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Inspection on 18/03/09 for Barleycroft Care Home Ltd.

Also see our care home review for Barleycroft Care Home Ltd. for more information

This inspection was carried out on 18th March 2009.

CSCI found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Barleycroft Care Home Ltd. Spring Gardens Romford Essex RM7 9LD     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jackie Date     Date: 2 0 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Barleycroft Care Home Ltd. Romford Spring Gardens Essex RM7 9LD 01708753476 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : jemma@festivalcare.com Festival Care Homes Ltd care home 80 Number of places (if applicable): Under 65 Over 65 0 80 0 dementia old age, not falling within any other category physical disability Additional conditions: 80 0 80 The maximum number of service users who can be accommodated is: 80 The registered person may provide the following category of service only: Care Home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (of the following age range: 50 years and over) Dementia - Code DE (of the following age range: 50 years and over) Physical disability - Code PD (of the following age range: 50 years and over) Date of last inspection Brief description of the care home Barleycroft is an 80-bed home arranged over three floors and operated by Abbey Healthcare 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 Care Homes for Older People Page 4 of 31 Brief description of the care home 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 700 pounds per week, this range is dependant on whether the person requires residential or nursing care. 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. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was unannounced and took place over three days. This was a key inspection and all of the key standards were tested. Staff were asked about the care that people using the service receive, and were also observed carrying out their duties. People using the service were asked to give their view on the service and their experience of living in the home. All of the shared areas were seen and some of the individual bedrooms. Staff, care and other records were checked. Feedback questionnaires were sent to people who use the service, staff and other professionals. Completed forms were received from, or on behalf of, 10 people who use the service, 19 staff and three healthcare professionals. In addition people who use the service, 5 relatives and the GP provided verbal feedback during the course of the Care Homes for Older People Page 6 of 31 inspection. Services are now required to complete an AQAA (Annual Quality Assurance Assessment) and the completed form was received in March 2009. Information provided in this document also formed part of the overall assessment. We would like to thank the people living at Barleycroft, their relatives and staff for their input during the inspection. What the care home does well: What has improved since the last inspection? An extra activity organiser has been employed to work at weekends and this has extended the activities offered. There are now pictorial menus to help people to make choices. A relative helped with this by taking the necessary photographs. The GP now sees each person on a monthly basis and therefore health care needs are very well addressed. Some of the nurses have received training so that they can now take blood samples. This is much quicker and also less stressful for the people living at Barleycroft. End of life care plans are now in place for everyone and the GP said that the end of life care was running very smoothly. Relatives spoke of the kindness and support that they and their families had been given when someone passed away. The call bell system has been changed so that they now ring on individual floors and not all. This means that staff do not waste time checking if the call is for their floor and also that there is less noise and disruption. In addition there is now a cordless telephone system which means that staff can take handsets with them. Therefore they do not have to return to the office to answer calls and this has improved communication. There is a small residents committee who meet monthly to discuss any issues about the home. One of the committee said that he was very happy at Barleycroft and had Care Homes for Older People Page 8 of 31 never heard any serious or bad complaints. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People thinking of moving into the home 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 people being admitted to the home and therefore staff have sufficient information to fully meet peoples needs. People can therefore have confidence that the service will be able to meet their needs. Evidence: Standards 1, 2, 3 & 4 were tested. Standard six does not apply, the home does not provide intermediate care. The Statement of Purpose and the Service User Guide were examined. They have been updated and the Service User Guide now contains pictures and more simple language to assist people to understand the information. They both contain appropriate information to enable people who are considering moving into the home and their Care Homes for Older People Page 11 of 31 Evidence: 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. A relative said,the manager took time to thoroughly explain how Barleycroft operates and gave me all the information I required. I was shown around and all my questions were fully answered. Before anyone is admitted to the home an assessment of their needs is carried out by the manager or deputy manager. The documentation inspected for people 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 person and a number of files were examined. All records inspected had assessment information recorded and the information had been used to develop pre-admission care plans. We were satisfied that a full assessment of need is undertaken prior to people moving into the home, and that the manager would not admit anybody unless she was sure that the assessed needs of the individual could be met. Each person is provided with a contract/statement of terms and conditions when they move into the home and examples of these was seen in individual files. Surveys returned by people using this service or their relatives also confirmed that they had contracts. Therefore people do have information about the service that they are entitled to. The service does not provide intermediate care. