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Inspection on 24/07/06 for Barn Park Residential Home

Also see our care home review for Barn Park Residential Home for more information

This inspection was carried out on 24th July 2006.

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

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

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

What the care home does well

Barn Park is homely, friendly, relaxed and the care delivered is of a good standard. Staff are particularly good at understanding and meeting the emotional needs of residents with dementia. All comments received about the home and its care of residents was positive and include: "My mother has been treated with endless patience and care by the staff of whom I cannot speak highly enough".

What has improved since the last inspection?

There has been continual upgrading of the fabric of the home. The certificate of registration was fully displayed as previously required, but was not the current certificate.

What the care home could do better:

Examining any record, policy or procedure was found to be very difficult. They appeared to be kept in different places. Some could not be found at all. Those found were incomplete, inconsistent or incoherent. Residents are therefore notprotected through information recorded on their behalf. Nor is their welfare fully promoted, as the assessment and care planning records were of limited use to staff, who should be using them to ensure deliver of care to a consistent standard, in a way agreed with the resident or their representative. Relying on individual staff knowledge is not sufficient to guarantee consistency. Care plans must be reviewed at least monthly, more frequently when necessary. They must be signed and dated, and the resident, or their representative, involved in the planning when at all possible. Medication storage is unsafe; the key kept behind the door and the door unlocked, near an exit to the garden and the kitchen. The temperature of the medicines fridge is not monitored to ensure they are stored at the correct temperature. Medicines are not always signed for once given, which could lead to mistakes. Some creams/ointments were being shared. They must only be given to the resident to whom they are prescribed. Written information about each medication has not been obtained as recommended, but the manager says this is proving impossible. Information provided prior to admission (The Statement of Purpose) does not give adequate information about the home environment, such as indicating the place where people smoke, outside one of the bedroom patio doors. Residents` rights are not fully protected through the contractual arrangements. The contract does not state which room they will occupy. The provider does not write to confirm that the assessed needs of the resident can be met by the home. This also protects the resident`s interests. Room changes are being made without informed consent from the resident, or agreement from others involved in the resident`s welfare. To protect residents, each must be given a copy of the complaints procedure. Staff should be able to readily access the Whistle blowing policy, which should contain the contact details for the Commission and Local Authority vulnerable adults team. These policies provide the method for reporting complaints or concerns about resident welfare. Residents were observed being treated with respect, and staff knock before entering bedrooms. However, comments recorded by staff were unprofessional and demonstrate disapproval or the resident, not respect. Not having the opportunity/choice as to whether you lock your bedroom door reduces dignity and the opportunity for privacy. This option should be available to all residents where it is assessed as safe. Resident choice is also reduced through the use of the quiet lounge as a bedroom for residents. A short stay resident was observed being moved out of the room on the second inspection visit. Rooms must only be used as bedrooms if approved by the Commission, which this was not. Residents with dementia should be able to benefit from an environment adapted to meet their needs, and which helps them make sense of `where theyBarn Park Residential Home DS0000003646.V304107.R01.S.doc Version 5.2 Page 7are` in the home. The home environment should be assessed by an Occupational Therapist. The home should to be kept clean at all times, with increased importance in the kitchen. Insects must be kept out of the kitchen, and safe temperatures for food storage must be ensured at all times. Concerns about cross infection, because of the smallness of the laundry room, could be reduced by the use of non-touch, dissolvable bags to hold soiled material. Staff should be able to dry their hands on disposable towels, rather than share fabric towels. Because of the poor record keeping it was not possible to establish if staff had been recruited safely. Staff recruitment must be done diligently and the necessary records, which are for the protection of the residents, must be in place at the home. All records, which are required by law for the protection of residents, must be in place at the home and available for inspection. Staff should receive a formal supervision at least six weekly. This provides a time when work issues can be discussed and training needs identified. Induction training should be completed within six weeks of staff starting, and the home`s policies and procedures need to be reviewed, and be available for staff use. Health and safety need to be better managed. Cleaning chemicals must not be accessible to confused residents; urgent action must be taken to make this safe. Fire doors must not be propped open, and fire safety checks must be undertaken routinely and not, occasionally, left for weeks. It is required that the home`s current Registration Certificate is displayed in a prominent place, so that the home`s ownership, management, the category and number of residents permitted at the home, is clear

