were addressed at the home. Currently residents are white British and generally of the Christian faith. The staff are from different ethnic groups but appeared to have a good understanding of the needs of the residents. A relative said, “the carers know my wife as well as I do.” Another said “They are very kind to my mum and the other residents. Mum is always smiling so this says how happy she is here”. A resident said, “the staff work very hard and are very caring and give us support”. The psycho-geriatrician said “this is one of the best dementia services in the Romford area.” What has improved since the last inspection? The manager and her staff have worked extremely hard in improving the care plans, which are now more comprehensive. All staff were observed to treat residents with kindness, respect and there was also positive interaction between residents and staff. Improvements have already been implemented such as appropriate colour schemes, touch and feel materials on the walls and appropriate pictures. These are proving to be a point of discussion with some of the residents. Signage on individual bedroom doors is now aiding the orientation of residents and enabling them to find their bedrooms. It was possible to observe lunch being served and again this was much more congenial for residents. Tables had been laid and cruets were available on each table. The atmosphere at lunch was much calmer and residents were observed being encouraged, in a very interactive and positive manner, to make choices between the meals offered, and to eat and drink. Some of the staff spoken to confirmed that they have undertaken training in dementia care, and that this has given them an increased awareness of the needs of people living with dementia. Residents said: “The care and support that I get is much better lately than 12 months ago.” “The activities have been much better in the last 3 months and are getting better all the time.” Barleycroft Care Home Ltd. DS0000062659.V336287.R01.S.doc Version 5.2 Page 7 A relative said. “I now have a lot of confidence in the home, including the staff, which I did not have originally”. It was very evident from observation and discussions with staff, and residents that the home is now operated for the benefit of residents. Every effort is made to retain the independence of those living with dementia, and for them to continue to exercise choice and control over their lives. The routines of daily living are flexible and varied to suit the individual needs and capacities of residents, together with their religious and social preferences. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Barleycroft Care Home Ltd. DS0000062659.V336287.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Barleycroft Care Home Ltd. DS0000062659.V336287.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their relatives are provided with sufficient information to enable them to make a decision about living in the home. Full information is gathered prior to residents being admitted to the home and therefore staff have sufficient information to fully meet residents’ needs. The home does not offer intermediate care. EVIDENCE: The Statement of Purpose and the Service User Guide were examined. They both contain appropriate information to enable prospective residents and their relatives to make a decision about living there. Copies of brochures are available in the reception area and these contain the Service Users guide, Statement of Purpose and a copy of the most recent inspection report. Therefore appropriate information about the home is available to prospective Barleycroft Care Home Ltd. DS0000062659.V336287.R01.S.doc Version 5.2 Page 10 residents and their relatives. More could be done around producing a service user guide in a pictorial format for the benefit of some of those people living with dementia, and this was discussed with the manager during the inspection. Prior to any residents being admitted to the home an assessment of the needs of the proposed resident is carried out. These assessments are now carried out by the manager and/or deputy manager and are discussed with the clinical director prior to admission. The documentation inspected for new residents recently admitted showed that this takes place. Information is also provided by placing authorities, these documents were observed to be held on file. Individual records are kept for each resident and a number of files were examined. All records inspected had assessment information recorded and the information had been used to continue assessments following admission to the home, and develop written care plans. The inspector was satisfied that a full assessment of need is undertaken prior to residents moving into the home, and that the manager would not admit a new resident unless she was sure that the assessed needs of the individual could be met. Barleycroft Care Home Ltd. DS0000062659.V336287.