CARE HOMES FOR OLDER PEOPLE
Barn and Coach House High Road North Stifford Essex RM16 5UE Lead Inspector
Jacqueline Graves Unannounced Inspection 6th March, 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Barn and Coach House DS0000018117.V332261.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.V332261.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Barn and Coach House Address High Road North Stifford Essex RM16 5UE 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) 01375 383543 01375 387715 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.V332261.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. 12th May, 2006 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.V332261.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key inspection site visit took place over several hours. The inspector spoke to some residents and observed others, spoke to the manager and some staff, toured the premises and examined some records. The care of two residents was case tracked. Pre-inspection information was provided by the home. In addition, five surveys were returned from relatives/friends, four from residents and one from a G.P. The inspector would like to thank staff and residents for their help with the inspection. What the service does well: What has improved since the last inspection?
The home has responded well to most of the requirements and recommendations made at the last inspection.
Barn and Coach House DS0000018117.V332261.R01.S.doc Version 5.2 Page 6 Small repairs and some redecoration have been carried out. Some new carpet has been laid. A bathroom and the laundry have been retiled and the laundry reorganised to make it easier for staff to use. A loop system has been installed in one lounge to help those residents who have hearing difficulties. Access to the drugs cupboard and laundry room has been limited by the use of keypad locks to make the premises safer for confused residents. A keypad lock has been fitted to the office to ensure that private information is secured. All residents now have care plans and it was evident that these are reviewed regularly. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Barn and Coach House DS0000018117.V332261.R01.S.doc Version 5.2 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.V332261.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 People are assessed to make sure the home can meet their needs. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Records examined showed that assessments had been carried out before people were admitted to the home and continue during the trial period to ensure the home can meet individual’s needs. Barn and Coach House does not admit people for intermediate care. Barn and Coach House DS0000018117.V332261.R01.S.doc Version 5.2 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 All residents have plans on which staff can base the care the care they provide. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All residents had a care plan and two were checked as part of case tracking. Staff were observed carrying out these resident’s plans but daily notes were not very informative about what had been going on in people’s lives. Relatives had provided some excellent profiles of residents to help staff work with and understand them. Records showed that residents were receiving treatment from the district nurse, G.P., chiropody service or other medical services when needed. Resident’s weight and nutrition intake is monitored. The manager advised that continence advice had been sought for residents recently to help promote people’s dignity and self-respect.
Barn and Coach House DS0000018117.V332261.R01.S.doc Version 5.2 Page 10 Medication is stored securely and well managed by staff. Photos of residents were on their files to aid identification. Those medication administration records seen were completed appropriately. Barn and Coach House DS0000018117.V332261.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Further suitable activities, including outside of the home, would enhance some resident’s lives. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff played music and chatted to residents during the morning. Some residents read newspapers and the T.V. was on. Staff had encouraged residents to pursue their own interests wherever possible. Some staff were seen to try to engage with those people who have dementia. As at the last inspection, some residents said they would like opportunities to go out of the home, as these are rare unless relatives take them. In surveys, relatives and friends said they are always made welcome when visiting the home and are able to visit at any time. Barn and Coach House DS0000018117.V332261.R01.S.doc Version 5.2 Page 12 Residents said they get plenty to eat. In surveys, two said they ‘Usually’ like the meals in the home and one said they ‘Always’ do. A menu is available to residents eating in the dining room. Barn and Coach House DS0000018117.V332261.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Adding details of the Commission to the complaints policy will ensure residents can refer on complaints if they wish. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager advised that all staff have attended training on the protection of vulnerable adults provided by a local authority since the last inspection. No allegations or incidents of abuse have been reported by the home. Some compliments had been made about the care at the home. In surveys, three residents said they knew how to make a complaint and one said they didn’t. However, the home’s complaints policy is summarised in the service user’s guide. This refers to NCSC (CSCI) but does not have the address or telephone number of the Commission should a resident wish to refer a complaint. Barn and Coach House DS0000018117.V332261.