CARE HOMES FOR OLDER PEOPLE Barn Park Residential Home Barn Park Halwill Beaworthy Devon EX21 5UQ Lead Inspector Anita Sutcliffe Unannounced Inspection 24th July 2006 08:30 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.V304107.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.V304107.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 Dereck Scantlebury Mrs Anna Patricia Scantlebury 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.V304107.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. PD, MD & DE categories are for people over 65 years of age only Date of last inspection 3rd March 2006 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 large 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 en-suite toilet facilities - one has an en-suite bathroom. There are two stair cases to the second floor, one 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. Fees charged are: £300 - £425 Additional charges are for: Hairdressing, chiropody, toiletries, transport and tickets for cinema, theatre etc. The latest inspection report is situated in a drawer in the entrance and the summary of the last inspection report is included with the Service User Guide, provided to potential residents. The home and business is currently for sale. Barn Park Residential Home DS0000003646.V304107.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The purpose of the inspection was to assess the homes compliance with Key National Minimum Standards and to look at information relating to a complaint raised with Commission. The inspector also reviewed progress on previously set requirements and recommendations communicated following the homes last inspection in March 2006. The inspection took place over three weeks and included unannounced visits to the home. The organisation provided up to date information about the service at Barn Park. The community psychiatric nursing service, and social services were given the opportunity to comment on the home. Comment cards were left at the home for the use of family and visitors. Only one was returned. During the visits to the home the care of residents was examined; all residents were met and conversations held with four. Two visitors were spoken with, as were staff, the registered manager/provider and the manager designate. Records were examined and the home was toured. What the service does well: What has improved since the last inspection? What they could do better: Examining any record, policy or procedure was found to be very difficult. They appeared to be kept in different places. Some could not be found at all. Those found were incomplete, inconsistent or incoherent. Residents are therefore not Barn Park Residential Home DS0000003646.V304107.R01.S.doc Version 5.2 Page 6 protected through information recorded on their behalf. Nor is their welfare fully promoted, as the assessment and care planning records were of limited use to staff, who should be using them to ensure deliver of care to a consistent standard, in a way agreed with the resident or their representative. Relying on individual staff knowledge is not sufficient to guarantee consistency. Care plans must be reviewed at least monthly, more frequently when necessary. They must be signed and dated, and the resident, or their representative, involved in the planning when at all possible. Medication storage is unsafe; the key kept behind the door and the door unlocked, near an exit to the garden and the kitchen. The temperature of the medicines fridge is not monitored to ensure they are stored at the correct temperature. Medicines are not always signed for once given, which could lead to mistakes. Some creams/ointments were being shared. They must only be given to the resident to whom they are prescribed. Written information about each medication has not been obtained as recommended, but the manager says this is proving impossible. Information provided prior to admission (The Statement of Purpose) does not give adequate information about the home environment, such as indicating the place where people smoke, outside one of the bedroom patio doors. Residents’ rights are not fully protected through the contractual arrangements. The contract does not state which room they will occupy. The provider does not write to confirm that the assessed needs of the resident can be met by the home. This also protects the resident’s interests. Room changes are being made without informed consent from the resident, or agreement from others involved in the resident’s welfare. To protect residents, each must be given a copy of the complaints procedure. Staff should be able to readily access the Whistle blowing policy, which should contain the contact details for the Commission and Local Authority vulnerable adults team. These policies provide the method for reporting complaints or concerns about resident welfare. Residents were observed being treated with respect, and staff knock before entering bedrooms. However, comments recorded by staff were unprofessional and demonstrate disapproval or the resident, not respect. Not having the opportunity/choice as to whether you lock your bedroom door reduces dignity and the opportunity for privacy. This option should be available to all residents where it is assessed as safe. Resident choice is also reduced through the use of the quiet lounge as a bedroom for residents. A short stay resident was observed being moved out of the room on the second inspection visit. Rooms must only be used as bedrooms if approved by the Commission, which this