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal care needs are set out in individual care plans that reflect their needs. Care plans provide staff with sufficient information to ensure that care needs were being met on a daily basis. EVIDENCE: BEECH (RESIDENTIAL DEMENTIA) AND BIRCH (NURSING DEMENTIA) UNITS The files of 8 residents were inspected. All had a comprehensive assessment from which had been produced a much more detailed care plan. Care Plans are now regularly reviewed on a monthly basis, or more frequently if necessary, and those viewed had been updated to reflect changing needs and current objectives for health and personal care. In some of the files there were night care plans, and in discussions with the care co-ordinator on Beech Unit these are being reviewed to ensure that all people living on this unit have a detailed night care plan. The files viewed on Birch unit also had night care Barleycroft Care Home Ltd. DS0000062659.V336287.R01.S.doc Version 5.2 Page 12 plans, but again these could be more detailed for the benefit of both residents and night care staff. Staff have attended a care plan workshop to assist them to develop appropriate and comprehensive care plans for individuals. Several staff have received first aid training to enable them to provide appropriate care for residents in the event of a fall or other injury. It was evident that, as far as is possible, residents and/or their relatives are now involved in the drawing up and reviewing of their care plan. In discussions with the manager it was apparent that this is not always possible, especially where relatives do not visit the home very often. Residents are now being encouraged to remain as independent as is possible, and, where able, residents are being assisted in undertaking personal and oral hygiene on a daily basis. This can be very time consuming for the care workers and those residents living with dementia, which is why it is essential that there is always sufficient staff time allocated to this. This is a fact that is appreciated by the manager and her senior team. Staff must continue to be aware of the importance of listening to what the resident is saying, and getting to know the meaning of words and phrases used by an individual resident. Also it is important that residents are not hurried. Staff did ensure that residents had any aids they needed such as hearing aids, glasses and dentures. As with the production of menus in pictorial format, so the manager may wish to give consideration to producing daily living tasks in a pictorial format, as this may assist in the continued independence of the person living with dementia. There was evidence that continence programmes were included in the care plan, and staff were more aware of the importance of ensuring that such programmes are implemented consistently. Wound care management is good and where necessary comprehensive care plans are in place. Advice is sought from the tissue viability nurse whenever necessary. All residents are registered with a GP, and also have the services of an optician, dentist and chiropodist, and there was evidence on the files that people living at the home are enabled to secure the services of a GP, optician, dentist and chiropodist as necessary. Nutritional screening is undertaken on admission but on a more frequent basis if the health needs of the resident indicate this. Appropriate action is taken if necessary with the involvement of the GP, nutritionist or dietician. All residents are weighed monthly and any increase/decrease in weight is now monitored. There is suitable equipment available so that people who need to use a hoist can be weighed. Barleycroft Care Home Ltd. DS0000062659.V336287.R01.S.doc Version 5.2 Page 13 The manager and deputy have attended a managing falls seminar and staff have received training on preventing falls. Residents are never sent to hospital or to attend appointments outside of the home without being accompanied. Wherever possible family and friends are encouraged to support these appointments, but where this is not possible then a member of staff will accompany the resident. In discussions with the care co-ordinator on Beech Unit she demonstrated an awareness that some behaviours in residents living with dementia, such as refusing food, quiet rocking, or really challenging behaviour, could be due to an individual experiencing pain, or other discomforts. Therefore, she was very well aware of the need to exclude this when trying to understand what residents were trying to express through their behaviour. Medication records on Beech Unit were inspected and were generally found to be in good order. However, where 3mls or 5mls of medicine is prescribed, staff administering medication should record the actual amount given on each occasion. This is so that there is an accurate record of medication that residents have received and also to ensure that residents receive the correct levels of medication. The care co-ordinator on Beech Unit and the Nurses on Birch Unit monitor the condition of service users on medication and if there are any concerns, they would call in the GP. Currently there are no residents who are able to self-medicate on either unit. Staff were observed to knock on a bedroom door before entering, and obviously had a good knowledge and understanding of the needs of residents with regards to what they preferred to be called. Staff were seen to treat residents with respect, understanding and kindness. During discussions with some staff it was very evident that they enjoyed working with people living with dementia, although some said that this could also be very stressful. It was also evident that recent training in caring for people living with dementia has added to the quality of the care being delivered. It was apparent in discussions with staff that they were able to care