Inspection on 03/01/08 for Barn and Coach House

This inspection was carried out on 3rd January 2008.

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

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 06/03/07

Barn and Coach House 12/05/06

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

Similar services:

Claremont House

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 and Coach House High Road Stifford Essex RM16 5UE Lead Inspector Kathryn Moss Unannounced Inspection 09:30 3 January 2008 rd 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.V358443.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. Barn and Coach House DS0000018117.V358443.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Barn and Coach House Address Barn and Coach House High Road 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.V358443.R01.S.doc Version 5.2 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. 6th March 2007 Date of last inspection Brief Description of the Service: The Barn and Coach House Residential Home provides care and accommodation for fifteen older people, including six people who suffer with dementia. The home is situated at the end of the village of North Stifford, close to Lakeside Shopping Centre and Grays Town. Accommodation is provided in eleven single bedrooms and two shared bedrooms, and the home has pleasant, homely lounge and dining areas. A stair lift that provides access to the first floor for people who are not able to climb the stairs, and the home has a bathroom equipped with a ceiling hoist to assist people who would be unable to get into a bath independently. The home is privately owned by Mrs Susan Merchant, and the registered manager is Ms Sharon Venton. A copy of the home’s Service User Guide is available within the home, and the current fees are £395 per week. Barn and Coach House DS0000018117.V358443.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. This inspection visit took place on the 4th January 2008, lasting eight hours. The inspection process included: discussion with the registered manager and the proprietor; inspection of a sample of staff and residents’ records; discussion with four staff members, three residents and a relative; a tour of the premises and observations of staff interactions with residents. Feedback surveys were also received from five staff and one relative. Inspection reports also draw on any other information relating to a service that has been received by the CSCI since the service’s last inspection (e.g. complaints, protection of vulnerable adult referrals, Annual Quality Assurance Assessments, responses to previous reports, etc.). What the service does well: Residents spoken to were very positive about the staff team at the Barn and Coach House. One person said that they thought the staff were ‘lovely’, and reported that ‘you only have to ask and they will get things for you’. During the inspection staff were observed to be caring and attentive towards residents, and it was positive to see staff spending time in communal areas with residents, and interacting well with them. The home has a small, stable staff team, which means that staff are able to get to know residents well. This was very evident from discussions with staff, who showed a good understanding of each individual and their needs, which ensured that appropriate support could be provided. Staff reported that they felt that the home ‘really felt like a home’, to them as well as to the residents. They said that they felt well supported by the manager and by other staff, which meant that they felt that they worked well as a team, and enjoyed their work. This was reflected in a friendly atmosphere in the home, and a relative also commented that they found the staff ‘cheerful and friendly’. Barn and Coach House DS0000018117.V358443.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The need to carry out all appropriate checks on new staff before they start work has been the subject of several previous requirements made of this home over the last few years. This is important in order to ensure that residents are sufficiently protected by the home’s recruitment practices. Whilst progress had been made regarding the issues previous identified, some pre-recruitment checks required by Regulation had still not been satisfactorily obtained by the home before staff started work. It is vital therefore that the home takes action to ensure that recruitment practices are rigorous. Service user plans provide evidence that the service understands what support each person needs, and ensure that staff have clear guidance on how to meet each person’s individual needs. Whilst it is noted that the home has a stable staff team who have good knowledge of each person’s needs and the support they require, care plans did not contain sufficient detail of the action required by staff to meet each person’s individual needs and therefore need to be developed further. As the home provides care to several people who suffer with dementia, the home needs to continue to develop dementia care practices and to ensure that care plans reflect any specific needs arising from an individual’s dementia. Barn and Coach House DS0000018117.V358443.R01.S.doc Version 5.2 Page 7 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. Barn and Coach House DS0000018117.V358443.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 Barn and Coach House DS0000018117.V358443.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 and 4. Standard 6 is not applicable at the Barn and Coach House. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents benefit from receiving sufficient information to enable them to make an informed choice about where to live. The home’s assessment process ensures that they can be confidant that the home will meet their needs. EVIDENCE: The home has a Service User Guide, which provides information about the home for prospective residents. This was not reviewed on this occasion, but copies were seen on the files of two people who had come to live in the home over the last year: these were noted to be dated 2002 and 2005 respectively, and referred to the CSCI by its former name. The proprietor confirmed that this document has been updated, and should therefore ensure that only current copies are issued to new residents in future. It was good to see the Barn and Coach House DS0000018117.V358443.R01.S.doc Version 5.2 Page 10 home’s new CSCI office address details added to a copy of the home’s complaints’ procedure displayed on the home’s notice board. The process for people coming to live in the home was discussed with the manager, who stated that they encourage prospective residents to first visit the home for a day, and that the manager also usually visits them in their own home environment. At this visit the manager gathers information about the person’s needs, and records this information. Files were viewed for two people who had come to live in the home over the last six months: both files contained contact information for other people involved in their lives, ‘profiles’, and a ‘daily living and needs assessment’. The daily living and needs assessment form covered relevant health and daily living needs, was in a clear format and contained appropriate information. These records provided information about each person’s key needs and abilities. Both files also contained other assessment information provided to the home, one from the local authority referring the person to the home, and the other from the person’s previous place of residence. This showed that the manager had obtained appropriate information prior to the person’s admission to enable them to determine whether they could meet the person’s needs. Staff consulted all felt that they had sufficient skills and experience to meet people’s needs, and an appropriate range of training had been made available to them (see Staffing section). Three people living in the home were spoken to during the inspection, and all were positive about the way staff supported them. Other people were observed to appear relaxed and content; when one person showed signs of confusion, the manager responded appropriately and sensitively. Two relatives provided feedback on the home, and both felt that staff had the skills and experience to look after people properly. The home is registered to care for six people who suffer with dementia: the four staff spoken to on the inspection showed appropriate understanding of dementia care issues and good knowledge of strategies for supporting individual residents. However, training records provided by the manager after the inspection showed that only seven out of the fifteen care staff (including the manager) had attended dementia awareness training. Barn and Coach House DS0000018117.V358443.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 and 10 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents’ benefit from care practices that ensure that their health and personal care needs are met, and that their privacy and dignity are upheld. EVIDENCE: A sample of three individual care plans were inspected on this visit. The home’s care records included a ‘Resident’s Care Plan’ form, which contained sections covering a range of daily needs, with space to record the action staff should take to meet each need. The care plans viewed addressed appropriate needs, but details of how staff should meet each need was generally quite brief. For example, in relation to ‘personal care and physical well-being’ one person’s care plan stated that they were ‘assisted up, washed and dressed and also assisted with bath and hair care’, but did not describe what actual assistance the person needed, what they could do for themselves, or any particular wishes. A care plan for someone who experienced mental health Barn and Coach House DS0000018117.V358443.R01.S.doc Version 5.2 Page 12 difficulties did not include any information on this, although their assessment identified some cognitive difficulties and review notes contained some good information on the person’s behaviour and a strategy for dealing with this. Care plans relating to people’s needs arising from dementia generally contained little detail about how to support these needs: however, staff spoken to showed good understanding of each individual, and were able to describe ways in which they helped them when they were confused or anxious. Reviews of care plans were being clearly recorded whenever a person’s needs changed: the manager is commended on clear and comprehensive review notes, which contained good information about the person’s changing needs. Routine monthly reviews were not being recorded, and the manager stated that this practice had been adopted following guidance on a previous inspection; she was advised to make a brief record to evidence that care plans are being reviewed monthly, even if no changes to care plans are required. The home recorded review notes on two different forms, and some additional information about needs and risks was also sometimes recorded on a ‘Care Plan Agreement form’ (e.g. evidence of support being provided to prevent pressure areas). It was noted that some needs were referred to in review notes but not included in the Resident’s Care Plan forms: the manager stated that initial care plans were not updated when needs changed, and that staff would refer to the review forms, one of which provided a brief summary of current needs and was considered to be the current ‘care plan’. However, this review form contained insufficient space to record comprehensive care plan information, and it was not clear from the file that the ‘Resident’s Care Plan’ form was not the current working care plan. Staff consulted felt that they had the knowledge and skills to meet people’s needs, and the two relatives consulted felt that the home usually gave the person living in the home the support and care they expected. Residents spoken to were positive about the staff caring for them, and daily notes reflected the personal care being given. Staff were observed being caring and attentive towards the people living in the home, and were respectful of their