was not. Residents with dementia should be able to benefit from an environment adapted to meet their needs, and which helps them make sense of ‘where they Barn Park Residential Home DS0000003646.V304107.R01.S.doc Version 5.2 Page 7 are’ in the home. The home environment should be assessed by an Occupational Therapist. The home should to be kept clean at all times, with increased importance in the kitchen. Insects must be kept out of the kitchen, and safe temperatures for food storage must be ensured at all times. Concerns about cross infection, because of the smallness of the laundry room, could be reduced by the use of non-touch, dissolvable bags to hold soiled material. Staff should be able to dry their hands on disposable towels, rather than share fabric towels. Because of the poor record keeping it was not possible to establish if staff had been recruited safely. Staff recruitment must be done diligently and the necessary records, which are for the protection of the residents, must be in place at the home. All records, which are required by law for the protection of residents, must be in place at the home and available for inspection. Staff should receive a formal supervision at least six weekly. This provides a time when work issues can be discussed and training needs identified. Induction training should be completed within six weeks of staff starting, and the home’s policies and procedures need to be reviewed, and be available for staff use. Health and safety need to be better managed. Cleaning chemicals must not be accessible to confused residents; urgent action must be taken to make this safe. Fire doors must not be propped open, and fire safety checks must be undertaken routinely and not, occasionally, left for weeks. It is required that the home’s current Registration Certificate is displayed in a prominent place, so that the home’s ownership, management, the category and number of residents permitted at the home, is clear to all who enter. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Barn Park Residential Home DS0000003646.V304107.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 Park Residential Home DS0000003646.V304107.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, & 4 (6 does not apply to Barn Park) Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Information provided prior to admission does not fully inform potential residents about the home. Residents’ rights could be further protected with the addition of more detailed information in the contract, and/or terms and conditions associated with residence at the home. Residents entering the home can be assured that their assessed needs will be met by a competent and caring staff, but the lack of coherence in assessment records impedes good care planning. Residents are not protected through confirmation that their assessed health and welfare needs can be met by the home. EVIDENCE: Barn Park Residential Home DS0000003646.V304107.R01.S.doc Version 5.2 Page 10 It was confirmed that the Statement of Purpose, dated February 2005, was currently in use. It does not provide sufficient information from which prospective residents can decide if the room offered is acceptable to them. For example, one ground floor room opens on to an attractive patio, which is used by people who wish to smoke. This being unacceptable to some people, they must be informed about it prior to admission to the home. To this end, rooms’ described in the Statement of Purpose must include all relevant information. A written Contract/Statement of Terms and Conditions sets out the respective rights and responsibilities of Barn Park and the prospective resident. The existing contract does not fully protect residents, as the room to be occupied cannot be identified within it. This leaves residents without proof of which room has been agreed for occupancy. Social services commented that residents are moved from one room to another without consultation or agreement. (See Standard 17). An assessment is made prior to admission of the needs of potential residents. As with other records at Barn Park, (see Standard 7, 29, 30 and 37) those examined were not consistently comprehensive or coherent. However, they generally demonstrated a sound understanding of the needs of people suffering from dementia, and were relevant to the residents in question. The provider must then write to confirm that the needs identified can be met by the home. This further protects the resident’s rights. The majority of residents at Barn Park are diagnosed with dementia. A social care professional said that the standard of dementia care at the home was good to excellent and that staff have good insight into meeting those illness related needs. It was also said that they handle challenging behaviour well. Regular visitors to the home felt the same. The home is not environmentally adapted to help resident with dementia orientate themselves within the building, other than pictorial signage at their room. However, this does not appear to be a problem to current residents, but should be considered within any future plans for the home. (See Standard 19). Barn Park Residential Home DS0000003646.V304107.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 at least once during a 12 month period. 