for people who may be dying, and that they would treat such residents with care and dignity, and the necessary religious rites observed where appropriate. End of life care plans are now being developed throughout the home, and this is currently focusing on the Gold Standard Framework. It is important that staff receive training in supporting residents at the end of their live as this can be quite stressful and draining, as well as rewarding. The manager was also very aware of the need to increase staffing levels at such times, to ensure that the needs of all residents could still be met without putting additional pressure on the staff. Barleycroft Care Home Ltd. DS0000062659.V336287.R01.S.doc Version 5.2 Page 14 Bonsai Unit. (Nursing Care) Individual care plans were available for each resident and the care of five residents was case tracked, and their care plans and related documentation inspected. An improvement was noted in the standard and detail of care plans since the last inspection. Care plans generally were found to be well detailed, with evidence of monthly reviews having been undertaken. Risk assessments are being routinely undertaken on admission around nutrition, manual handling, continence, risk of falls and pressure sore prevention and are being reviewed on a regular basis. Night care plans have now been developed and identified specific choices such as the time a resident wishes to go to bed; have their light turned off; low light left on all night; and preferred night time drink. Care plans also included some reference to ‘End of Life’ wishes, and the use of tools such as the Gold Standards Framework (GSF). However, further use of this and other models of care such as the Liverpool Care Pathway (LCP) and Preferred Place of Care should be to be developed. The documentation/ health records relating to wound management; catheter care; the management of a resident with diabetes; and the most recently admitted resident were examined. The records for these residents were again found to be well detailed, adequately maintained and of an improved standard since the last inspection. Files evidenced timely referral to, and involvement from, health care professionals including, tissue viability and diabetic nurse specialists; speech and language therapist, GP; optical and dental services. A number of monitoring charts were examined including blood sugar monitoring, repositioning and fluid intake/ output charts. Blood sugar was being monitored in accordance with the directions in the individuals care plan. However, fluid and repositioning charts were not being maintained accurately or were being completed retrospectively. In discussion with the nurse in charge it was apparent that the charts had been transferred from a folder to each individual’s file. This highlighted an issue of accessibility for staff and where these charts may be best located to ensure timely and accurate completion. Discussion with staff and observation on the day would suggest that residents were receiving adequate fluids and being repositioned in line with their care plans, but that staff were failing to record this on each occasion or completing charts retrospectively. There are call bells in all rooms but it was noticeable that for some residents being cared for in bed not all call bells had been placed where they could reach them should they require assistance. From discussions with the nurse on duty it was evident that the residents concerned were not able to use the call bell. If residents are unable to use the call bell this must be recorded in their care Barleycroft Care Home Ltd. DS0000062659.V336287.R01.S.doc Version 5.2 Page 15 plans along with details of how the individual will be checked to see if they are alright. Staff talked about and were observed to treat residents in a respectful and sensitive manner. They were seen to be very gentle when undertaking moving and handling tasks and offered explanation and reassurance throughout the activity. An audit was undertaken for the handling and recording of medicines on the unit and a random sample of Medication Administration record (MAR) charts were examined. Discussion with the nurse in charge and the review of medication records show that staff are following policies and procedures, so as to ensure that residents are safeguarded with regard to medication. Barleycroft Care Home Ltd. DS0000062659.V336287.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ social and recreational needs are being met and they are being supported to make choices and exercise control over their lives in as far as they are able. Family contact is encouraged and relatives are welcomed and encouraged to be involved in what happens at the home. Residents are offered a choice of meals to suit their individual needs and preferences and they have their meals in a pleasant environment. EVIDENCE: There is a general programme of activities available for all residents, and these include singalongs, board games, bingo, drawing, quizzes and visiting entertainers. Bedrooms had also been personalised by the residents with the help of relatives and staff, and one lady was able to show the inspector her bedroom and she said “these are pictures of my family, and I can see the garden from my window”. Several residents were involved in showing the inspector around Barleycroft Care Home Ltd. DS0000062659.V336287.R01.S.doc Version 