privacy and dignity. The home assesses risks relating to moving and handling and risk of falls, and training evidence showed that staff had received training in this subject. Healthcare needs were well met, with evidence of diet and weights being monitored, and of appropriate referral to healthcare services when required. The manager reported that the home had good support from local GPs and district nurses, and a few staff had attended training in relevant healthcare issues (e.g. continence care, palliative care, Parkinson’s Disease, etc.). No people living in the home had a pressure area at the time of this inspection, although one person was bed bound and was therefore at some risk: pressure relief equipment was in place and staff were monitoring the person’s skin and seeking advice from district nurses when required. No pressure area risk assessments were in use in the home, and pressure area Barn and Coach House DS0000018117.V358443.R01.S.doc Version 5.2 Page 13 preventative care was not detailed in this person’s care plan, although a risk assessment noted the equipment in use. The home is registered to care for several people who suffer with dementia. The manager and staff spoken to during the inspection showed a good understanding of dementia care issues, and of strategies for supporting specific people living in the home. Training records showed that only about half of the staff had completed dementia care training, and all staff need to complete this. The need to clearly record the strategies and actions required of staff to meet people’s needs arising from dementia (i.e. within care plans) was discussed with the manager. For people demonstrating challenging behaviours, there are not currently any formal systems in place for recording and monitoring any incidence of challenging behaviour (i.e. to monitor the frequency, and identify any triggers or solutions), other than as part of daily notes. The home’s administration of medication policy and procedure was not reviewed on this occasion. Senior staff spoken to showed an understanding of appropriate procedures, and demonstrated that they made an effort to find out what the drugs prescribed for each resident were for. Only the manager, deputy manager or senior carers administer medication: the manager stated that relevant staff had completed Safe Handling of Medication training with Thurrock Borough Council, and also a workshop provided by Boots; four staff were also due to start a distance learning medication administration course. Two senior carers spoken to during the inspection stated that they had not yet done medication training with the home, but had relevant previous experience and were booked to attend this training. The home does not currently have a system in place for assessing (and recording) staff competency at this task. Medication held within the home was seen to be stored safely; the home does not have a controlled drugs cabinet, but senior staff reported that no residents are currently prescribed any controlled drugs. Medication Administration Records (MAR) were pre-printed by the pharmacist with details of each medication. Medication received into the home was clearly recorded on these MAR; records of medication returned to the pharmacist were not inspected on this occasion. Records of medication administered to people living in the home were well-maintained, with drug administration consistently signed for, and no gaps observed. Barn and Coach House DS0000018117.V358443.R01.S.doc Version 5.2 Page 14 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 and 15 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents’ benefit from flexible daily routines and from opportunities to participate in activities. The home provides a varied and balanced diet. EVIDENCE: Routines within the home were flexible: at the start of the inspection it was good to see that two people had chosen to have a lie-in and were still in bed, and another two were still having their breakfast at 9.30am. Staff spoken to were clear that people could get up and go to bed when they wished, reporting that one person chooses to go to bed late and then gets up mid morning. Night staff spoken to reported that although they assist one person up before day staff come on duty, this is because the resident is awake and wanting to move, and that most people are assisted with their morning routines once day staff come on duty. Staff spoken to were clear about giving people choices, and were observed offering choices on several occasions during the day. Barn and Coach House DS0000018117.V358443.R01.S.doc Version 5.2 Page 15 Care plans were noted to have a section for recording the support that people need with ‘daily living and social activities’: in the sample viewed, these contained a general statement about encouraging people to participate in activities, and could be developed to be more individual and detailed. One file viewed contained some good information about the person’s likes and dislikes, although this information was not present on all files viewed. Daily reports included comments on how the person had spent their day, and showed evidence of activities taking place (e.g. for one person included listening to music, watching TV, sing-a-long, and puzzles). During the day of the inspection, staff were observed to be regularly present in the lounge area with residents, and to interact well with them. The deputy reported that she had completed a puzzle with one person that the morning, and in the afternoon staff were observed chatting to people and discussing plans to paint someone’s nails after tea. At various times the TV was on or music was being played. One service user spoken to confirmed that activities were available, and that they joined in with these. A suggested timetable of daily activities was written on a notice board in the lounge, which included: games and reminiscing, armchair exercises, sitting and chatting, hand massage, nails, sing-a-longs, etc. Staff said that whilst it could sometimes be hard to motivate some people to do activities, they