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 disorganised and of limited value in informing staff how to care for residents in a consistent and planned way. Health and personal care needs are met through staff skill and experience, but the monitoring of health could be further improved. Medicines are not stored safely and they are not handled in accordance to legislation or good practice guidelines. Residents are not treated with sufficient respect. EVIDENCE: Plans of how staff are to deliver care to residents are of very limited use. When asked to bring the full information for inspection it was found kept in several different places. That which was found was incoherent and disorganised. Most of it was unsigned and undated. No all care plans included a photograph of the service user, necessary for their protection. Barn Park Residential Home DS0000003646.V304107.R01.S.doc Version 5.2 Page 12 Health and social care professionals commented that the care at the home was good, but that communication was sometimes poor with mixed messages given and team work needing improvement. This is consistent with reliance on the knowledge of a limited number of staff, rather than a joined up, consistent approach by all staff, and being based on planned care. The manager said that care planning is being reviewed and updated, but this issue has been raised by CSCI on previous occasions with the same response from the home, but no consistent improvement. Care plans did contain assessment of individual risks, including moving and handling, pressure sores and managing emotional needs. These showed some good insight into the care of residents with dementia. Residents’ personal care needs were well met. Attention to detail, such as jewellery and manicured finger nails suggesting an approach which considers the resident’s personal preferences, and beyond the basic need for cleanliness and hygiene. Residents’ health care needs are generally met, but weight gain or loss is not monitored through weighing them or any other accepted safe method. Checking if clothes still fit is not satisfactory. It is especially important to make this assessment where dietary input may be poor, such as in the case of dementia. The way medicines are stored at the home is unsafe. In a busy area (off the kitchen) next to an external door in an unlocked room with the keys hung behind the door, they are available to anybody with limited knowledge of the area. The cupboard in which they are kept is wooden and easily broken into by a determined person. The cupboard, which contains medicines registered as needing additional safety, (controlled drugs) are correctly stored, but again the key is kept openly accessible. The manager has now purchased the correct book for recording the use of controlled drugs. The fridge where medicines were stored did not have a thermometer and no temperature taken to ensure storage at that required necessary. The home uses a monitored dosage system, but then removes the tablets prior to administration, which is generally unsafe. The reason given is that a resident may knock the staff member’s hand when holding both the pot and the dispenser. They therefore choose what they feel to be a safer method, dispensing individually into the pot before taking it to the resident. It was a previous recommendation that patient information leaflets for all drugs in use in the home should be obtained so that information is readily available should there be concerns. The home has so far been unable to do this. Barn Park Residential Home DS0000003646.V304107.R01.S.doc Version 5.2 Page 13 The medication record was examined. There were some gaps in staff signatures. Medicines once given must be signed for immediately to prevent mistakes being made. If not given the reason must be recorded at the time. On touring the building prescribed creams were seen on two occasions with the original prescription name removed. This suggests that they are being used for residents to whom they are not prescribed and to whom they do not belong. The medicines policy and procedure need updating to include every parameter connected with the storage, handling, administration and disposal of medicines at the home. A community psychiatric nurse said that staff were always ready to consider reduction in medication in the best interest of the resident. Residents felt that staff treated them with respect. Staff and visitors confirm that staff knock before entering bedrooms. However, residents do not have the option to lock their bedroom doors for privacy, (see Standard 19). There are issues of concern connected with residents’ rights, (see Standard 17). There were comments recorded by staff of a resident ‘whinging’, and another of a resident being “foul mouthed and evil tempered”. These two comments indicate disdain and lack of respect for the individual. Barn Park Residential Home DS0000003646.V304107.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 at least once during a 12 month period. 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 are supported to have a fulfilled life. Residents receive a nutritious varied diet, which meets individual choice. EVIDENCE: The atmosphere at the home is fairly relaxed; residents were observed reading newspapers, chatting to each other and staff. Library books are changed regularly for variety. There are organised activities, with details displayed on the notice board. A trip o the zoo, planned for the following week, includes nearly all residents. Photographs displayed show previous events held in the garden and visitors spoke of the Easter bonnet contest and the friendly, supportive atmosphere at the home. At both visits residents were seen having breakfast informally. Routine is as relaxed as possible. Some care plans contained detail relating to the resident’s history. This helps to inform staff how to deliver quality, individual care for those residents unable to communicate their needs freely. Barn Park Residential Home DS0000003646.V304107.R01.S.doc Version 5.2 Page 15 Residents said they were very satisfied with the food at the home, and visitors confirmed that there was always food available, when ever needed. The dining room is attractively laid; some eat in the lounge. (See also Standard 8). Barn Park Residential Home DS0000003646.V304107.