5.2 Page 17 the units and the garden, and were really happy to show the pictures along the corridors. One lady said “that picture is of Bournemouth, and I go there sometimes.” Another resident was seen engaging with an activity board that had a zip, shoelace, light switch and telephone. The new activities co-ordinator who has commenced work since the last inspection, has undertaken a lot of work both in developing activities for all residents and in improving the ambiance around the home. Residents living with dementia are now more involved in activities and on the day of the inspection were seen helping to produce a Spring collage for one of the units. They are also helping in the planting of a sensory garden, and many enjoy walking or sitting in the garden area to which there is now easy access. It was also evident that all staff appreciate that activities are the remit of all, and staff were engaged in sitting and talking to residents and playing a ball game with others. The improved activities appeared to have had a marked improvement on the behaviour of some of the residents who seemed more in a state of well being and calmer. Residents living with dementia have a very short concentration span and this does make the organising of activities very difficult, but the activities co-ordinator and other staff are aware of this. Annual festivals are celebrated and these include the birthdays of residents. On the day of the inspection it was evident that the residents had celebrated Easter as there were appropriate mobiles and other decorations in evidence around the home. A church service is held on the first Wednesday of each month and the priest will also see residents individually if they so wish. On Birch & Beech units drinks and snacks are freely available throughout the day, and during the night. Lunch was observed being served, tables were appropriately laid, and the meals were nicely presented and served. Residents were not being hurried and sufficient staff were on hand to give assistance where required, and any assistance was being given in a positive and caring manner. A choice was being offered to residents, and they were able to make a decision at the time of the meal. On Bonsai unit the serving of the lunchtime meal was observed and provided residents with an appealing and nutritious meal. Staff were seen to offer assistance where necessary and this was done discreetly and individually. Tables were seen to be nicely laid with tablecloths, condiments, cutlery and napkins. Pureed meals were presented in an attractive and appealing manner and residents who required assistance were not hurried. There was a nice atmosphere and staff tried hard to make the meal an enjoyable experience for the residents. It was evident during the inspection that residents had easy and Barleycroft Care Home Ltd. DS0000062659.V336287.R01.S.doc Version 5.2 Page 18 frequent access to drinks and snacks. A selection of cake, biscuits and fresh fruit was available with hot and cold drinks mid morning. Menus were viewed and these give a choice for residents, but there are also other choices available if neither of the main dishes are liked. Menus are going to be produced in pictorial format to aid choice. Staff are also very aware of the need for some residents to be given food that they can easily pick up with their fingers, as they may no longer use cutlery due to their increased dementia. It was apparent from observation and talking to some residents and staff, that residents can choose when to get up and go to bed. Contact with family and friends, and the local community is encouraged. Children from a local school visited at Christmas and sang Christmas Carols in each unit. Relatives’ meetings are held and this gives relatives an opportunity to discuss concerns and to be informed about what is happening in the home. A newsletter is also produced which provides information for both residents and their relatives, although it probably would not be able to be understood by all of the residents. The newsletter contains information about recruitment, staff promotions and training. There is also information and photographs about various activities and events. For example, the Christmas party and a trip to the Museum of Childhood. Recently one of the residents celebrated their 60th wedding anniversary and the party was held in a marquee in the garden of the home. The manager and one of the other residents also attended the party. The daughter of a resident said “we can visit at anytime. If my mother wants to come and see my father at 9pm, it is not a problem”. It was obvious during the inspection that the manager and her staff are very aware that Barleycroft is the home of the residents and they are trying to make this as appealing as is possible. The manager and staff were also very aware of the need to minimise any reduction in the freedom of residents to walk about the home, and realistic risk assessments are in place that balances safety with the individual’s right to be as free and in charge of their actions as possible. The manager also ensures that the rights of all residents are recognised and addressed and balances the needs of all with the needs of individuals. Appropriate signage and décor is now being put into place to aid the orientation of residents living with dementia. Also pictures around the home are now more in keeping with the