Inspection on 03/01/07 for Barna House

This inspection was carried out on 3rd January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Barna House 27/02/06

Barna House 26/09/05

Barna House 22/02/05

Barna House 21/06/04

Barna House 16/03/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Barna House 60 Clarendon Avenue Leamington Spa Warwickshire CV32 4SA Lead Inspector Deborah Shelton Key Unannounced Inspection 3rd January 2007 09:50 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 Barna House DS0000004209.V324619.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. Barna House DS0000004209.V324619.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Barna House Address 60 Clarendon Avenue Leamington Spa Warwickshire CV32 4SA 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) 01926 421186 Mr B Thorpe-Smith Mrs Eibhlin Agnes Thorpe-Smith Ms Tracy Mauchlen Care Home 12 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (11) of places Barna House DS0000004209.V324619.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th February 2006 Brief Description of the Service: Barna House is a large converted town house providing domestic, homely accommodation for up to 12 older people. Nursing care is not provided at this Home. Service users have assess to community health services such as GPs, district nurses etc. There are 10 single rooms, 3 of which have en-suite toilets, and 1 double room. There is a large lounge/dining room and 2 bathrooms in the home. There is a patio area at the rear with raised flowerbeds, planted pots and hanging baskets. Barna House is located close to the town centre of Leamington Spa and is therefore within easy reach of shops, churches, parks and doctors surgeries. Street parking for up to two hours is available in addition to pay car parks within a short distance. Bus stops are near by and the railway station is about a mile and a half away. The current scale of charges is £345 - £500 per week. Additional charges are made for chiropody, hairdressing, newspapers/magazines, toiletries and dry cleaning. Barna House DS0000004209.V324619.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The following are the findings of an unannounced inspection visit that took place between the hours of 09:50am and 3.45pm on Wednesday 3 January 2007. The manager was on duty along with the deputy, a care assistant and a cleaner. Twelve people were living at Barna House, one of these people was in hospital at the time of the visit. Two residents were ‘case tracked’, this involves finding out about the individual’s experience of living in the care home by meeting with them, talking to them and their families about their experiences (where possible). Care files are read, these include, risk assessments, daily records, care plans and other relevant information. Staff training records are reviewed to ensure training is provided to meet resident’s needs. A tour of the premises is also undertaken. Documentation regarding staffing, health and safety, medication and complaints was also looked at. The inspector was introduced to a majority of the people that live at Barna House and conversations were held with four people. Some of the documentation was looked at in the lounge, this enabled the inspector to see residents in their usual surroundings and see the interaction between staff and residents. The inspector did not dine with residents on this occasion. Commission for Social Care Inspection comment cards were sent out to residents and relatives. Nine responses were received from relatives and five from residents. Their comments are included in the main body of this report. The inspector would like to thank staff and residents for their cooperation and hospitality. What the service does well: The atmosphere at the Home is relaxed and friendly. Residents were happy to talk to the inspector about their life at Barna House and were interested in what is going on in the outside world. Residents were at ease in their surroundings and offered the inspector drinks, meals and even overnight accommodation saying that she would enjoy the stay! Barna House DS0000004209.V324619.R01.S.doc Version 5.2 Page 6 Staff had an excellent rapport with those under their care and had a good knowledge of resident’s wants and needs. Management, staff and owners chatted freely to residents and were interested in how they were feeling. The manager and staff are dedicated to meet the needs of residents encouraging independence as much as possible. Systems in place are well established, work well and staff have a good understanding of them and their role within the Home. Residents made positive comments about their life at Barna House, some of which are detailed below: “I am totally happy here” “everyone gets on really well” “staff are kind and have a joke, its like a big family, everyone gets on really well” “there are no problems here” The environment is well maintained and provides a cosy, homely atmosphere. What has improved since the last inspection? Four requirements were made at the last inspection and work has been undertaken on three of them. Two have been fully met and one is still in the process of being addressed. Vulnerable adults training was undertaken by nine of the twelve staff employed in September 2006. The manager reported that this training will be updated as necessary. The Home’s whistle blowing procedure required updating to include contact details to enable staff to report abusive practice. This issue has been addressed and staff have been issued with a copy of this amended procedure. Although the method of cleaning commode pans has not changed, certain infection control measures have been put in place. An audit undertaken by an infection control nurse reported that due to the Home’s current layout the method of cleaning commode pans in the bath is an acceptable option. Infection control measures such as protective goggles, disposable gloves and aprons have been put in place. The “bathroom” sign has been removed from the door and a lock has been put up. Residents are aware that they are no longer able to use this bathroom. The manager reports that this was not in use anyway as residents are unable to climb in and out of it. Barna House DS0000004209.V324619.R01.S.doc Version 5.2 Page 7 The manager is still not recording hot water or radiator temperatures. Risk assessments are in place to identify the risk of injury to residents and the owner has obtained quotes for making safe radiators and plans to take action to address this issue shortly. