Inspection on 16/08/07 for Barn Park Residential Home

This inspection was carried out on 16th August 2007.

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 Park Residential Home 09/01/08

Barn Park Residential Home 07/03/07

Barn Park Residential Home 24/07/06

Barn Park Residential Home 03/03/06

Barn Park Residential Home 20/10/05

Barn Park Residential Home 08/03/05

Barn Park Residential Home 14/10/04

Barn Park Residential Home 23/03/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Barn Park Residential Home Barn Park Halwill Beaworthy Devon EX21 5UQ Lead Inspector Anita Sutcliffe Unannounced Inspection 16th August 2007 10:00 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 Park Residential Home DS0000003646.V343723.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 Park Residential Home DS0000003646.V343723.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Barn Park Residential Home Address Barn Park Halwill Beaworthy Devon EX21 5UQ 01409 221201 01409 221602 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) Mr William Derek Scantlebury Mrs Anna Patricia Scantlebury Mr William Derek Scantlebury Care Home 22 Category(ies) of Dementia - over 65 years of age (22), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (22), Old age, not falling within any other category (22), Physical disability over 65 years of age (22) Barn Park Residential Home DS0000003646.V343723.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Key inspection 06/03/07 Random inspection 26/06/07 Brief Description of the Service: Barn Park is a large Victorian House on the edge of Halwill village. It is registered to provide personal care to 22 elderly people, who may have physical disabilities, dementia or mental disorders. It is privately owned and managed. District nurses and local GP’s provide any medical care. The home has been extended but still retains many of the features of the original house. The property is set in extensive grounds. On the ground floor the home has a dining room, lounge leading to a conservatory, an additional private lounge, six single bedrooms, a bathroom with toilet and two other toilets. There is a stair lift to the first floor where there are twelve bedrooms, two of which may be used as double rooms, four of the single rooms have ensuite toilet facilities - one has an en-suite bathroom. There are two stair cases to the second floor, both with a stair lift, where there are two bedrooms with en-suite toilets and a staff sleep in room. The home has equipment to aid residents’ mobility. Current fees charged are: £300 - £450 Additional charges, as stated in the home’s contract are: ‘Medical requisites, hairdressing, chiropody, newspapers, clothing and other items of luxury or a personal nature, and transport. The latest inspection report is situated in a drawer in the entrance hall of the home. Barn Park Residential Home DS0000003646.V343723.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Since the last key inspection was completed on the 7th March 2007 a Random Inspection was carried out on 26th June. This included one and a half hours closely observing how four residents spent their time, checking the plans of care of residents and a full audit by the Regional Lead Pharmacist for the South West, of how the home handles medication. Legal notices were then issued in relation to medication and the home’s failing to plan care adequately. The Random Inspection report is not published but is available on request from the Commission. Reference to the findings of the Random Inspection is made within this report. The purpose of this inspection was to assess the homes compliance with Key National Minimum Standards for Older People and the Legal Notices issued on 26 July. The manager/owner did not provide up to date information about the service at Barn Park until six weeks later than required to do so. However, this has been included in the report. The inspection included two unannounced and one announced visit. One of the unannounced visits was during the evening. All service users (residents) were met and fourteen gave opinion through survey. Six staff and five family of residents also completed anonymous survey. Information was received from a health care professional in regular contact with the home. Care, recruitment, training, medicines and complaints records were examined. All areas of the home were visited. Discussion was held with the registered manager, matron and deputy matron. What the service does well: Family of residents when asked about the home said: • • • • “They consider the individual resident’s requirements and care for them accordingly”. “They look after the residents well”. “Pleasant and cheerful and caring”. “A wonderful home for my mother. She loves her room and the outlook and has made many friends. We are very satisfied with the running and standard of Barn Park. It’s a home from home”. Staff said that what they did best was: Barn Park Residential Home DS0000003646.V343723.R01.S.doc Version 5.2 Page 6 • • “The way the care staff look after the clients. They are all good workers who care about our clients very, very much”. “Provide a friendly, homely feel”. Barn Park is homely and