memories of residents, and some residents were able to talk to the inspector about some of the pictures. A visit was made to the kitchen and the inspector was able to discuss the storage, preparation of food and menus with the head cook. The kitchen area was inspected and found to be clean with foods being stored and labelled Barleycroft Care Home Ltd. DS0000062659.V336287.R01.S.doc Version 5.2 Page 19 appropriately. Kitchen staff were aware of the dietary needs of all residents. The food is provided four days a week by an external catering company; who supply cook/ chill for the lunchtime meal four days a week. On the other three days the cook prepares fresh food in the main kitchen. A cooked breakfast is available every other day and includes sausages, bacon and eggs. One resident regularly requests kippers. There is appropriate use of full fat milk and cream wherever possible in custards, soups and milk puddings as nutritional supplements. Fresh fruit is available daily. The menu planned for the evening included plated salads, omelettes, jacket potatoes and soup. Barleycroft Care Home Ltd. DS0000062659.V336287.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure that is easily accessible to residents and relatives and that is followed in the event of a complaint being made. Residents are now safeguarded by the systems and practices in the home. EVIDENCE: The home has a written complaints policy and procedure and this is displayed in the reception area. There is also a complaints box on the wall where relatives can leave complaints or comments if they wish. Most residents, due to their level of dementia, may not be able to use a formal complaints system Any complaints received by the home are documented and the action taken to investigate the complaint is recorded along with whether the complainant is happy with the homes investigation. Complaints forms and records of complaints are now kept on each unit. These are then monitored by the manager and by the clinical operations director. At the time of the last inspection there were a number of current protection concerns that were being investigated by the local authority in line with the Safeguarding Adults procedures. The majority of the investigations are linked to one of the units. Unfortunately these have not been concluded and any recommendations and requirements that are made will need to be implemented in the home. In the interim these issues have been discussed with the manager and senior representatives of Festival Care and action has Barleycroft Care Home Ltd. DS0000062659.V336287.R01.S.doc Version 5.2 Page 21 been taken to safeguard residents. Staff have received training in Safeguarding Adults, falls prevention, first aid, food hygiene and dealing with challenging behaviour/aggression. Care plans are more comprehensive and up to date. Staffing levels have increased at peak times. There has not been any further reports of adult protection issues and the number significant/serious incidents has decreased. In addition the recruitment procedure has been tightened up and the clinical operations Director or Quality & Support manager view all new staff files prior to a new starter commencing work. Therefore systems are now in place to ensure that residents are safeguarded. Barleycroft Care Home Ltd. DS0000062659.V336287.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26. Quality in this outcome area good. This judgement has been made using available evidence including a visit to this service. The home is clean and well maintained. It is decorated and furnished to a good standard. The signage and décor are appropriate for people with dementia and this increases their choices and independence. Residents now have unrestricted access to their rooms and communal areas. EVIDENCE: Barleycroft is an 80-bed home arranged over three floors. The home is purpose built and is accessible throughout for people with physical disabilities and mobility problems. There is a lift to each floor. There are 80 single bedrooms all with en suite facilities. The external grounds are well maintained. CCTV cameras are fitted around the exterior of the building and this offers protection to residents, staff and visiting relatives. Barleycroft Care Home Ltd. DS0000062659.V336287.R01.S.doc Version 5.2 Page 23 A tour of the home was undertaken and the units were found to be well-lit, clean, pleasant and hygienic with no offensive odours. It was also apparent that residents are now using the two lounges on each unit. Specialist equipment such as hoists and handrails were evident, and any other equipment would be provided to enable a resident to maintain independence. There is a mixture of suitable baths and showers, which gives a resident choice. The toilet doorframes are painted in a different colour with appropriate signage to aid orientation for people living with dementia. All of the toilets were equipped with toilet paper, towels and soap, and hot water was plentiful. The manager and staff are proactive around infection control. The activities co-ordinator is continuing to find appropriate pictures and photographs for display in the corridors and sitting areas to provide points of interest for residents. Also she is continuing to expand on which touch and feel materials have been fixed to the walls of the corridors. Residents were able to walk around the home freely without being told to “sit