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Barna House DS0000004209.V324619.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 Barna House DS0000004209.V324619.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The pre-admission process provides staff with the information needed to meet the health and social care needs of residents. EVIDENCE: The care file of the most recently admitted resident was looked at to evidence whether pre-admission assessments are undertaken and to review the documentation used during this process. Standardised documentation is used and that seen was fully completed. Sufficient information is gathered before agreeing a placement at Barna House, care plans provided by Social Services also form part of the assessment. Barna House DS0000004209.V324619.R01.S.doc Version 5.2 Page 10 The manager confirmed that potential residents and their relatives are invited to look around the Home, stay for a meal and meet staff and other residents. Each resident is provided with a copy of the Service User’s Guide and given details about the Home. Resident’s stay for a six-week trial period before agreeing to become a permanent resident at Barna House Barna House DS0000004209.V324619.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Care plans give comprehensive consideration to all aspects of health, personal and social care and provide staff with the necessary information to be able to meet the needs of residents. Residents have good access to a wide range of health professionals which results in their healthcare needs being met. Systems and practices regarding storage and administration of medicine are good. The Home’s policies and procedures for dealing with medicines protect residents from risk of harm. Residents are treated with respect and their rights to privacy and dignity are maintained. Barna House DS0000004209.V324619.R01.S.doc Version 5.2 Page 12 EVIDENCE: Two care files were reviewed at this inspection, including that of the most recently admitted resident. Care files contained standardised documentation which is easy to read and in good order. Documentation regarding the most recently admitted resident was not yet fully completed. The resident was admitted for a period of respite care in December. Some of the documentation was fully completed and contained sufficient details. Other care plans were in the process of being developed. Pre-admission documentation contained sufficient details to guide staff regarding the care needs of this resident in the short term. The manager confirmed that the care plans would all be up to date by the end of the week. The care plans completed related to personal care and mobility. Daily entries were recorded at the end of each shift and each detailed how the resident had spent their time and any care interventions carried out. The second care file reviewed was that of a resident who has lived at the Home for over five years. Very detailed information is recorded to guide staff. A pen picture is included in the care file which records information of a historical nature about the resident, her family, past working history, previous hobbies etc. Care plans were all reviewed on a monthly basis and had been updated as necessary. Staff had recorded relevant comments in review documentation. Risk assessments were in place regarding falls, burns from radiators, nutrition, pressure areas and various personalised assessments relating to individual risks. These had been reviewed and updated monthly or as required. Maintenance and inspection records are available in the care file for each piece of specialist equipment used by the resident i.e. hoist. Lists of likes and dislikes regarding food are recorded. One to one activity records are kept. This details the type of activity that the resident likes to undertake and what activities they have actually joined in. Details of medical visits are recorded as well as visits made by District Nurse, Chiropodist and optician. Resident said that they have visits from chiropody, optician and dentist whenever they need. They also felt that their care needs are being met at Barna House. Barna House DS0000004209.V324619.R01.S.doc Version 5.2 Page 13 Four residents responded to the Commission for Social Care Inspection survey stating that they always receive the care and support needed whilst one resident responded that they sometimes receive the care and support needed. One of the residents spoken to on the day of the visit stated that: “my health needs are met, I am well”, “I see the GP or dentist whenever I need to but I don’t need to much because I am well”. Another resident said: “there is no problems seeing the GP, he comes whenever you need him”, “I don’t have problems with my health and staff help me out with anything, I don’t have anything to worry about”. A GP called into the Home briefly during the inspection to see a few residents. The manager reported that the GP surgeries are all close to the Home and visit whenever needed. Medication records and storage was reviewed. Controlled medications seen were stored and records were kept in a satisfactory manner. Staff are double signing both the controlled medications register