friendly and there is a core of experienced, competent staff who have been at the home for a long time. Residents are treated with respect and enabled to be individual. For example, some pets continue to live with their owners. Residents benefit from the good working relationship the home has with the district nursing service, who are responsible for providing all nursing care and also advise staff regarding the physical day to day care of residents. There is a good standard of activities arranged at the home and staff join residents to chat and socialise. It isn’t ‘us and them’. The information provided about the service (completed by matron) showed a good insight into the home’s strengths and weaknesses. Staff made very good effort to help residents complete surveys toward the inspection and ‘give them a voice’. Matron and deputy matron are working very hard to improve the home and the registered manager/provider is very clear in his desire that residents should have a happy home at Barn Park. What has improved since the last inspection? There has been continual improvement at the home over many months, although there have also been some back ward steps. The most significant improvement is the standard of assessment and care planning. Staff now have the information from which they can provide a consistent level of support and care to residents. Staff said, both through survey and discussion, how useful they now found the plans, although it “took some time to get used to them”. However, this improvement needs to be sustained and built upon. The home has moved the storage of medicines to a new office taking them away form the open door where they were not securely kept, this putting residents at risk. Staff induction and ongoing training is now more organised. Within the last year there has been a newly built and well-equipped laundry room. Liquid soap and disposable paper towels for staff hand washing have also helped improve the standard of hygiene at Barn Park. The office has been moved away from the kitchen; records and medicines are now more secure. There is more space and records are kept in an orderly way. Hygiene is now less compromised as staff should do not need to enter the kitchen to get to the office. Barn Park Residential Home DS0000003646.V343723.R01.S.doc Version 5.2 Page 7 There is a new chair lift to the upper floor which staff say are easier to operate and improve access around them, which improves safety on the stairs. The matron reports that there are new arrangements for residents to receive eye care within the home. Also, physiotherapists and occupational therapists to solve seating and mobility problems – this was not checked during the inspection. Some bedrooms and the dining room have been redecorated and refurnished, keeping the environment fresh and in good condition. A staff member said: “Management are working hard to improve but Rome was not built in a day. As a whole it is much improved”. What they could do better: The registered provider/manager has now decided not to sell the home. It is currently unclear who is in charge of the day-to-day care and management at the home, the ‘matron’ or ‘deputy matron’. A staff member said: “The majority of problems at Barn Park are due to management. There are no standards that are set and staff tend to work at different levels and not together. Sometimes it is not clear who is in charge”. Another said: “There is no channel through which problems can be aired and fairly dealt with. It seems not to matter whether you are good or bad at the job”. The Statutory Notice, to improve the standard of medication handling at the home, has not been fully met, although staff have worked hard towards doing so. Although risk from this is much reduced it is not removed. Again we found the health and safety of residents compromised. We tried a call bell and found it was not in working order, uneven paving slabs were a trip hazard and we alerted the Fire Service to concerns about the home environment. There was no assessment of risk to residents when using the garden, which was difficult to access because of overgrown plants and a serious of steps. The provider must ensure all equipment is serviced and maintained on a regular basis and put in place systems for checking that the home is safe. The standard of written information about the home is insufficient for people who are considering moving to Barn Park. A Statement of Purpose and Service Users’ Guide must be available to residents, potential residents and the Commission. Staff should receive training in caring for people with dementia and the home environment should be adapted so that it is best suited to their particular needs. Barn Park Residential Home DS0000003646.V343723.R01.S.doc Version 5.2 Page 8 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 Park Residential Home DS0000003646.V343723.R01.S.doc Version 5.2 Page 9 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 Park Residential Home DS0000003646.V343723.R01.S.doc Version 5.2 Page 10 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, 2, 3 & 4 (Standard 6 does not apply to Barn Park) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who may wish to