down” by care staff. The rear garden area is laid to lawn, paving and flowerbeds and has sitting areas for residents, and has disabled access. During the course of the visit some residents spent time in the garden, as it was a warm day. Work has commenced on a sensory area of the garden, as this will enhance the pleasure of the garden for those residents living with dementia. A new staffroom has been created for staff to take their breaks and therefore they no longer need to use residents’ lounges for this. The laundry area was visited and this was found to be clean, with soiled articles, clothing and foul linen being appropriately stored, pending washing. The laundry personnel were aware of health and safety regulations with regard to handling and storage of chemicals. Personal Protective Equipment (PPE) such as clothing, gloves, goggles and facemasks were available and in use. There is a good system in place for the marking of residents clothing. Hand washing facilities are prominently sited throughout the home and staff were observed to be practising an adequate standard of hand hygiene. Barleycroft Care Home Ltd. DS0000062659.V336287.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels have been increased at peak times and are now satisfactory to meet residents’ needs. There is a commitment to training and the staff team have been provided with appropriate training to enable them to meet the needs of the residents. This includes the specific needs of people with dementia. The recruitment process has been tightened up and this safeguards residents as they are receiving care from people who are properly vetted. EVIDENCE: Since the last inspection additional staff are on duty in each unit at peak times in the morning and evening. Feedback from staff was that this has helped a lot and that there are now sufficient staff on duty. Some relatives still felt that there were not always enough staff on duty but acknowledged that this might be due to the fact that they did not know who was on duty and that staff were busy with residents in their rooms. It might be helpful to relatives and possible residents to have the details of who was on duty displayed on each unit. Overall the inspectors were satisfied that staffing levels are now sufficient to provide a safe and appropriate service for the residents. The Barleycroft Care Home Ltd. DS0000062659.V336287.R01.S.doc Version 5.2 Page 25 manager is aware of the need to keep this under constant review and does have the authority to increase staffing levels if a specific need arises. At the time of the random inspection in March 2007 it was found that some staff had been working excessively long hours and working without sufficient breaks between shifts. This has now been addressed by the manager and there was evidence that she is now monitoring the situation. There is a rolling programme of training that is facilitated by the senior qualified staff team and external trainers. Since the last inspection there has been a tremendous amount of additional training. This has included dementia awareness and dementia voice training to give staff the necessary skills to enable them to provide an appropriate service for people with dementia. Other training has included fall prevention, fire training, first aid, managing violence and aggression, medication and POVA. Staff are encouraged to undertake NVQ qualifications and 18 staff (excluding registered nurses) have achieved NVQ level 2 or above. Overall there is a commitment to training from both the organisation and the care staff. Staff have received appropriate training to enable them to safely meet the needs of the residents at the home. The recruitment procedure has been tightened up and the clinical operations Director or Quality & Support manager view all new staff files prior to a new starter commencing work. No new staff had been recruited since the last inspection. However, the inspector examined the personnel file of a member of care staff on the first day of their induction programme. This file was found to be in good order with necessary references, Criminal Records Bureau (CRB) disclosure, and application form duly completed. Therefore systems are now in place to ensure that residents are safeguarded. Two residents participated in the interviews for new staff and both enjoyed this. One resident said “I liked being involved and it was an interesting experience”. The other said “I was invited to sit on the panel by management. I think that it is a good idea for residents to have their say.” This is good practice and shows that residents’ views and opinions are sought and valued. Barleycroft Care Home Ltd. DS0000062659.V336287.