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are identified and staff have clear information about how to meet these. People receive good personal care, excellent health and end of life care that meets their individual needs and preferences. The principles of respect, dignity and privacy are put into practice. Evidence: Standards 7, 8, 9, 10 & 11 were tested. For this inspection we visited each of the three units at this home. In each unit we checked the files of two people and also the medication. Each person has a detailed care plan that gives staff clear information on a persons needs and how to meet them. The care plans seen had been reviewed and when necessary updated on a monthly basis. For example one person used to be able to mobilise with a zimmer frame but due to a fractured hip now requires the support of two staff to mobilise. The care plans are linked to risk assessments that are also reviewed on a monthly basis. The care Care Homes for Older People Page 13 of 31 Evidence: plans cover all the necessary areas and this includes continence, social needs, cultural needs, sexuality and mobility. The risk assessments seen were appropriate to the individual and include moving and handling assessments, dependency assessments, bedrail assessments and nutritional assessments. Most of the care plans had been signed by the person or their relative. There are also nightcare plans in place and these confirm that attention is paid to individual needs and preferences. For example, for one person the night care plan states that the toilet light should be left on and the door open. It also says that she likes a cup of tea before she goes to sleep. All the people living a Barleycroft are registered with a local doctor and specialist help is received when needed. Records are kept of medical appointments and these show that people have checks from the optician, dentist and chiropodist. District nurses provide nursing support for the residential unit. The previous organisation paid for a general practitioner to be retained for the service and the new organisation have continued to do this. The GP visits each week and also when required. He also sees all of the residents at least once a month. The GP said that Barleycroft was a good service and the staff were very aware of patient issues and that in turn they made him aware of them. He also said that staff were helpful with whatever he asked and this includes statistical yearly checks that he has to carry out for asthma, diabetes and dementia. The doctor said that some of the nurses were now trained to take blood and that this was a positive thing. Feedback from other healthcare professionals was also very positive. The consultant psychiatrist said, the staff team are good in terms of asking for help and advice on health care needs and following the advice given appropriately. A community mental health nurse said, the home maintains a good standard of care whilst caring for individuals and for clients with severe physical and mental health problems. The chiropodist/podiatrist said, the care service has improved so much with regards to individual care. A relative said, my mum had to have a scan recently at hospital. The carer that went with her needed to know her well. He really made the visit to the hospital as stress free as possible and really put my mind at rest. He called me on my mobile to let me know how things went. The nurses spent time with me to explain mums medical problems and the action that needed to be taken. It was evident that people living at Barleycroft receive very good healthcare from the staff team and that staff support people to access other healthcare services as and when needed. We checked the medication on each floor. On the nursing units medication is administered by the nurses and on the residential unit by the senior carers that have been trained to do this. Each unit has a treatment room and medication is stored in appropriate locked facilities in the treatment rooms. Each treatment room also has an appropriate controlled drugs cabinet. On the top floor nursing unit the temperature of Care Homes for Older People Page 14 of 31 Evidence: the treatment room and of the medicines fridge are checked and recorded each day. The temperature of the treatment room was satisfactory but the medicines fridge temperatures were too low and this needs to be addressed so that medication is stored at the appropriate temperatures. Most medication is in a monitored dosage system and medication outside of this was stored in separate containers for each person. The medication was clearly labelled and the cabinet was neatly organised. Opening dates were recorded on creams and eye drops and confirmed that these were in date. Medication Administration Records(MAR) were appropriately kept and up-to-date. These also contained photographs of each individual and any allergies that they might have were highlighted in red. There was also a record of the signatures of staff who were able to administer medication. These are all good practice. Appropriate records were being kept for controlled drugs and each entry had two signatures as required. We counted the controlled drugs and the numbers agreed with the record. There is also a store of homely remedies on this floor. This is for the whole building and there