Inspection on 12/05/06 for Barn and Coach House

This inspection was carried out on 12th May 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Barn and Coach House 03/01/08

Barn and Coach House 06/03/07

Barn and Coach House 10/11/05

Barn and Coach House 30/06/05

Barn and Coach House 21/01/05

Barn and Coach House 26/07/04

Barn and Coach House 27/01/04

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Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Barn and Coach House Barn & Coach House High Road North Stifford Essex RM16 5UE Lead Inspector Jacqueline Graves Key Unannounced Inspection 12th May, 2006 09:15 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 Barn and Coach House DS0000018117.V290893.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Barn and Coach House DS0000018117.V290893.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Barn and Coach House Address Barn & Coach House High Road North Stifford Essex RM16 5UE 01375 383543 01375 387715 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Susan Carol Merchant Ms Sharon Maureen Venton Care Home 15 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (15) of places Barn and Coach House DS0000018117.V290893.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home provides accommodation and personal care for up to 15 Older People over the age of 65 years. The home provides accommodation and personal care for up to 6 service users with dementia over the age of 65 years. 10th November 2005 Date of last inspection Brief Description of the Service: The Barn and Coach House Residential Home provides care and accommodation for fifteen older people. It has eleven single bedrooms and two shared rooms. Each bedroom has a call bell facility and T.V. point. The home has a stair lift, which provides access to the first floor, for people who are not able to climb the stairs. The home has a large garden to the front of the property and some car parking space. The home is privately owned. It is situated at the end of the village of North Stifford and is close to Lakeside Shopping Centre and Grays Town. Barn and Coach House DS0000018117.V290893.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over three and a half hours and involved case tracking two residents, looking at care plans and some other records, talking to residents, relatives and staff and observing lunch and everyday life in communal areas. Some bedrooms and bathrooms were inspected. The home was asked to complete pre-inspection information so that some aspects of the home could be assessed through this; the home did not return the questionnaire. Questionnaires were left for some residents, health professionals and relatives who visit the home to gauge their views, and time allowed for their return. By the time of writing this report, three relative/visitor questionnaires had been returned. Comments from these are incorporated into the report. The manager was on annual leave so the deputy assisted with the inspection. The inspector would like to thank her, the staff and residents for their help with the inspection. What the service does well: What has improved since the last inspection? Increased training for staff has been provided with better staff attendance. The home has responded to some requirements and recommendations. Barn and Coach House DS0000018117.V290893.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Barn and Coach House DS0000018117.V290893.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Barn and Coach House DS0000018117.V290893.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,4,6 Further signs to help people find their own rooms would help those who have dementia. EVIDENCE: Staff mentioned that a trainer had advised them to work with people who have dementia by orientating them to their real situations. This goes against most current ways of thinking and staff felt this was not good practice. The home has put signs on some doors to help people, who have dementia, recognise their own rooms. Staff said that a religious representative visits the home once a month to hold a service for those residents who wish to attend. The inspector was advised that no residents wish to go out of the home to attend a place of worship at the present time. Residents’ files showed that they had been supplied with service user guides, containing statements of terms and conditions, when moving into the home. One had a contract, which had been partly completed. It was not possible to Barn and Coach House DS0000018117.V290893.R01.S.doc Version 5.1 Page 9 determine if the person was purchasing their care privately but if so, a contract must be provided. The inspector was advised that the home does not accept people for intermediate care. Barn and Coach House DS0000018117.V290893.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,11 The home provides access to health professionals. Arrangements are made to meet the last wishes of residents. EVIDENCE: The care plans of two residents were checked. One showed a detailed social history of the resident, which would be very useful to staff in working with them. Staff have received training in death, dying and bereavement to help them manage this difficult aspect of caring. Staff are offered extra support when needed. On those care plans checked, the last wishes of residents had been recorded. There was a record of visits by health professionals to both residents. Barn and Coach House DS0000018117.V290893.