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 There is a reasonable standard of accommodation. The provision of a sluice facility would improve hygiene. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was clean with no foul odours. All four surveys from relatives reported that the home is ‘Always’ fresh and clean. Some repairs, redecoration and general maintenance have been carried out since the last inspection. An additional handrail has been put in a corridor to help residents move around the home. Barn and Coach House DS0000018117.V332261.R01.S.doc Version 5.2 Page 15 The laundry room has been reorganised so it is easier for staff to use. It has been re-tiled, with hand washing facilities for staff to make a more hygienic environment. There is a system for moving and cleaning foul laundry safely and the home reports exploring the possibility of providing a sluice facility. Barn and Coach House DS0000018117.V332261.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Residents are well supported by staff. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Pre-inspection information advised that existing staff cover any vacancies. In relative’s surveys all four reported that in their opinion there are always sufficient numbers of staff on duty. The manager reported having sufficient staff and that training was going well with relevant training such as food hygiene, first aid, manual handling, reminiscence, Parkinson’s disease, infection control and fire training being provided. Many staff are reported as working towards achieving NVQ level 2 and two have currently achieved this. Staff spoke of the induction they had received to help them work with the residents. One member of staff described improving their understanding of dementia through reading and were very keen to further extend their knowledge in order to better understand the residents, which was commendable. As so many of the residents have dementia, the inspector thought that training on dementia should be provided to new staff soon after joining the home.
Barn and Coach House DS0000018117.V332261.R01.S.doc Version 5.2 Page 17 Two staff recruitment files were examined to check the home’s recruitment process. Criminal record bureau (CRB) checks had been carried out. One file had sufficient proof of identity but there was a query over the person’s name and last employment, which the home was asked to clarify. The second file did not have sufficient proof of identity nor explore a considerable gap in employment. Both files contained only one reference and as one was on the home’s form, it was suggested the home request a company stamp. Barn and Coach House DS0000018117.V332261.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 There has been some improvement to how the home monitors the quality of its service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager reported that she has started holding surgery every four weeks on the weekend when relatives who work can call in to discuss the care of their family members and ascertain their views. She has also started a newsletter for family and friends to keep them informed about what is going on at the home. The home uses satisfaction questionnaires to review the quality of the service.
Barn and Coach House DS0000018117.V332261.R01.S.doc Version 5.2 Page 19 The provider was asked to make unannounced visits to the home and write reports of them under regulation 26, to monitor the quality of care in the home. They were also asked to provide these to CSCI for a while to evidence that this was being done; two reports have been provided. The home reports that it does not deal with resident’s finances. Certificates showing the lift and hoist equipment had been checked were seen. It was noticed that one bath hoist was overdue a service which the home said would be followed up. The home had recently been visited by the fire service. Records showed that fire alarms were tested often but not always weekly. The manager described how staff simulate fire drills. Barn and Coach House DS0000018117.V332261.R01.S.doc Version 5.2 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 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X N/A X X 2 Barn and Coach House DS0000018117.V332261.R01.S.doc Version 5.2 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. Standard OP12 Regulation 16(2)(m) Requirement Facilitate local/community activities, for example shopping should residents require this. Previous timescales 1/9/05, 01/02/06, 01/08/06 partly met Carry out all required recruitment checks. Previous timescales of 15/7/05 and 01/03/06 not met, 01/07/06 not inspected Timescale 01/08/07 not met Ensure there is proof of I.D.and this is checked, that two references are obtained and all gaps in employment are explored. 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, 26/7/04. 01/08/07 partly met. Timescale for action 01/06/07 2. OP29 19(1)(a)( b)Sch.2 01/06/07 3. OP33 26(1)-(5) 01/06/07 Barn and Coach House DS0000018117.V332261.R01.S.doc Version 5.2 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard OP16 OP26 OP28 OP29 OP30 Good Practice Recommendations Provide details of CSCI on the complaints policy in the service user guide. The home should have a sluice facility that is separate from the laundry. That a minimum of 50 staff obtain NVQ Level 2. That references have a company stamp or headed paper to help ensure they are authentic. Provide dementia training for new staff soon after joining the home to help them meet the needs of people with this disease. Ensure that all hoists are well maintained. Test fire alarms weekly. OP38 Barn and Coach House DS0000018117.V332261.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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
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