is a letter signed by the doctor with regard to homely remedies and administration. On the middle floor, nursing dementia unit, the medicines fridge temperatures were satisfactory but the room temperatures were too high. A portable cooler was being used to keep the temperature to an acceptable level and quotes are being obtained for air conditioning. It is recommended that permanent arrangements are made to keep the temperature of this room at a more constant and acceptable level for the storage of medication. Appropriate records were being kept for controlled drugs and each entry had two signatures as required. We counted the controlled drugs and the numbers agreed with the record. Again a monitored dosage system is used with separate boxes for most of the medication not in the monitored system. This unit has two medicines trolleys and two sets of Medication Administration Records (MAR) so that each of the two nurses on duty can administer medication. This helps to speed up the process and makes it more manageable. However only one of the trolleys is secured to the wall when not in use. In the interest of medicines security and to meet legal requirements the medicines trolley must be tethered to a fixed point when not in use. Medication Administration Records(MAR) were appropriately kept and up-to-date. These also contained photographs of each individual and any allergies that they might have. There was also a record of the signatures of staff who were able to administer medication. A copy of the information signed by their GP about homely remedies was in the file. A new medication for one person had been handwritten on the record and signed by the GP. Again medication was very well-organised and staff said they were clear about good practice and had taken on board previous requirements and information from a pharmacist inspection. On the ground floor residential dementia unit the senior carers have received Care Homes for Older People Page 15 of 31 Evidence: medication administration training and are assessed for competency. The recorded temperatures for the room and for the medicines fridge were satisfactory. Appropriate records were being kept for controlled drugs and each entry had two signatures as required. We counted the controlled drugs and the numbers agreed with the record. Most medication is administered via a monitored dosage system. Medication Administration Records(MAR) were appropriately kept and up-to-date. These also contained photographs of each individual and any allergies that they might have. There was also a record of the signatures of staff who were able to administer medication. A copy of the information signed by their GP about homely remedies was in the file. For one person who sleeps very late their medication is now administered in the afternoon. This was discussed with and agreed by the GP. Overall the administration of medication is robust and in line with good practice and legal requirements. It was apparent in discussions with staff that they are able to care for people at the end of their life and that they would treat people with care and dignity. End of life care plans have been developed throughout the home and staff have received training in this area. The service has been working towards accreditation for end of life care and preferred place of care. This was unfortunately delayed due to the change of ownership but it is hoped that this will be achieved later this year. The GP is very much involved in the end of life care program and in best interest decisions. He said that end of life care ran smoothly with all of the needed paperwork. A relative spoke of the kindness and good care that her mother was given at the end of her life and also of how well her father was supported after her mothers death. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People continue to be offered a range of activities in the home and on occasions in the community and this is an ongoing development. Family contact and contact with the local community is encouraged and visitors are welcomed at the home. As far as possible people are helped to exercise choice and control over their lives and how they spend their time. Evidence: Standards 12, 13, 14 & 15 were tested. The service employs a full-time activity coordinator from Monday to Friday and there is now a weekend activity coordinator. The full-time activity coordinator has a qualification in dementia care. There is an activity programme with visiting entertainers and people have the opportunity to go out to various events. For example a professional storyteller comes in on occasions and at this time children from the local school join them. Some people went to Southend for a day trip, others went to the Care Homes for Older People Page 17 of 31 Evidence: dogs and the end of March people were due to go to Queens Theatre to see Sweeney Todd. The Council for music in hospital, which is a group of professional musicians, have visited twice. There are links with the local primary school and people went to the school to see a school concert and also a group from the school came to sing carols. Celebrations are organised for all occasions including Christmas and Easter, Halloween, Valentines Day, Mothers Day and Fathers Day. For example on Mothers Day each lady was to be given flowers and there was a special meal. At Christmas each person is given a gift on Christmas morning. A quarterly newsletter is produced and this contains photographs of all sorts of events. There are a lot of photographs around the home as well. Last year zoo lab visited the home bringing a variety of different animals. There are pictures of people holding snakes, rabbits and other animals. Activities are not necessarily group activities. For example the activity coordinator will usually take one of the gentleman to see his wife who is staying on one of the other units. With some of the people that are cared for in bed