were encouraged to spend time interacting with residents and felt that they had sufficient time to do this. The manager stated that some trips out of the home are arranged, with staff often coming in on their days off to assist; however, she stated that residents were often not interested in going on trips. When asked what they felt the home could improve upon, one staff member consulted felt that there could be more trips out. A visitor spoken to reported that they were able to visit the home at any time, and found staff ‘cheerful and friendly’. People living in the home were able to receive visitors in their rooms, and the home’s visitor’s book reflected regular visitors to the home. The manager send a monthly ‘newsletter’ to relatives to tell them about any events in the home, and also advises them of the date of a monthly ‘surgery’ when she makes herself available in the home to talk to any relatives. The home has a four-week lunch menu that provides a range of appropriate and balanced meals. Whilst there was only one choice of main meal each day, staff spoken to stated that the cook knows what people like and dislike, and will always do someone something different. Staff said that the cook asks people each morning if they are happy with the choice on the menu, and a resident reported that the cook often comes round and checks whether they have enjoyed the meal. Meals seen on the day of the inspection smelt and looked appetising. Drinks were served at regular intervals, and staff were seen to provide additional drinks at a resident’s request. Staff at teatime were observed offering people a choice of sandwiches and cakes, and making sure people had eaten enough. Staff reported that drinks and snacks (biscuits and Barn and Coach House DS0000018117.V358443.R01.S.doc Version 5.2 Page 16 cakes) are also offered to people during the evening. When asked what they felt the home does well, one staff member stated that they felt residents were ‘well fed, with home cooked meals, cakes, crisps, sweets and snacks whenever residents wants them’. Three residents were spoken to during the inspection, and all three were positive about the meals, with one person being clear that they could ask for something different if they did not like what was being served. Barn and Coach House DS0000018117.V358443.R01.S.doc Version 5.2 Page 17 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 and 18 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from practices and procedures that safeguard them and ensure that any concerns are listened to and addressed. EVIDENCE: The home’s complaints policy was seen displayed in the home, together with a label showing the new CSCI office address and phone number. The manager often works shifts in the home, and is readily available to both residents and visitors. Relatives consulted as part of this inspection did not have any concerns: both were clear that they could speak to the manager at any time, and one person felt that the home had responded appropriately if they had raised any concerns. Residents observed during the inspection were seen to be confidant to make requests to staff, and staff responded to these. The home has a complaints’ record book: this contained a few entries, but no entries had been made since 2005. Previous entries were for relevant concerns, and it was positive to see seen that even quite minor concerns had then been recorded and dealt with. In discussion with the proprietor, she was clear that she considered that all concerns should be recorded (not just formal complaints) but felt that the home may not have been recording these in recent years. A monitoring report submitted by the provider following the Barn and Coach House DS0000018117.V358443.R01.S.doc Version 5.2 Page 18 inspection showed that the proprietor had already pursued this issue, and that staff are to be encouraged to record all concerns, however small, in the home’s comments and complaints book. One complaint relating to the home had been received by the CSCI since the last inspection. Issues relating to the concerns raised by the complainant were reviewed during the inspection and also discussed with manager and staff, and no evidence could be found to substantiate these. No Safeguarding (or Protection of Vulnerable Adults (POVA)) concerns have been raised in the home over the last year. The home’s POVA policy and procedure were not viewed on this occasion, but the Annual Quality Assurance Assessment submitted by the home prior to the inspection showed that this policy was in place and had been reviewed just over a year ago. Staff spoken to during the inspection all felt able to raise any concerns with the manager, and were aware of the need to report concerns. Thurrock Borough Council had provided POVA training to staff: training records showed that ten of the fifteen staff currently employed at the home had completed this. Barn and Coach House DS0000018117.V358443.R01.S.doc Version 5.2 Page 19 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, 22 and 26 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents’ benefit from a home that is safe, well-maintained, clean and homely. EVIDENCE: On the day of the inspection, the home was warm and had a homely and comfortable atmosphere. Bedrooms viewed were all clean, tidy and well personalised, with evidence that people could bring their own furniture and possessions into the home. Free-standing privacy screens were seen in the shared bedrooms viewed. Décor varied: most rooms were in a satisfactory condition, but a few were beginning to be in need of redecoration. The manager confirmed that rooms are redecorated and carpets replaced when new people move into the home. Evidence of decoration and maintenance Barn and Coach House DS0000018117.V358443.R01.S.doc Version 5.2 Page 20 records were not viewed on this inspection; the manager stated that the home planned to decorate and re-carpet the landing area, and showed an awareness of some of the environmental issues relating to dementia care practices (e.g. signage, carpet patterns, etc.). The home