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,15 Some activities take place in the home with limited opportunities to mix with others in the community or to go out. EVIDENCE: A menu is written to show each day’s meal. Some residents ate at tables in the lounge, where they remain all day, while the majority ate at tables in the dining room. All residents had the same meal on the day of the inspection. Staff advised that an alternative would be provided for anyone who did not want the main meal. One resident found large portions of food off-putting and staff said they serve them small portions. However, the portion was too large on the day of the inspection and staff had to remove some food. A temporary cook was in place to cover leave; staff reported that good home cooking was produced and the residents consulted about their food preferences. Barn and Coach House DS0000018117.V290893.R01.S.doc Version 5.1 Page 12 Activities are dependent on the staff on duty at the time. Staff said they were planning a party for July and had taken residents to a shopping centre and for lunch out at Christmas time. Residents do not have opportunities to go out routinely unless they have relatives to take them. The T.V. and radio were on in the morning and staff chatted with residents. Staff said they try to spend extra time talking with those residents who now remain in their rooms at all times. Sometimes they organise singsongs, play games or paint ladies’ nails. When asked about activities for those residents who have dementia, the staff said they use pictures and songs to reminisce, and stroke people’s hands to show that they are engaging with them. They found that one resident liked to carry out light housework but could no longer do this. Staff were observed to find ways to interact with those people who have dementia. Barn and Coach House DS0000018117.V290893.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The home has made staff aware of how to protect vulnerable adults. EVIDENCE: Training for staff on the protection of vulnerable adults has been provided. Staff felt the training was useful. No reports or allegations of abuse have been made to CSCI. Barn and Coach House DS0000018117.V290893.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22,24,25,26 People are able to personalise their rooms. Attention to noise levels in the lounge and the possibility of a loop system would improve the environment for those residents who have hearing difficulties. Additional handrails would help people to move more independently around the home. EVIDENCE: A visitor showed the inspector their relative’s room and said they were pleased with how it was kept clean and tidy by staff. This and other rooms seen, showed that residents are able to personalise their rooms with their own possessions. All those areas of the home inspected were free from unpleasant odours. Some communal areas of the home are in need of redecoration. There is a pleasant garden to the front of the property, which one resident and their relative were using on the day of the inspection. As the garden is not secure, most residents have to be accompanied there by staff. Staff said they Barn and Coach House DS0000018117.V290893.R01.S.doc Version 5.1 Page 15 try to take residents out to the garden in warmer weather to get some fresh air and sunshine. In the large lounge, a resident complained about a banging noise; staff advised this was a door. The inspector thought the noise levels in the large lounge, from a T.V and music playing simultaneously, would have been overwhelming for those residents who wear hearing aids/having hearing impairments. As observed at the last inspection, there are handrails in places around the home but no handrails in the corridor to assist people. The inspector watched a resident grabbing at staff where there were no handrails, to try to keep their balance. Some lights, which were not working at the last inspection, had been repaired. However, bedside lighting in a shared room was not working and was not available in another bedroom seen. It was also noticed in the shared room that although there is curtaining around the sink area, there is no curtain / screening when someone is using the commode, to offer them privacy. Bathrooms were clean. Hand towels were in use, which present a risk of cross infection. There are paper towel dispensers, but, as highlighted at the last inspection, these would be very difficult for elderly people to use; the inspector could not get any paper towels out. Some toiletries and a face cloth were stored communally and could possibly be shared which is unhygienic. Barn and Coach House DS0000018117.V290893.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30, Training is provided to help staff work safely and competently. Improvements to the way staff are recruited would help ensure residents, safety. EVIDENCE: Staff described attending recent training on the protection of vulnerable adults, death, dying and bereavement, moving and handling, first aid, dementia and reminiscing. They felt the training had helped them in their role but queried the validity of some of the things they had been advised regarding the care of people with dementia (see standard 4). The home does not yet have the minimum of 50 staff trained to NVQ Level 2. There was a vacancy for night staff, which was being advertised. The inspector was advised that day staff cover the vacancy as staff wish to earn extra money and the home prefers not to use agency staff. Staff said that at times they can feel stretched, but felt they could meet all residents’ needs. They felt they worked well as a team and supported each other. In questionnaires, three relatives said they felt there were always sufficient numbers of staff on duty. It was reported that the home has a gardener and the proprietor carries out repairs and redecoration. Barn and Coach House DS0000018117.V290893.R01.S.doc Version 5.1 Page 17 The way the home recruits staff was checked. It was found that a declaration made before a Criminal Records Bureau check did not match the result of the check and that no references had been obtained. Neither was there a copy of a passport, birth certificate or a photo as evidence of identity. Barn and Coach House DS0000018117.V290893.