the activity coordinator may just talk to them or read to them. Theres also a small sensory room and the activity coordinator does aromatherapy massages. The activity coordinator has made links with a sixth form college with a view to students being involved in arts and crafts at the home. There is now a small residents committee of six people. They look at food, care, activities and any other business and their views are sought as far as possible. Relatives can visit whenever they wish to and during the two lunchtimes we observed people being assisted to eat by their relatives. A relative said, the home is very welcoming, there is a real sense of family. One of the relatives took the photographs that are now used for the pictorial menus. The quarterly newsletter gives people information about what has happened and what is planned. Recently a workshop on dementia was run by the Alzheimers Society for relatives. Every effort is made to involve families although this is not always taken up. We observed lunchtime on the ground floor and the first floor units. Menus are varied and are now available in a pictorial format. On both floors the tables were laid with tablecloths and people had matching napkins. One of the people living at Barleycroft on the ground floor often helps with this. On the ground floor there was also condiments and menus on the table. People were served individually and offered a choice of what they wanted. One person decided against the dinner and kitchen staff prepared a sandwich for her. People were offered a cold drink with their meal but there was only orange juice and it is recommended that a choice of drinks, including water be made available with meals. A lot of people needed support and staff sat with them encouraging them or feeding them as necessary. One person said he liked the food and that it was very good. A relative spoke of the support and encouragement that Care Homes for Older People Page 18 of 31 Evidence: staff had given her mother to eat and drink. She said that staff had gone out of their way to find something that she particularly liked and had spent time encouraging her to drink just a small amount at a time. The meals were served from a hot trolley that had been sent down from the kitchen. Staff were observed to check and record the temperature of the meals before they served. The meals are pureed if required. We also visited the kitchen to talk to the chef. The kitchen was clean and foods were stored and labelled appropriately. The kitchen was well organised. The kitchen staff had a list giving details of the dietary needs of people living there. The necessary records were kept including fridge, freezer and food temperatures. There was also a good stock control and use by system in place. There was a good stock of fresh, dried and frozen goods. Recently it had been identified that the fridge was not working properly and it was replaced. The chef in charge of the kitchen works from Monday to Friday and there is also a weekend chef. Care Homes for Older People Page 19 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Barleycroft are safeguarded by the working practices and support of the staff team. In addition their rights are actively promoted. Evidence: There is a written complaints policy and procedure displayed in the reception area. There is a complaint box on the wall were relatives can leave complaints or comments. Complaints received are documented and the action taken to investigate the complaint is recorded by the manager. Complaints forms are available on each floor to make it easier for people to complain if they wish to. However for most people living at Barleycroft it would be very difficult for them to complain due to their dementia. After discussion with relatives a new form was devised for missing clothes/items as relatives felt that it was not appropriate to use the complaints form for this. We checked the complaints records and this confirms that complaints had been appropriately noted and investigated. One of the people living at Barleycroft said that he had never heard any serious or bad complaints. A relative said, all staff, nurses and managers are always available to talk to. Another said, Jemma (the manager) has an open door policy and I know that if I ever have a problem she is always available. The home has policies and procedures for safeguarding people from abuse. Staff have had safeguarding training and are very aware of safeguarding issues and their responsibilities. Staff also talked about MCA (Mental Capacity Act) and DOL Care Homes for Older People Page 20 of 31 Evidence: (Deprivation of Liberty) training and were also aware of those issues and its impact on their work. IMCA (Independent Mental Capacity Advocates) have been used to advocate when people have not been able to express their wishes. The manager is very clear about individual rights and responsibilities and advocates for people. The section on staffing later in this report gives information that confirms that there is an appropriate recruitment procedure and this also helps to safeguard people living in the home. The home does not deal with peoples overall finances, but some people have small cash amounts held in safekeeping . The section on management and administration gives more details on this and confirms that systems are in place to safeguard people from financial abuse. The manager audits and monitors accident records and prepares a summary on this. She checks for any recurring patterns and addresses any issues that arise. Care Homes for Older People Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean and comfortable home that is suitable for their needs. Evidence: Standards 19, 20, 21, 22, 23, 24, 25 & 26 were tested. 