was observed to have a range of equipment available that was appropriate to the needs the home aims to meet. The home has one bathroom with a ceiling track hoist over the bath, a mobile hoist (although few residents currently require the use of a hoist), and a stair lift. Toilets were equipped with toilet frames and grab rails, and wheelchairs were available. Bedrooms were equipped with call bells, and records showed that these are tested weekly. A pressure relief mattress was seen on one person’s bed. The Annual Quality Assurance Assessment submitted by the home prior to this inspection confirmed that a policy for preventing infection and managing infection control is in place in the home. This was not inspected on this occasion. Training records showed that just over half of the staff team had attended infection control training. Communal areas were free from any unpleasant odour, although a couple of the bedrooms viewed had slight odour where the resident experienced continence difficulties. To alleviate this, plugin air fresheners were seen to be in use in some rooms: the manager was advised to seek the advice of the fire officer on the use of these within the home. No bedrooms had ensuite toilets, and therefore rooms are equipped with commodes: the home lacks appropriate facilities for cleaning commode pans, and staff currently clean these in the laundry are. This has been recognised by the home as an area that needs to be addressed, and it was therefore positive to note that plans were progressing to install a sluice sink and macerator in a separate area of the home. The laundry contained a washing machine with wash cycles that met infection control requirements, and the home uses red bags to transport soiled linen into the washing machine, thus minimising the risk of the spread of infection. Barn and Coach House DS0000018117.V358443.R01.S.doc Version 5.2 Page 21 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 and 30 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides staff in sufficient numbers, and with suitable skills and experience, to ensure that residents’ needs are met. Residents are not sufficiently protected by the checks the home carries out on new staff prior to appointment. EVIDENCE: At the time of this inspection, the home employed fifteen permanent care staff (including the manager, who works regular shifts alongside carers). There are three care staff on duty throughout the day, and two at night; the home also employs a cook seven days a week, and domestic support on weekdays. The manager confirmed that they can be flexible with staffing if additional needs arise. Staff spoken to were committed to their work, and the manager stated that staff are usually willing to do extra shifts to cover shortfalls (e.g. through sickness); the home does not therefore generally use agency staff. Staff spoken to felt that the allocation of staff time throughout the day allowed them to provide flexible routines, and that service users could get up or go to bed when they wished. Three service users were spoken to, and all three felt that Barn and Coach House DS0000018117.V358443.R01.S.doc Version 5.2 Page 22 there were enough staff on duty to be able to provide them with assistance promptly whenever they needed help. Recruitment records were viewed for three staff recruited since the last inspection. All three had completed application forms that included their employment history and names of referees (including their last employer). Whilst there were no obvious gaps in employment histories, on two of the forms the applicant had only stated the years of their previous employments, not the months: the lack of detail regarding previous employment dates made it difficult to check for any gaps. No declarations of criminal record or of health had previously been obtained for staff: however, the proprietor demonstrated that she has now updated the home’s application form to include these two areas of information in future. Files viewed did not contain a photo of the person, but the manager provided evidence on other staff files that photos are normally obtained. All three files contained evidence of identification, two written references, and a Criminal Records Bureau (CRB) and POVA check; one reference had not been received before the person started work. All three staff had started prior to a full CRB check being received: in two files there was evidence that a POVAfirst check had been received before the person started work, but the third file did not contain evidence of a POVAfirst check. The manager was able to locate and provide evidence of this following the inspection, but it was noted that this had not been received before the person started work. On three previous inspections a requirement had been made of the home regarding recruitment checks in relation to ensuring evidence of identification, two references, and exploring any gaps in employment history. Whilst the specific issues previously identified had now been met, evidence of recruitment checks still did not fully meet regulatory requirements. All staff consulted as part of this inspection felt that their induction had covered ‘very well’ everything they needed to know when they started, with one person adding that “when I started working I was always with someone senior that I could go to if I wasn’t sure about anything, I never felt I was on my own”. The manager described the induction process as including an initial induction day covering orientation to the home, and three further induction days covering various care tasks. There was evidence of a checklist of issues covered each day, with comments by manager showing an assessment of the person. Whilst new staff complete the Skills for Care ‘Common Induction Standards’ skills audit to identify what prior experience and training they have, there is no specific evidence of the completion of the Common Induction Standards during the induction period, although the manager was aware of these standards and had information on these available in the home. Staff consulted were positive