move into Barn Park do not always have the information they need towards deciding if it will suit them, but their needs would be assessed prior to moving in. The needs of residents with dementia could be met more fully at the home. EVIDENCE: The registered provider Mr. Scantlebury confirmed that written information available, which is to describe the service provided at Barn Park, was the most current. It is a large wordy document, unlikely to be read by potential residents because of the format, which is not suitable for older people who may have impaired eyesight or dementia. It is also grossly out of date having been produced in 2003. Mr Scantlebury said it was never given to potential residents adding: “They’re not interested in paperwork”. He was dismissive of the need to do this saying that they people look around and “they come Barn Park Residential Home DS0000003646.V343723.R01.S.doc Version 5.2 Page 11 because of our good reputation”. Nine residents whose opinion was surveyed said they did receive enough information about the home before moving in; four said they did not. The home is required to produce a statement of what the home provides and a guide for residents about the home, in a usable format, so that they have the opportunity to ask relevant questions and have detailed information should they decide to move into the home. Mr. Scantlebury said the contract does this. Residents are provided with a contract when they move into the home, but this does not include the necessary depth of information and the complaints procedure described within it does not fully protect the resident. The assessment of a recently admitted resident was examined for this key inspection. It was clear that senior staff (known as matron and deputy matron) and a health care professional, were involved in the assessment. It is not clear that the potential resident had any involvement. We are told that they did, but this involvement needs to be clear within the assessment record. The assessment contained some good depth of information from which care could be planned. However, there was some contradiction of information between the home’s assessment and a hospital referral, that being the history of falls. Under the section called Mobility it said: ‘Walks with one stick. Not prone to falls’ whilst the hospital referral said: ‘Reason for admission: falls resulting in fracture’. Whilst the accuracy of information must be correct the general standard of assessment is much better, staff having worked hard to improve this. At the random inspection in June we spent one and a half hours in the conservatory/lounge observing how residents spent their time. We were assessing their well-being and staff ability to understand and meet the needs of residents, who may have dementia and so may be less able to do this verbally. We found that staff interaction with those residents was good. They were offered choice, treated with respect, there was humour, sensitivity and the atmosphere was relaxed. They especially related to a dog, which was the source of conversation. The home has some bright pictures and signs to help people with dementia find their way around. These have been well thought out. The matron and deputy matron have an understanding of how the environment affects residents. However, sink taps of a modern design have just been purchased. Good mental skills and hand/eye coordination would be needed to use them, and research supports that they are not suitable in this setting. The providers had given no thought to this before buying a new bulk supply of the taps. A care assistant asked about training in dementia said: “We had training in dementia care about 2 years ago”. Deputy matron said there was a video for dementia training. It wasn’t confirmed that any staff had seen it. Records Barn Park Residential Home DS0000003646.V343723.R01.S.doc Version 5.2 Page 12 showed that senior staff had training in challenging behaviour in dementia care in 2002. There should be training for all staff in dementia and dementia care so that staff are best able to care for residents with this condition. Barn Park Residential Home DS0000003646.V343723.R01.S.doc Version 5.2 Page 13 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care planning is now better organised and of use in informing staff how to care for residents and the management of medicines in the home has improved since the last inspection, although there is still the potential to place people at risk of harm. EVIDENCE: There has been an ongoing requirement that care at Barn Park is planned so that staff are aware of how to meet the needs and wishes of residents and the care they deliver is of a consistent standard. Previously staff themselves had voiced their dissatisfaction with the lack of care planning and information available to them. At the time of the Random Inspection in June matron and deputy matron were trying to make those improvements. However, we found some plans were so poor (a resident supposedly ‘still mobile’ whilst they had been very ill in bed Barn Park Residential Home DS0000003646.V343723.R01.S.doc Version 5.2 Page 14 for some time until their death, and another plan had not been