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 three separate units, one on each floor. There are 80 single bedrooms all with en suite facilities. The gardens are well maintained and used by people living at Barleycroft. On day of visit one person was in the garden with the activity coordinator cleaning some garden furniture ready for use. There is a sensory part to the garden and garden furniture and umbrellas. The garden at the front of the building has been improved and there is now a water feature and a bench. CCTV cameras are fitted around the exterior of the building and this offers protection to people using this service, staff and visiting relatives. A tour of the home was undertaken and the units were found to be well-lit, clean, pleasant and hygienic with no offensive odours. Specialist equipment such as hoists and handrails were evident, and any other equipment would be provided to enable people to maintain independence. There is a mixture of suitable baths and showers, Care Homes for Older People Page 22 of 31 Evidence: which gives people a choice. Some bathrooms have been repainted with friezes and are more homely. The toilet doorframes are painted in a different colour with appropriate signage to aid orientation for people living with dementia. There are signs and photos on doors and photographs and sensory boards around the building. 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. There is an ongoing maintenance and decorating programme. The handymen confirmed that he was due to start decorating some of bedrooms the next week. Specialist equipment is available including hoists and handrails. Pressure relieving mattresses are in place for those requiring this and most people have profiling beds. Since the last inspection the call bell system has been changed to one that rings on the individual floor and not on all floors as previously. The telephone system has also been changed so that staff can take handsets with them and do not have to return to an office to answer the phone and this has improved communication. Hand washing facilities are prominently sited throughout the home and staff were observed to be practising an adequate standard of hand hygiene. Care Homes for Older People Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported and protected by the recruitment practices of the service. People are supported by a caring, competent and well trained staff team. Evidence: Standards 27, 28, 29 & 30 were tested. At the time of the visit there were 71 people living at the home. On the top floor which is the nursing unit there were 17 people and staffing levels on this unit were one nurse and three carers during the day and at night there is one nurse and two carers on duty. On the middle floor there were 27 people, this is a dementia nursing unit. The staffing levels were two nurses and four carers during the day and one nurse and two carers at night. The ground floor is a residential dementia unit and there were 27 people. The staffing was one senior carer and three carers on duty during the day and one senior carer and two carers at night. In addition there are ancillary staff including domestic and catering staff, a handyman and a gardener. Theres also an activity coordinator and office staff. Staff spoken to all said that staffing levels were sufficient for the people that they have at present as there are vacancies on each floor. There is an ongoing training programme which is facilitated by senior qualified staff Care Homes for Older People Page 24 of 31 Evidence: and external trainers. Records show that the staff have all of the required mandatory training and also specialised training. For example induction, fire safety, health and safety, food hygiene, moving and handling, first aid, infection control and dementia awareness. Four staff have completed advanced dementia training. Three of the nurses have completed venepuncture training to enable them to take blood samples. Also equality and diversity, safeguarding, nutrition, the Mental Capacity Act and medication. Sixteen of the care staff have completed NVQ level 2 or above and a further nine are working towards this. In addition three of the bank staff have completed NVQ level 2 or above. Staff said they have had a lot of training over the last couple of years and that they have learnt a lot. They said that they felt confident in the knowledge that they had and that they were being kept up-to-date with what was new. Another member of staff said, my induction covered everything that I need to know about my job. On top of that we were made familiar with the structure of the building in case of emergencies such as fire. A random sample of staff files were checked and this included two staff who had started quite recently. The files are very well-organised and contained recruitment, training and supervision records. Files seen had POVA (Protection of Vulnerable Adults) first checks when appropriate. Also CRB(Criminal records Bureau) checks, application forms, references and confirmation of identification. There were also interview questions, appraisals and personal development plans. The manager had record of nurses PIN numbers and confirmation that the appropriate checks had been carried out for this. A member of staff said, yes they did process my CRB and I had to wait until it was out and then I started work. Therefore a robust recruitment process is in place. Observations at the time of the inspection were that staff were patient and kind to the people in their care and there was a calm and relaxed atmosphere. Feedback from a health professional was, the care service is experienced in dealing with dementia/the ageing process and respect every individual of any race and religion. Another said, the home has employed a good team who work well together. The environment in the home is friendly and caring. My experience of most staff is that they are skilled and caring. Feedback on behalf of a person living at Barleycroft was, the care and support both my family and myself receive is of the highest standard. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Barleycroft benefit from a home that is very well managed and organised and where their rights and well being are actively promoted. They live in a safe home. Evidence: Standards 31, 32, 33, 35, 36, 37 & 38 were tested. The manager is a qualified nurse with experience of managing services for older people in the private and public sector. She has achieved NVQ level 4 in care. Feedback from staff and relatives was that the service has continued to improve under the leadership of the manager. From discussions with the manager it is obvious that she is aware of what is good practice and that she advocates very strongly for the people in her care. She has also put systems in place to monitor the quality of care provided on a regular basis. For example audits and random checks. Evidence was seen of both. There is also a system in place for monthly awards. One for employee of the month and the Care Homes for Older People Page 26 of 31 Evidence: other for floor of the month. Staff said: Jemma has brought big changes and a lot of training. The service continues to get better and the support is very good. The management give us very good support. Jemma makes changes that are better for the residents. Jemma is firm but fair. Relatives said: staff, nurses and managers are always available to speak to. I have seen the home go from strength to strength over the past three years. Heathcare professionals said, the home has employed a good team of management and staff who work well together. Barleycroft is a good, well run home. The managers does not act as an appointed agent for any of the people living at Barleycroft. Their financial affairs are managed by their relatives/representatives. The home holds small amounts of personal money which is used for such things as newspapers, hairdressing and chiropody. The money is stored in separate wallets in the safe. A computerised financial system is in place and is managed by the homes administrator. Secure facilities are provided for the safekeeping of money and valuables held on peoples behalf. The money is accessed by the administrative staff and the management team carry out spot checks. Evidence of this was seen and the last check had been carried out by the manager on 17th March. The cash held for six people was checked and amounts recorded tallied with cash held. Peoples monies are securely stored and systems are in place to protect them from financial abuse. The system of formal supervision is in place and records are kept of staff supervision. Evidence of this was seen in the staff files examined. Staff spoken to confirmed that they received regular supervision and very good support. Also that staff meetings are held. Therefore staff have the opportunity both collectively and individually to discuss work practice, any concerns and the development of the service. The maintenance person carries out the required health and safety checks and records of these were detailed, accurate and up-to-date. Hot water temperatures are checked monthly at all outlets. Wheelchairs are checked monthly and this check includes tyres, brakes and frames. Bed rails are also checked monthly to ensure that they are in the correct position, joints are safe and for wear and tear. The fire call points are checked weekly and three fire drills were held in 2008. The door magnets are also checked regularly. The service benefits from having a competent and regular handyperson. In addition to this the necessary checks are carried out by other professionals. Portable appliance testing was carried out in June 2008, nurse call system serviced in October 2008, the lift in August 2008, the fire alarm system in February 2009, the gas safety in June 2008. There was also a satisfactory statutory health and safety check in January 2009 and a satisfactory food safety inspection in August 2008. Care Homes for Older People Page 27 of 31 Evidence: In 2008 Festival Care, the organisation responsible for Barleycroft merged with Abbey Healthcare who are now responsible. There was evidence that monthly monitoring visits had been carried out and these covered the necessary areas and confirmed that systems are in place to monitor the quality of the service. Some relatives voiced concerns about the change of company and the lack of information that they received about this. There have been some changes to staff terms and conditions and to management arrangements. For example the the Deputy Manager was fully supernumerary under the previous organisation. He is now working on the floors and has 8 hours supernumerary on a weekly basis. Relatives were concerned that this would affect staff retention and the quality of the service. They are also concerned that staffing levels will be reduced. The quality of care and of the service provided has improved immensely and people have been receiving an excellent service. It is important that any changes are not detrimental to this. A representative of Abbey Healthcare met with relatives recently but it is evident that more work is needed to restore relatives confidence. Care Homes for Older People Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The medicines fridge on the top floor must be adjusted, repaired or replaced. So that medicines are stored at the correct and required temperatures. 15/05/2009 2 9 13 All medicines trolleys must be tethered to a fixed point when not in use. In the interest of medicines security and to meet legal requirements. 30/05/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 It is recommended that permanent arrangements are made to keep the temperature of the treatment room, on the middle floor, at a more constant and acceptable level for the storage of medication. It is recommended that a bigger range of drinks is available at mealtimes so that people can be offered a choice. 2 15 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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