and the medication administration records (MAR). Photographs have been made available on MAR sheets. This is a good practice recommendation that has been addressed since the last inspection. Six staff have undertaken the safe handling of medication course. These are the staff responsible for the administration of medication to residents. Residents spoken to said that they receive their medication at the same time each day and that they were happy that staff gave them their medication. The Home has a homely remedies policy that has been signed by the relevant GPs. The manager reported that the medication cupboard is cleaned and checked on a weekly basis. The cupboard did not contain any excess stocks and was clean and hygienic. Medication is issued to the Home in blister packs and received every twenty-eight days. The manager said that the pharmacy providing the medication is a very short walk from the Home and gives an excellent service. The pharmacist visits the Home to complete audits on a six monthly basis. Medication records, systems and practices in the Home were satisfactory and improvements have been made since the last inspection. Barna House DS0000004209.V324619.R01.S.doc Version 5.2 Page 14 Throughout the inspection all staff, including domestic staff were seen to treat residents with respect and dignity. Staff chatted with residents in a relaxed and friendly manner and were seen to offer residents a choice in all areas, for example choice of meal and drink. Residents were seen to wander freely around the Home and appeared relaxed in their surroundings. One resident commented that staff treat you with respect and they always knock on bedroom doors before entering. Residents were appropriately dressed for the time of year. Barna House DS0000004209.V324619.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The lifestyle experience in terms of meals and social/leisure activities meets the expectations of residents. The service ensures that visitors are made welcome and the residents’ benefit from visits from family and friends. Residents are able to maintain contact with family and friends as they wish and were happy that they still had some control over their lives and the choices that they make which improves their sense of wellbeing. Meals are well presented, wholesome and provide residents with a nutritious and balanced diet. EVIDENCE: On the day of the inspection residents were seen to be at ease in their surroundings and were enjoying chatting amongst themselves. Some of the residents spoken to showed the inspector their nails that had been manicured and varnished by a member of staff. Barna House DS0000004209.V324619.R01.S.doc Version 5.2 Page 16 Residents said that they enjoyed having a manicure. Pat-a-dog visited and residents were happy to see the dog and make a fuss of it. The owner of the dog confirmed that she had been visiting Barna House for many years and enjoyed visiting the Home. Regular religious services are held and residents are able to visit local churches if they wish. Care plans seen record the leisure activities that the individual resident likes to undertake. Residents were watching the television, reading books and magazines and chatting amongst each other. Five residents responded to the Commission for Social Care Inspection survey. Four of the five residents confirmed that there is always activities arranged by the Home for you to take part in, one respondent reported that activities only sometimes occur. One resident spoken to during the inspection commented that “there is not a lot to do but there is not a lot we can do because we are all old, the dog comes to see us and we do exercise to music”. Other residents said “we sit and chat to each other or read or watch the TV, we all get on really well”. During the inspection there was one relative visiting a resident. Staff made the visitor welcome and offered refreshments. The manager said that families are encouraged to be involved in the Home. Nine relatives responded to the Commission for Social Care Inspection survey said that they are always made to feel welcome, can visit their relative in private and are kept informed of important matters. One resident informed the inspector that she has a very large family and that when they visit staff always have a laugh with them. Details recorded in care files demonstrate that residents are given some choices regarding daily life at the Home. Preferred times for rising and retiring are recorded. Residents were given a choice of meal and drink. Menus seen confirmed that a choice is always given and staff were seen to offer alternatives that are not recorded on menus if residents do not like the choices available. The ethos of the Home appears to be based around maintaining independence. Care plans record that independence is to be encouraged. One resident confirmed “you are able to make choices and are encouraged to do things for yourself. However, staff are always on hand if you need assistance”. Another resident said, “you can go to bed and get up when you want, you do have choices”. “you try and do some things for yourself but staff help you whenever you need”. Barna House DS0000004209.V324619.R01.S.doc Version 5.2 Page 17 Residents meetings are currently not held as the manager stated that these have not worked in the past, as residents are not interested. The manager said that as this is such a small Home they are able to spend time chatting to residents finding out what they want and need and are able to offer choices in this way. The cook was not on the premises on the day of inspection as she was taking sick leave. The manager was in the process of contacting another member of staff to cover whilst she was engaged in making the dinner. Residents were offered tea, coffee, water or squash drink throughout the day. Biscuits and homemade cake were also