about the training provided by the home: all five who completed feedback surveys felt that they were given training that was relevant to their role and kept them up to date. Three of the staff spoken to Barn and Coach House DS0000018117.V358443.R01.S.doc Version 5.2 Page 23 during the inspection had been in post for less than a year, and reported that they had already attended training in POVA, moving and handling, fire safety, food hygiene and health and safety. The two relatives who provided feedback as part of this inspection both felt that staff had the skills to look after people properly. The Annual Quality Assurance Assessment completed by the home prior to the inspection showed that four staff have completed NVQ levels 2 or 3, and training records submitted by the home show that a further five care staff are in the process of completing this training. This should ensure that the home meets the standard for NVQ qualifications within the home. The manager stated that Thurrock Borough Council provide the home with training in key subjects (e.g. POVA, first aid, food hygiene, dementia, Parkinson’s Disease, medication, etc.), and also provide some training in other relevant topics (e.g. infection control, continence care, etc.). The manager explained that the home receives details of the training available, and is informed of spaces on courses that new staff can attend. Moving and handling training has previously been provided by an outside company, but the manager intends to train to deliver this training internally; fire safety training is delivered internally through a video training pack produced by the Fire Authority. The manager stated that some staff had recently completed some training in Infection Control, Health and Safety, and nutrition through a local college, and some were due to start some distance learning courses in the Safe Handling of Medication and in Palliative Care. Staff training records submitted by the home following the inspection showed varying completion of training, with some subjects having been completed by the majority of staff (e.g. moving and handling, food hygiene and first aid), and only 50-70 of staff having completed other subjects (e.g. fire safety, POVA, and dementia). Barn and Coach House DS0000018117.V358443.R01.S.doc Version 5.2 Page 24 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 and 38 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well-managed, and residents benefit from the knowledge and experience of the registered manager. The home is run in the best interests of residents, and health and safety practices protect staff and residents. EVIDENCE: The registered manager of the home has many years experience of both working in and managing a care home. She has previously completed the City and Guilds ‘Foundation Management for Care’, and is currently part way through completing the ‘Registered Manager’s Award’ (NVQ level 4 in Barn and Coach House DS0000018117.V358443.R01.S.doc Version 5.2 Page 25 Management). Her training record showed that she regularly attends other training and keeps up-to-date with all core training. The manager works shifts in the home each week, enabling her to work alongside other staff, observe staff practice, and get to know the needs of residents. All the staff spoken to during the inspection were very positive about the manager, finding her approachable and supportive. One person commented on the fact that the manager ‘would never ask you to do something she wouldn’t do herself’. Staff felt there was good teamwork in the home, and felt that the supportive and ‘home-like’ atmosphere meant that staff enjoyed working there and generally stayed working at the home for some time. Supervision records were not specifically inspected, but were seen present on some of the staff files viewed. Staff completing feedback surveys all confirmed that the manager gave them enough support and met with them to discuss how they were working, with two stating that they meet with the manager every two months, and three adding that they can speak to the manager at any time they need, including when the manager is off duty. The home had submitted an Annual Quality Assurance Assessment (AQAA) prior to the inspection: information provided on the AQAA was brief, and ‘plans for improvement’ for many outcome areas were quite limited in scope or detail. Feedback on the AQAA was given to the proprietor during the inspection. With regard to quality assurance practices in the home, the proprietor stated that the home previously sent feedback questionnaires to relatives several times a year to seek their feedback on the home, but did not receive many responses back. She reported that new survey forms were being implemented for service users, relatives and professionals, and a questionnaire seeking feedback about the home’s admission process was seen completed on one new resident’s file. The manager holds a monthly ‘surgery’ in the home when she is available to relatives to discuss any concerns. The proprietor provided evidence that she was actively exploring ways of monitoring aspects of the home’s performance: an assessment checklist was now being used to monitor some aspects of the home, and the proprietor was planning to implement a variety of other internal audit forms. Therefore, whilst quality assurance processes need further development, it was positive to note that the proprietor had already identified this as an area for action. Although the manager confirmed that the proprietor regularly visits the home, there was little evidence at the home of written reports of monthly monitoring visits by the proprietor (only three in the last year), as required by Regulation 26 of the Care Homes Regulations 2001. Despite this having been highlighted as a requirement on several previous inspections over the last three years, the CSCI had not received any Regulation 26 reports from the home since the last inspection; following discussion with the proprietor, one was submitted shortly after this inspection. These reports form an important part of the