reviewed since 2004) that Statutory Enforcement Notices were served. This is the first step toward prosecution of the registered providers and the registered manager for those offences. At this key inspection we saw that all plans were in a new format and all had been updated. We examined two closely. Where a resident had recently died the plan had been reviewed and updated properly. Where a resident was new the care plan was satisfactory, but would still benefit from more detail. Three staff said that the plans are now useful. We observed them being used to provide information and to record events. A member of staff surveyed said: “This is improving 100 from the last survey”. The home should now also include in plans of care how residents’ personal and social needs will be met. We spoke to a district nurse who visits the home. She said that staff need a lot of support, and so she makes herself available to them, but that they genuinely care about the residents. She cited how well staff had managed a ‘nasty wound’, which healed during the resident’s time at the home. Six residents asked if they receive the care and support they need said: ‘always’, eight said ‘usually’ and one said ‘sometimes’. One added: “It’s all right”. Twelve said they always receive the medical support they need, and two said they usually do one adding: “I believe it is very good”. There have been repeated requirements that the home ensure safe handling of medicines at Barn Park and so the Regional Lead Pharmacist accompanied us for the Random Inspection in June 2007. Findings at that inspection led to Enforcement Notices being served for unsafe handling of medicines. This is the first step toward prosecution of the provider for those offences. Following the March Key Inspection the home moved the storage of medicines to a new office taking them away from the open door as described in previous reports. During the June inspection we found the medicine cupboard keys in a drawer accessible to any staff; still not kept securely. At this inspection we found the cabinet locked. However, we saw two sets of keys in use. Again this is not safe storage of medicines. On opening the medicines cupboard we also found the keys to the controlled drugs sitting on the controlled drugs box. A member of staff said: “We might as well not have locked it”. Although much improved we found that storage of medicines at the home remained insecure. During the June inspection we found that staff were removing medicines from their original packaging and putting them into other containers which they felt were easier to use. However, this did not include the name, quantity, dose of medicine or date of the preparation. This practice was contrary to the Medicines Act 1968 and was unsafe practice. It has now been stopped. Barn Park Residential Home DS0000003646.V343723.R01.S.doc Version 5.2 Page 15 During the June inspection we found some medicines were prescribed to be taken ‘when required’. No information was available to staff for them to know under what circumstance the medicine could be administered to the resident. This was likely to lead to inconsistencies. At this inspection we were told that letters have been written to GP’s asking for this clarity, but no replies have yet been received. We are therefore extending the timescale for this requirement. During the June inspection we found staff administering medicines were not all trained to do so and there was no check on the competence of staff. Staff are now undertaking distance learning in the handling of medication and matron has records of monthly checks of the medication records. Additional training has been requested from the pharmacy that serves the home and matron must extend her checks of competence to include the way medicines are ‘handled’ as well as the way they are recorded. This requirement is repeated. During the June inspection we found medicines prescribed for specific residents were being given to others because stock had run out. This has now stopped. At this inspection we saw ‘over the counter’ pain killers given to a resident. Whilst this is accepted practice, there must be a policy so that staff follow a safe method for doing this. Neither the deputy matron or care assistant giving the pain killer were aware of such a policy. At a following visit the matron said there was one. That policy must be available for staff use and guidance to ensure this is done safely. Staff were seen being polite and respectful to residents and records produced by staff also supported this. No resident or family survey suggested other than that staff treat residents with kindness and respect and privacy is promoted. Barn Park Residential Home DS0000003646.V343723.