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 & 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The procedure for making complaints does not fully benefit residents. Residents’ rights are not fully protected. Residents are protected from abuse. EVIDENCE: The Service Users’ Guide to the home states that the home welcomes comments, concerns and complaints. The provider/manager states there have been two complaints made since the previous inspection. One is a complaint under investigation by the Commission. The manager designate confirmed that residents do not receive a copy of the home’s complaints procedure and this is reiterated in the Service Users’ Guide where it says the procedure can be seen on request. The procedure must be given to each resident, and must include the fact that the Commission can be contacted ‘at any stage’ of a complaint, and not only if the complainant is unhappy with the way the provider has dealt with it. The Commission’s contact details are already included. The contractual arrangements between a resident and the provider should include the right to a specific room, and detail the reasons why that right might no longer be possible. The Contract/Terms and Conditions used by Barn Park do not include a room number but do state that everything possible will Barn Park Residential Home DS0000003646.V304107.R01.S.doc Version 5.2 Page 17 be done to ‘respect the rights of older people in the home’. Comments have been received which suggest that residents may be expected to move rooms, and it is confirmed that, where they are there for short term care, this has happened. Investigation of the complaint that a resident was expected to move room without reasonable consultation with them, or their family/representative is proven. The proof is based on the lack of records of any consultation. Nor was there a reason for the change recorded within care planning (or any other records provided). Consultation did take place with the resident’s doctor, and whether the move was in the resident’s best interest was not examined, only the complaint itself. Staff have an understanding of the vulnerability of the residents in their care and how to protect them from abuse. Most have received training at some time. It is also confirmed by a health care professional that they manage aggression between residents quite well. Residents said that they felt safe at the home. The home has a policy on protection from abuse and staff knew of the Local Authority ‘Alerter’s Guide’ detailing what to do if concerns are raised. They had confidence they could approach the provider and manager with any concerns. However, the Whistle Blowing policy, for use should staff not wish to disclose concerns within the home, should be made more readily accessible to them, and contain the contact details for Social Services as well as the Commission. Barn Park Residential Home DS0000003646.V304107.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment is homely and comfortable, but safety and cleanliness should be better promoted. EVIDENCE: On inspection the home was maintained to a safe standard, but some areas appeared worn, others had new furnishings and fittings. Communal space in the home includes a comfortably furnished lounge and a conservatory, which provides a light and airy space with views over the gardens. Cooling extractor fans were in use there during the very hot weather and the standard of equipment to aid residents’ independence is generally good. The dining room cannot presently accommodate all the residents at one sitting. The provider has stated that he has submitted plans for an extension, which would resolve this problem. He says those plans continue to be rejected by the planning authority. Barn Park Residential Home DS0000003646.V304107.R01.S.doc Version 5.2 Page 19 Extensive accessible grounds surround the premises, which include gardens and a patio area thus providing outdoor space if preferred. An assessment of the premises by a suitably qualified professional has yet to be undertaken and the requirement is continued. The provider states that Occupational Therapists cannot be found that will do this. He was reminded that an assessment by an expert in dementia care would also be of value. Resident’s own rooms do not have suitable locks to which they are offered a key, so they do not have the option to lock their room for privacy and the dignity of having that choice available to them. Nor do most rooms have a lockable storage space that can be used for items of personal value. (See also Standard 10). All the rooms visited were attractively decorated and comfortably furnished. Most rooms contained many personal possessions including items of furniture brought to the home by residents. Residents have lockable storage in their room for valuables or medication. At the first visit the home clearly needed cleaning. Debris was found in the communal areas, corridors and bedrooms and there was a slight but unpleasant pervasive smell in the home. The vent above the cooker contained this dirt and dust. The manager said there were problems at that time with cleaning. Another member of staff said not enough cleaning staff were employed. On the second visit the home appeared generally clean. The laundry is very small, but does house commercial laundry machines, necessary for the level of laundry at the home. The separation of clean from dirty laundry is necessary to reduce any risk of cross infection. In the limited space this is difficult, but could be improved using non-touch bags to remove the risk from contact. The laundry room is also used to home cleaning chemicals, but has a fire exit sign so the door cannot be locked. This poses an unacceptable risk to confused residents who might swallow the chemicals. (See Standard 