home’s quality assurance practices, demonstrating that someone who is not involved in the day-to-day care delivery is regularly monitoring the home and seeking Barn and Coach House DS0000018117.V358443.R01.S.doc Version 5.2 Page 26 feedback from staff and residents. A continued failure to complete these reports would be viewed as a failure to comply with regulatory requirements, and the CSCI would need to consider whether further action should be taken. The home does not look after any money on behalf of the people living at the home. The manager explained that where people need support with their finances, their relatives’ assist them. Most personal items are provided either by relatives (e.g. toiletries and clothing) or the home (e.g. sweets, flowers, drinks when out on trips, etc.). If a person needs other items the home will purchase these for them and invoice their relative: the home has a duplicate receipt book and provides relatives with receipts for any expenditure (e.g. chiropodist fees). Evidence of records relating to residents’ monies was therefore not inspected on this visit. The AQAA submitted by the home confirmed that the home has a Health and Safety policy and procedure that had been reviewed just over a year ago. This was not inspected on this occasion. Staff training records showed that staff are provided with appropriate health and safety training: records generally showed a good level of training completed, although indicated that not all staff had completed training in some areas of health and safety (e.g. fire safety and infection control). The home has a fire policy and a fire risk assessment; evidence was seen that a fire officer had recently visited the home and been satisfied with the outcome of their inspection. The home’s AQAA indicated that fire equipment had been serviced within the last year, and records seen on the inspection showed that the home carries out regular checks on fire alarms, fire doors and emergency lighting. Evidence of regular fire drills was maintained. The AQAA provided evidence that all utilities and equipment in the home had been serviced within appropriate timeframes. The home’s records showed regular internal checks on call alarm systems, and on hot water tap temperatures to ensure no risk of scalding. No specific checks were being carried out to minimise risk of Legionella: however, the proprietor had obtained a checklist relating to Legionella, and following the inspection submitted a Legionella risk assessment that indicated that weekly central hot water storage temperature checks are to be carried out, and shower heads cleaned. The home had a risk assessment relating to chemicals, but no other safe working practice risk assessments were in place within the home. Accident records were seen to be completed and maintained. Barn and Coach House DS0000018117.V358443.R01.S.doc Version 5.2 Page 27 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 2 x 3 3 x N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X 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 X 3 X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 2 Barn and Coach House DS0000018117.V358443.R01.S.doc Version 5.2 Page 28 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 OP29 Regulation 19 Requirement To ensure that residents are protected, all recruitment checks required by Regulation must be carried out prior to a new carer starting work. This particularly relates to ensuring that no staff start work before a POVAfirst check has been received, and to ensuring that information on prior employment dates is sufficiently detailed to enable the manager to check whether there are any gaps in a person’s employment history. This is a repeat requirement in relation to recruitment checks, although different issues have been highlighted on this occasion. Previous requirements have been made on several inspections. Timescale for action 31/01/08 Barn and Coach House DS0000018117.V358443.R01.S.doc Version 5.2 Page 29 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 OP7 Good Practice Recommendations The home should develop residents’ care plans, to ensure that they are person centred and contain sufficient detail about the support required by staff to meet each person’s needs, including needs relating to dementia care and to meeting social and recreational needs. The home should implement a system for identifying (e.g. through risk assessment) people at risk of developing pressure areas. Details of appropriate pressure relief intervention should be clearly recorded in their care plan. It is recommended that the home develop its practices in relation to assessing and monitoring dementia care needs (e.g. mental health monitoring tools, behaviour monitoring records, care plans relating to managing challenging behaviours, etc.). As part of staff training in the administration of medication, the home should implement a way of assessing that staff are competent at this task. It is recommended that the home consider what arrangements they might need to be in place in the event that a resident is prescribed a controlled drug (i.e. in relation to storing and recording controlled drugs). The manager should implement systems for evidencing that new staff cover the Core Induction Standards, and are assessed as meeting these, during their induction. The manager should ensure that all staff have completed all core training. It is recommended that the manager implement a clear system for summarising staff training, in order to enable her to easily review the staff team training, and to identify when updates are due. To protect staff, the manager should ensure that risk assessments are carried out for all safe working practices throughout the home, and the significant findings recorded. 2. OP8 3. OP8 4. 5. OP9 OP9 6. 7. OP30 OP30 8. OP38 Barn and Coach House DS0000018117.V358443.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Regional Contact Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 Barn and Coach House DS0000018117.V358443.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!