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ individuality is promoted and they are helped to have a fulfilled and happy life. EVIDENCE: At the first key inspection visit we were shown a cake recently baked by a resident. Staff are often seen chatting and spending time in the lounge and the home is generally a happy place. Staff say, and a visitor confirmed, that activities include: Singer/entertainer once a month. Tuesdays and Thursdays five or six residents attend a day centre. Weekly hairdresser visit. Alternative weeks there is Karaoke. A weekly visit by a professional activities worker who organises a quiz, games, music etc. - A member of staff has two hours Mondays and Fridays allocated to do activities. DS0000003646.V343723.R01.S.doc Version 5.2 Page 17 Barn Park Residential Home Eight residents said there are always activities they can take part in, three said there usually are and one said they were unable because of their health. Comments included: “I like to sing”, “I’d like a dart board” and “I don’t choose to take part in activities”. However, as yet the plans of care do not include how social needs, wishes and preferences are to be met. These should be included as part of the care planning process (see Standard 7). The deputy matron that at this time there were no residents who wished to follow any faith or visit church, and nobody from the local church visits the home. Of the five survey responses received from resident’s family two said the home always helps their relative keep in touch, two said sometimes and one made no reply. Three said the home always keeps them up to date with important issues, one said the usually do and one did not reply. Asked what the home does best one resident’s family said: “They consider the individual resident’s requirements and care for them accordingly”. During the unannounced evening visit staff were assisting residents to bed when they asked to be taken. Staff say that residents make their needs known and they respond. Two residents’ family said the residents are always supported to live the life they choose and two said usually. Asked if they like the meals seven residents said always, five said usually and three said sometimes. Comments included: “Food is very good” and “It’s not bad”. Staff monitor the weight of residents so that any concerns will be identified quickly. Barn Park Residential Home DS0000003646.V343723.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s approach to handling complaints and safeguarding residents should be more robust. EVIDENCE: Eight residents said the always knew who to speak with if they were not happy adding: “matron or deputy”, “I speak to my daughter” and “I am happy”. Three said they usually do and two said sometimes. One said they didn’t know adding: “I can’t imagine”. Nine residents said they did know how to complain and six said they didn’t. Three residents’ family asked if they knew how to make a complaint said yes and two said no. Three said there was an appropriate response to concerns raised and one said there usually was. When asked if any complaints had been made to the home the deputy matron said she thought not but was unable to find ‘the complaints book’. We found complaints forms when examining the complaints policy; she was unaware they existed. There have been no complaints made to the home and none received by the Commission. Barn Park Residential Home DS0000003646.V343723.R01.S.doc Version 5.2 Page 19 We examined the home’s whistle blowing policy. It is that which would advise staff what action to take if they had concerns. We found it talked of ‘investigation’ almost from the outset of concern raised. We then asked the deputy manager (in charge of the home at the time) what she would do if an allegation were made against a member of staff whilst she was in charge. She also talked of an initial ‘investigation’. Neither of these is correct. Any allegation, which might be of an act of abuse, must be passed immediately to the Local Authority Safeguarding team and not dealt with within the home itself. The home’s policies must be corrected and senior staff, who undertook a course in Adult Protection July 2006, must ensure they know how to respond correctly. Other staff have received training in how to protect residents from abuse. Barn Park Residential Home DS0000003646.V343723.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The physical lay out of the home is pleasant, clean and comfortable but not fully safe and independence is compromised. There is continual improvement. EVIDENCE: Staff have worked hard to provide coloured signage to help residents with dementia find their way around the home. One resident’s family said how much her mother loved her room and the outlook. Rooms visited varied between very homely and personalised to satisfactory. Furniture was of adequate quality and in good repair and there is continuing upgrading at the home, with the dining room currently being redecorated. During the random inspection on the 26th June we were concerned when, finding the front door locked, staff were having to look for the key so we could Barn Park Residential Home DS0000003646.V343723.R01.S.doc Version 5.2 Page 21 leave. When asked what would happen were there a fire staff said: “follow the fire exit signs”; we could see none from where we were. We found not all doors would shut sufficiently or had the necessary fire safety strips to prevent fire spreading. We therefore contacted the Fire Service with our concerns and they subsequently visited the home. This led to requirements to improve fire safety. These were being addressed at the time of the key inspection visits. (See Standard 