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,36,38 The fire service identified shortfalls in fire safety, which must be responded to so that residents and staff are kept safe. By reporting on unannounced visits to the home, the provider could improve the quality of the service provided. EVIDENCE: Examination of staff files showed that staff supervision is recorded. The deputy confirmed that she and the manager carry out supervision. As the manager was not present it was not possible to check if she receives regular supervision by the provider. Staff said they are shown a video on fire safety and carry out drills, although records of these could not be found at the time of inspection. Records were seen of checks of water temperatures to prevent the risk of scalding and Legionella and of tests of fire systems. Essex Fire Authority reported shortfalls Barn and Coach House DS0000018117.V290893.R01.S.doc Version 5.1 Page 19 in fire precautionary arrangements, which had been noted on numerous occasions. The deputy advised that these were being addressed. Staff said that the provider frequently visits the home but only one official report of a visit to monitor the home has been sent to CSCI since this was required at the last inspection. Barn and Coach House DS0000018117.V290893.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 X 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 X X 2 X 2 2 1 STAFFING Standard No Score 27 3 28 X 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 1 X X 3 X 2 Barn and Coach House DS0000018117.V290893.R01.S.doc Version 5.1 Page 21 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. 2. Standard OP2 OP12 Regulation 5(1)(c) 16(2)(m) Requirement If residents are paying for their care privately, check that they have a contract. Facilitate local/community activities, for example shopping, should residents require this. Previous timescales 1/9/05, 01/02/06 partly met That sufficient handrails are provided and paper towel dispensers are suitable for use by elderly / infirm people. Timescale 01/05/06 not met That the possibility of a loop system to assist those residents with hearing difficulties is explored. Provide screening in shared rooms to ensure that people can use a commode in privacy. Ensure rooms have sufficient lighting. Previous timescales of 12/7/05 and 01/01/06 not met Provide a means of hand washing and drying in the laundry. Residents toiletries must not be stored communally. Previous timescales of DS0000018117.V290893.R01.S.doc Timescale for action 01/08/06 01/08/06 3. OP22 23(2)(n) 01/08/06 4. 5. OP24 OP25 16(2)(c) 13(3) 01/08/06 01/08/06 6. OP26 16(2)13(3 ) 01/09/06 Barn and Coach House Version 5.1 Page 22 7. OP29 19(1)(a)( b)Sch.2 12(5)(a) 8. OP32 9. OP33 26(1)-(5) 1/8/05 and 01/01/06 not met Provide an individual means of hand drying, which older people can practically use, in communal bathrooms, to prevent the spread of infection. Carry out all required recruitment checks. Previous timescales of 15/7/05 and 01/03/06 not met The registered provider should maintain good personal and professional relationships with staff. Previous timescale of 4/3/05 not met and 01/02/06 not inspected The registered provider, or their representative, must visit the home in line with this regulation and must supply a copy of the report of the visit to CSCI and the home. Previous timescales of 4/3/05 and 26/7/04 not met as only one report of a visit has been supplied since the last inspection Comply with the Fire Precautions (Workplace) Regulations 1997 (as amended) - in this case to ensure that fire doors are maintained-as requested by Essex Fire Authority. 01/07/06 01/09/06 01/08/06 10. OP38 12(1)(a) 23(4)(a) 01/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP22 Good Practice Recommendations Consider the impact of noise levels on residents. Provide further signs to help those with dementia find their own DS0000018117.V290893.R01.S.doc Version 5.1 Page 23 Barn and Coach House 2. OP4 2. 3. 4. 5. 6. 7. OP9 OP15 OP19 OP24 OP26 OP28 room. That as the home is maintained and redecorated, consideration is given to current good practice regarding helping people with dementia find their way around the building and identify their own rooms. Consider the impact of noise levels on residents. Provide further signs to help those with dementia find their own room. That as the home is maintained and redecorated, consideration is given to current good practice regarding helping people with dementia find their way around the building and identify their own rooms. That photos of residents are on medication records to assist identification. Not inspected Food should be presented in a manner that is attractive and appealing – this refers to the request for smaller portions to be served to one resident. Redecorate those communal areas of the home that are in need of redecoration. Provide bedside lighting in the absence of residents own provision. The home should have a sluice facility that is separate from the laundry. A minimum of 50 staff obtain NVQ Level 2. Barn and Coach House DS0000018117.V290893.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: 0845 015 0120 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 Barn and Coach House DS0000018117.V290893.R01.S.doc Version 5.1 Page 25 - 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. 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