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management team have worked hard to address the requirements made at the last key inspection and also to address concerns about the service. The result of this is that the management of the home is more robust and the quality of service provided to residents has improved. EVIDENCE: The manager is a qualified nurse with experience of managing services for older people in the private and public sector. The manager has achieved NVQ level 4 in care. Feedback from staff and relatives is that the quality of the service has improved since she has been managing the service. There has been a marked improvement in the service since the last inspection and it is Barleycroft Care Home Ltd. DS0000062659.V336287.R01.S.doc Version 5.2 Page 27 evident that the management team have been committed to this and that they have put systems in place to monitor and develop the service provided. The responsible individual undertakes Regulation 26 monthly monitoring visits regularly and a copy of the report is sent to the Commission. Festival Care actively canvass residents and their families twice a year to get their views on the service. Evidence of the survey being completed was provided to the inspector. In addition a quality and support manager has been appointed in the organisation and she has been conducting a full audit of the homes documentation and assisting the manager to improve the quality of the service. Therefore systems are in place to monitor the quality of the service provided. Currently the manager does not act as an appointed agent for any resident. Resident’s financial affairs are managed by their relatives/ representatives. The home does hold amounts of personal money which is used for newspapers, hairdressing, chiropody etc. The money is stored in separate wallets in the safe. There is a computerised financial system in place, which is managed by the home’s administrator. Secure facilities are provided for the safekeeping of money and valuables held on resident’s behalf. The money is accessed in the main by the administrative staff and the deputy carries out spot checks. Residents’ monies are securely stored and systems are in place in the home to protect residents from financial abuse. One of the inspectors was able to speak to the maintenance person and to inspect a wide range of maintenance records. This included fire safety, emergency lighting, water temperature checks and hoist maintenance. These records were found to be detailed, accurate and up to date. There is an effective system in place for the reporting of items requiring repair. A system of formal supervision is in place. Records are kept of staff supervision and staff spoken to confirmed that they receive regular supervision. Therefore staff receive the support that they need to carry out their duties appropriately. There are small serveries on each floor and at the time of the last key inspection some of the food stored in the fridges was not labelled or had exceeded their “best by” dates. This was still the case in one unit at the time of this visit. Relatives bring in items and these are stored in the fridge. It would appear that staff do not check or dispose of these items. The manager must clarify whose responsibility it is to monitor the cleanliness and appropriate storage of foods in servery fridges and ensure that food is appropriately wrapped and labelled and that out of date items are disposed of. It was suggested to the manager that she might like to raise this issue with relatives and explain that any out of date items would be disposed of as this is in the best interests of residents. Barleycroft Care Home Ltd. DS0000062659.V336287.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 3 2 Barleycroft Care Home Ltd. DS0000062659.V336287.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES 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 P7 Regulation 12, 13 Requirement Timescale for action 31/05/07 2. OP8 12 3. OP9 13 Call bells must be placed within reach of residents so that they can summon assistance when needed. If they are unable to use the call bell this must be recorded in their care plans along with details of how the individual will be checked to see if they are alright. (Previous date for compliance 31/1/07 not met) Fluid and repositioning charts 31/05/07 must be maintained accurately to ensure that residents are receiving sufficient fluids and are being repositioned when required to keep them comfortable and to help prevent pressure sores. 15/05/07 When directions for administering medications are variable, e.g. one or two tablets, 3 or 5 mls, then the dose given is to be entered on the MAR chart. This is to ensure that people receive the correct amounts of medication. (Previous date for compliance 31/1/07 not met) DS0000062659.V336287.R01.S.doc Version 5.2 Barleycroft Care Home Ltd. Page 30 4. OP38 16 The manager must clarify whose responsibility it is to monitor the cleanliness and appropriate storage of foods in servery fridges and ensure that food is appropriately wrapped and labelled and that out of date items are disposed of. (Previous date for compliance 31/1/07 not met) 31/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP1 OP11 Good Practice Recommendations It is recommended that a service user guide in a pictorial format be produced for the benefit of some of the people living with dementia. It is recommended that further use of the Gold Standard Framework and other models of care such as the Liverpool Care Pathway (LCP) and Preferred Place of Care be to be developed. It is recommended that staff receive training in supporting residents at the end of their live as this can be quite stressful and draining, as well as rewarding. 3. OP11 Barleycroft Care Home Ltd. DS0000062659.V336287.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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 Barleycroft Care Home Ltd. DS0000062659.V336287.R01.S.doc Version 5.2 Page 32 - 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. 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