38). All parts of the home were adequately clean, fresh and pleasant at the time of the visits. Ten residents said the home is always fresh and clean, three said it usually is, one said sometimes. One didn’t know. One resident added: “The cleaner is very good”. There is now liquid soap and paper hand towels in bedrooms, the laundry and kitchen so that staff are able to wash their hands as needed. A district nurse said that hygiene is improving. The new laundry has a good level of equipment and is more suitable to meet the needs of residents. The second visit to the home was on a sunny day and we visited the garden. It has a paved and patio area, plus pleasant lawns and shrubs. However, there is a step at the patio door, steps to the garden and then some overgrown plants, awkward for those with poor mobility. We then found very uneven paving stones, a trip hazard likely to cause a fall. Residents should be safe to visit the garden unaccompanied. The current arrangement restricts their independence and the garden is not currently safe. (See Standard 38). During the second visit to the home we tested the call bell system in one bedroom and found it did not work. Staff tested the other bells and found others the same. This was apparently because batteries needed replacing. This left those residents unable to contact staff and vulnerable. (See also Standard 38). The provider has a continuing programme of investment and improvement for the home. This has included better hand washing facilities for staff so as to prevent infection, a new chairlift, new laundry and equipment, new office space to help staff be more organised and improve the security of records and medicines. Barn Park Residential Home DS0000003646.V343723.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff in the home are dedicated, adequately trained and in sufficient numbers, but residents are not protected by robust recruitment or supervision of staff. EVIDENCE: Four staff surveyed said they have enough time to do their work and one said they didn’t. During the three visits (two unannounced) there were adequate numbers of staff for the number and needs of residents in the home. The matron and deputy said they considered staffing numbers were adequate and there were no comments received to suggest otherwise. The provider reports that the home does not employ agency staff. Two relatives of residents felt care staff have the right skills and experience, two felt they usually do and one said: “How do I know”. There are several care staff who have been with the home over a long period of time. This provides consistency and experience. A member of staff said: They are all good workers who care about our clients very, very much”. The entirely positive comments about staff include, from residents’ family: “They look after the residents well” and “Pleasant and cheerful and caring”. Barn Park Residential Home DS0000003646.V343723.R01.S.doc Version 5.2 Page 23 The home has started using a ‘bought in’ staff training system. Staff read the information and then record answers to questions. This is followed by an exam, marked by the training organisation. We looked at the training records of staff. They indicate that training has been too ‘ad hoc’ until more recently, but there is a renewed attempt to ensure all necessary training is now undertaken. Recently all staff did a First Aid Course and three senior staff have taken a course in Fire Safety. The provider reports that currently, of the twenty care staff employed, seven have achieved the National Vocational Qualification (NVQ) level 2 or above in care and four are currently working towards it. This qualification is an indicator of staff competence. We examined the recruitment records of two recently employed care staff. The home has been diligent in ensuring that criminal records checks have been completed prior to starting employment. However, for one of the two the employment history was very inadequate. It was not possible to determine dates of previous employment and one reference was from ‘a couple of years ago’. Although recruitment is now safer it remains less robust than it should be. Records of Induction training for newly recruited staff were seen and show that adequate training is provided for new staff. Barn Park Residential Home DS0000003646.V343723.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, 32, 33, 35, 36, 37 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Despite good intentions, and a willingness to provide a good service to residents, there remains unclear leadership, poor standards of safety, and mostly ad hoc systems for assessing the quality of the service provided to residents. EVIDENCE: There was only praise about the home from family of residents, one saying: “We are very satisfied with the running and standard of Barn Park. It’s a home from home”. Residents made no mention of management as such. Barn Park Residential Home DS0000003646.V343723.R01.S.doc Version 5.2 Page 25 The Providers/Manager (Mr. Scantlebury) has now decided not to sell the home and is re-thinking how it would be best managed. Following the Key Inspection in March 2007, when comments from staff made it quite clear they