38). The staff office in use is accessed through the kitchen. This requires care staff to go through the area frequently. Residents were also seen in the kitchen. During the second visit the external door from the kitchen was open. Residents could enter it from the garden, and the open door had allowed flies into the room, where food was being prepared and served. The situation was very unsatisfactory, posing a risk of accident and/or food contamination to both residents and staff. The provider has plans to change the use of the rooms containing the laundry equipment and the staff office. Protective clothing was seen available for staff use and hand gel was available throughout. These reduce the possibility of cross infection. However, the Barn Park Residential Home DS0000003646.V304107.R01.S.doc Version 5.2 Page 20 home still uses fabric hand towels (including the staff toilet) rather than single use paper towels, which would reduce the possibility even further. Barn Park Residential Home DS0000003646.V304107.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 at least once during a 12 month period. 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. The numbers and skill mix of current staff were appropriate to meet the needs of current residents, but newly employed staff do not receive a safe level of induction training. Recruitment practice does not fully safeguard residents. EVIDENCE: Residents and visitors agreed that there are sufficient numbers of staff at the home. Staff commented that additional cleaning staff hours were needed, and the debris seen on the floors the first visit supports this. (See Standard 19). Staff were observed working during both visits, and visitors and health and social care professionals agreed that staff are competent in their work. Staff training records are poor, but certificates from training, and discussion with staff, provided evidence that their knowledge was satisfactory. The more recently recruited staff have not received an adequate level of induction training, although in the one instance there were acceptable reasons for this. All newly recruited staff must receive induction training within six weeks of starting employment to fully equip them for the work they are to do. Barn Park Residential Home DS0000003646.V304107.R01.S.doc Version 5.2 Page 22 The recruitment records of three recently employed staff were examined. Each contained two references. However, the manager could not find records of checks undertaken to confirm the applicant has no criminal record. He cannot therefore determine if the applicant is fit to work with vulnerable people. (See also Standard 37). In addition, although staff sign to say they have no criminal record this does not include any ‘spent’ conviction, which would further ensure safety. Barn Park Residential Home DS0000003646.V304107.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is not managed with sufficient regard for residents’ rights, wellbeing or safety. EVIDENCE: The registered provider/manager has decided to sell the home, and it is currently advertised for sale. The day to day care continues under leadership of the manager designate, who has nearly completed her NVQ level 4 (Registered Managers Award) and has a sound understanding of the needs of the residents. During an inspection visit a resident’s property was being moved out of the small lounge, which had a bed and chest of drawers in it at the time. The room is approved by the Commission as a communal space for use by all Barn Park Residential Home DS0000003646.V304107.R01.S.doc Version 5.2 Page 24 residents, not as a bedroom. The provider/manager does not act in the best interest of residents at the home. The manager said that quality assurance within the home is fragmented, but new files are being introduced to bring together all the information, an example being the health and safety audit undertaken by an outside agency. At present satisfaction surveys are given to residents able to complete them, or in most cases sent to family on their behalf. The manager has good insight into resident’s abilities. Staff meetings are “ad hoc and as necessary” and are recorded. Resident meetings are not formally held as this has proven too difficult in the past. No residents’ money is kept on their behalf. The provider chooses to invoice for anything spent on their behalf, such as hairdressing. The home’s record keeping is very poor. Records were non existent, disorganised or apparently missing. Policies and procedures, which should safeguard residents, need to be found and reviewed. Fire safety records were inconsistent, with gaps in the record of safety checks. Fire doors are sometimes propped open. However, staff do demonstrate knowledge of what to do in the event of fire. Risks to residents are not sufficiently assessed or reduced. Cleaning chemicals are stored where residents can access them easily and pose an unacceptable risk due to the confusion of resident with dementia. The provider outlined a plan for room changes, which he says would make the situation safe. A food fridge thermometer recorded a temperature too high for the safe keeping of food. No action had been taken to ensure the safe storage of the food. In June of this year an environmental health officer had highlighted this same problem, but no apparent changes followed. The water temperature of hand basins was found to be extremely hot, posing the risk of scalds to confused residents. The home could not find assessments of this risk, which must be undertaken on each individual where the hazard exists. Barn Park Residential Home DS0000003646.V304107.R01.S.doc Version 5.2 Page 25 Barn Park Residential Home DS0000003646.V304107.R01.S.doc Version 5.2 Page 26 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 2 