had many issues about the management of the home, no arrangement was made to discuss their concerns with them, either as a team or individually. The first staff meeting, which was to inform staff the home was no longer for sale, was quite recent, during this inspection. Staff confirmed that they were able to ask questions at the end and “there was quite a lot of discussion”. Staff surveyed for this inspection, when asked what needed improvement said: • “The majority of problems at Barn Park are due to management. There are no standards that are set and staff tend to work at different levels and not together. Sometimes it is not clear who is in charge”. • “Better communication”. • “Lack of communication”. • “Have a management team who works/talks together so they can support the care team” • “To improve team working skills”. Mr. Scantlebury insists that he has taken measures to address all the issues listed and staff morale is improved. Toward clarity of role and clear leadership the staffing rota must include the hours that Mr. Scantlebury is managing the home. Following the inspection visit on 26th June we contacted the Fire Service to express concerns over standards of fire safety at the home. They subsequently visited and reported that the home was not ‘fully complying with fire safety regulations’ and that ‘fire safety issues’ had to be ‘effectively managed’. Those steps are now being taken. During this inspection we tried one of the call bells in the home and found it was not working. Staff were asked to check all the call bells and found others not working. This puts vulnerable residents at risk as they might be unable to summon help if needed. We visited the garden. Access to the garden is either through the kitchen, a resident’s bedroom or from the lounge/conservatory. Clearly, residents should be using that exit. However, there is a step at the door, several steps to the garden and some overgrown bushes to negotiate. The patio below has several uneven paving slabs. Asked if risks in the garden had been assessed Mr. Scantlebury said no. Staff health and safety training has included First Aid, moving and handling and Fire Safety. However, safety at Barn Park continues to be reactive. We Barn Park Residential Home DS0000003646.V343723.R01.S.doc Version 5.2 Page 26 should not be the ones who find faulty equipment and risks to residents. There must be systems in place at the home to do this. These must include risk assessment and improved checks that equipment is working. Information provided by the home does state that they contract the services of a Health and Safety consultant. Matron has started regular monitoring of care plans and medication records, to check they are complete and up to date. Mr. Scantlebury insists residents’ needs and wishes are known to staff and so this ensures a quality service. For example, he said each resident is asked about their choice of food on the day. However, one resident surveyed said: “I wish to speak to Derek (Scantlebury) but I can never catch him”. Staff asked whether they receive supervision or observation of their work said: • “Management are having staff training and this should be implemented within the next 2-3 months”. • “There are no regular meetings on one to one with senior staff. You only learn about change if you happen to be present when it is being discussed”. • “After last inspection this was mentioned but has never happened”. These replies were received prior to the one staff meeting held. Mr. Scantlebury insists that an informal approach to communication between himself and staff is adequate. However, this does not ensure that staff have the voice they want or that working practice is managed in a structured, and effective, way. Mr. Scantlebury is regularly at the home and always contactable when not. We feel confident that any issues family might have could be taken to him. However, there remains no effective quality assurance system, based on the views of all people with connection to the home, primarily residents and staff. The deputy matron, shown the July inspection report, confirmed that the management of resident’s finance remains the same. We spoke to a resident’s family who confirmed that the home keeps no money for them and they are invoiced for any expenses. The home is failing to meet its statutory requirements under the Care Standards Act 2000. There are repeated requirements, in particular regarding health and safety and the safe handling of medication. When Mr. Scantlebury personally assured the Commission that all care plans had been reviewed and updated, following the previous key inspection, this was untrue. Mr. Scantlebury is required to submit data about the home, and despite a warning letter from the Commission, it was still not provided until asked for during the third inspection visit. Barn Park Residential Home DS0000003646.V343723.R01.S.doc Version 5.2 Page 27 The standard of administration at the home has improved. Policies, procedures and records are now better organised. However, there is no Statement of Purpose or Service User’s Guide (see Standard 1), which the home is required to produce. Barn Park Residential Home DS0000003646.V343723.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 3 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 2 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 1 2 X 3 2 2 1 Barn Park Residential Home DS0000003646.V343723.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 (1) (2) & 5 (1) (2) Requirement The home must produce a Statement of Purpose and Service User’s Guide, which will provides detailed and current information about the service provided at Barn Park. This must be in a format that is suitable for potential residents and include all the detail listed in Schedule 1 of the Care Homes Regulations. Both must be supplied to the Commission. The Guide must be supplied to all residents and the Statement available to them on request. This information will help potential residents make a fully informed decision as to whether the home is suitable to meet their needs. All medicines must be stored securely and in accordance with current regulations to prevent the unauthorised access to them and to ensure that they are available to be administered to the person to whom they are prescribed. Medicines must only be Barn Park Residential Home DS0000003646.V343723.R01.S.doc Version 5.2 Page 30 Timescale for action 15/10/07 2. OP9 13(2) 15/09/07 administered by people who have been assessed as having the necessary competence and skills to carry out the task. This means that people can be confident they are given their medicines safely. Previous requirements for this regulation made for 31st. August 2006, 15th March 2007 and 17th August 2007 have either not been met or only partially met. 3. OP9 13(2) It must be clearly described within a resident’s plan of care when a medicine, prescribed to be administered, ‘as necessary’ may be given. This will ensure all staff do so in a consistent way. Staff must not be employed to work in the home unless a full employment history is available and one references is clearly linked to the last employer, especially if that employment involved working with vulnerable people. Previous requirements for this regulation made for 31/08/07 and 30/06/07 have been only partially met. 5. OP33 24(1)(2) There must be a system at the home for reviewing at appropriate intervals, and improving, the quality of care provided at the care home. Results of this review must be supplied to the Commission and made available to residents. This will ensure that the service is run in resident’s best interest and with their involvement. All information required under DS0000003646.V343723.R01.S.doc 30/09/07 4. OP29 19(4)(b) 30/09/07 31/12/07 6. OP37 17 30/09/07 Page 31 Barn Park Residential Home Version 5.2 Schedule 4 must be kept in the care home. This includes a record of all staff working in the care home, including the registered manager, and whether the hours recorded on the roster were actually worked. It is required that this information is made available and must make clear who is in charge at any one time. Previous requirements for this regulation made for 14/08/06 and 31/07/07 have not been met. 7. OP36 18(2) Staff should have their work observed and should meet regularly with a senior member of staff on a one to one basis to discuss issues pertaining to their work. This will ensure their standard of work is satisfactory. A previous requirement for this regulation made for 31/05/06 remains unmet but is still within timescale. 8. OP37 24(2) Information about the home, requested by the Commission, must be provided within the given timescale so that it is available prior to inspection visits. The home must have systems in place so that any safety hazard to residents (environmental or connected with the maintenance of equipment) is identified and dealt with before it poses a risk. The paving stones in the garden, or any other surface used, must be evenly laid to reduce the risk of trips and falls. 31/08/07 12/09/07 9. OP38 13 30/10/07 10. OP38 13 01/05/08 Barn Park Residential Home DS0000003646.V343723.R01.S.doc Version 5.2 Page 32 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 OP4 Good Practice Recommendations The specialist needs of people should be met through staff training in dementia care and adapting the environment to take into account the specific needs of residents with dementia. The policy describing how ‘over the counter’ remedies may be given should be clearly available to all staff who administer medication so that they have the information necessary to ensure those medicines are given safely. Staff should be aware of how a complaint to the home is to be recorded. Staff, who may be in charge of the home, should be fully aware of how an allegation, which may be abuse, is to be handled, so that the best possible outcome will be achieved and residents protected. Residents should have safe access to the garden so that they have the benefits from open air space and their independence is promoted. 2. OP9 3. 4. OP16 OP18 5. OP19 Barn Park Residential Home DS0000003646.V343723.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Park Residential Home DS0000003646.V343723.R01.S.doc Version 5.2 Page 34 - 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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