2 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 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 1 18 2 2 X X 2 X X X 2 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 2 2 1 Barn Park Residential Home DS0000003646.V304107.R01.S.doc Version 5.2 Page 27 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 OP3 Regulation 14 Requirement The registered person must confirm in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the service user’s needs in respect of his health and welfare. Service users’ individual plans must be reviewed by staff in the home at least once per month. The plans must be signed, dated and include a photograph of the service user. Carried forward from 1st. April 2006. There must be a method for assessing service user weight gain or loss so that any concern will be identified promptly. The medicines policy and procedure should include every parameter connected with the storage, handling, administration and disposal of medicines at the home. All medicines kept in the home must be securely stored. Medicines administered must be DS0000003646.V304107.R01.S.doc Timescale for action 31/08/06 2. OP7 15 01/10/06 3. OP8 12 31/08/06 4. OP9 13(2) 01/11/06 5. 6. OP9 OP9 13(2) 13(2) 31/08/06 14/08/06 Page 28 Barn Park Residential Home Version 5.2 7. OP9 13(2) 8. 9. OP10 OP16 12(4) 17 10. OP26 13(3) 11 12. OP26 OP22 23 23 13. OP29 19(4)(b) 14. OP31 7, 8 15. OP31 9 CSA Part 2 (12) (2)(a) signed as given or a reason recorded for why they have not. Medicines (in this case ointments) must only be given to those for whom they are prescribed. Residents must be treated with respect. (This refers to comments in care records). The provider must supply a written copy of the complaints procedure to every service user, or person acting on their behalf. The provider must ensure hygiene is maintained within the home. This relates to the need to separate clean from soiled laundry, prevent flies from entering the kitchen and keep the vent above the cooker clean. All parts of the home must be kept clean. The registered person must demonstrate that an assessment of the premises and facilities has been made by a suitably qualified person, including a qualified occupational therapist. Carried forward from 12th October 2004. The provider must ensure the fitness of workers through obtaining the information specified in paragraphs 1 – 9 of Schedule 2. A Registered Manager must be in post who has an NVQ level 4 in Care / Registered Manager’s Award or who is working towards these qualifications. (Requirement modified) Still within previous timescale for compliance. Only rooms within the home, which are approved by the Commission as suitable to be service user’s bedroom accommodation, must be used DS0000003646.V304107.R01.S.doc 14/08/06 14/08/06 01/09/06 31/08/06 31/08/06 01/11/06 31/08/06 01/10/06 14/08/06 Barn Park Residential Home Version 5.2 Page 29 16. OP37 17 17. OP37 s. 28 C.S. Act 18. 19. 20. OP38 OP38 OP38 13 13 13 21. OP38 13 as such. The information listed in Schedules 3 & 4 must be kept within the care home, kept up to date and available for inspection. The registered provider must display in a conspicuous place the most recent Certificate of Registration issued by the Commission. Carried forward from 1st. April 2006 Fire safety checks must be routinely made with records kept. Fire doors must not be propped open. Risk assessments must include all hazards, both on an individual and general basis. (This refers to very hot water at hand basins). Chemicals (in this case cleaning products) must be stored so that confused service users do not have unsupervised access to them. 14/08/06 14/09/06 14/08/06 14/08/06 31/08/06 14/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations The Statement of Purpose should clearly set out any information relevant to the environment, which informs or has an affect on the service user if admitted. In this case patio doors from a bedroom leading to a patio where people regularly smoke. The terms and conditions/contract should include all information listed in the standard, including which room is to be occupied. Assessment of need records should be comprehensive, DS0000003646.V304107.R01.S.doc Version 5.2 Page 30 2. 3. OP2 OP3 Barn Park Residential Home 4. 5. 6. 7. 8. OP7 OP9 OP9 OP18 OP19 9. 10. 11. 12. 13. 14. OP19 OP26 OP26 OP30 OP36 OP37 complete and coherently organised. Care planning records should be comprehensive, complete, and coherently organised. Patient information leaflets for all drugs in use in the home should be obtained. The temperature of the medicines fridge should be taken and recorded. The whistle blowing policy should be readily accessible to staff and contain contact details for the Commission and the Local Authority vulnerable adults team. Door to service users’ private accommodation should be fitted with locks suited to the service user’s capabilities and accessible to staff in emergencies. Service users should be provided with keys unless their risk assessment/care planning suggests otherwise. Upgrading of the premises should take into account the specific environmental needs of service users with dementia. There should be a non touch (red bag) system available to ensure clean and soiled laundry is kept separate. Staff should have disposable hand towels available to them to reduce the risk from cross infection. Staff should receive induction training to NTO (National Training Organisation) specification within 6 weeks of appointment in their posts. Staff should be supervised at least 6 times per year. Policies and procedures should be reviewed and available so as to inform staff in their daily work. Barn Park Residential Home DS0000003646.V304107.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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