available. Staff were seen offering residents a choice for the main lunchtime and the evening meal. Residents appeared to enjoy the food that they were given. Staff had a good knowledge of the likes and dislikes of individual residents. Some of the comments made by residents regarding the meals are detailed below: “the food is OK, it is not what you would do for yourself but it is nice” “there is plenty to eat, you get tea and coffee regularly” “the food is good” Three of the respondents to the CSCI survey reported that they usually like the food served whilst two said that they always like the food served. The inspector did not dine with residents on this occasion. The kitchen area was reviewed and was clean and hygienic. The Home have received a gold food hygiene standards award from the Environmental Health Department. Menus demonstrate that meals are varied and nutritious. Barna House DS0000004209.V324619.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 and 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Complaints are handled objectively and service users are confident that their concerns will be listened to and acted upon. Policies and procedures concerning the protection of vulnerable people are appropriate and residents are protected from harm. EVIDENCE: Neither the Commission for Social Care Inspection nor Barna House have received any complaints since the last inspection. The complaint log book was reviewed and as noted at the last inspection the complaint received had been investigated and appropriate action taken. Copies of the complaint procedure are on display in the Home. Residents spoken to were happy that if they had any concerns the manager or staff would sort them out. They confirmed that the manager and all staff are approachable. One resident said that “everyone gets on well and everything is OK. There are no problems, if there were I would speak to the manager or staff but there are no problems at all”. No adult protection issues have been raised at this Home. Barna House DS0000004209.V324619.R01.S.doc Version 5.2 Page 19 Evidence was seen to demonstrate that all staff have an up to date protection of vulnerable adults and criminal records bureau check. Nine staff undertook protection of vulnerable adults training in September 2006, this was because of a requirement made at the last inspection. The whistle blowing procedure has also been amended to record contact details for staff should they have any concerns regarding abusive practices. Staff appeared to have a good relationship with those under their care, they were patient and kind and residents were engaged in joking and laughing with them. Barna House DS0000004209.V324619.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, 21, 25 and 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The standard of the environment within this Home is generally well maintained providing an attractive, hygienic and homely place to live therefore improving the quality of life for residents. EVIDENCE: A tour of the communal areas, the bedrooms of those resident’s being case tracked and the bedrooms of three other resident’s were reviewed. All were found to be well maintained, clean and hygienic without unpleasant odours. Bedrooms had been personalised with pictures and ornaments. Communal areas such as lounge and dining room were domestic in nature and had a homely feel. Furnishings were in a reasonable state of repair apart from dining chairs, which were starting to look shabby. Barna House DS0000004209.V324619.R01.S.doc Version 5.2 Page 21 Some bedrooms have recently been re-decorated and re-carpeted. One resident commented that the “Home is always clean and tidy, I have a nice room, it’s a nice place”. Bathrooms were clean and hygienic. The bathroom on the first floor of the Home is still in use as a commode cleaning area. The door is now lockable and the “bathroom” sign has been removed. The manager reported that this bath was never used as it is not of the assisted type and residents would be unable to get in. The report of the infection control nurse states that providing certain infection control measures are put into place the use of the bathroom to clean commodes is an acceptable option because of the current Home layout. The manager is still not recording the temperature of radiators. However, the owner has received quotes for replacing all of the radiators with low surface temperature radiators and a quote for having covers fitted. Work will commence shortly to either ensure temperatures are below 430C or to provide an alternative means of ensuring residents are not at risk of burn from hot radiators. Risk assessments are in place. The front of the building has been repainted and a new canopy fitted. Externally the Home looks fresh and clean. The rear garden is planted with brightly coloured flowers and chairs and tables are available for residents to sit out in warmer weather. Barna House DS0000004209.V324619.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 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The Home is well staffed with adequate numbers available. The staff team are enthusiastic and have a good relationship with those under their care. The number of care staff with an NVQ 2 qualification will help to ensure that the skill mix of staff on duty will support meeting the needs of residents. Staff recruitment and selection procedures ensure that only those individuals deemed to be suitable are employed to work at Barna House. Improvements are needed to the amount of mandatory and induction training undertaken. Lack of induction training might reduce the care staffs’ competence and could result in the risk of harm to the residents. EVIDENCE: Twelve people were living at Barna House, one of these residents was in hospital. The manager, deputy, a care assistant and a domestic were on duty. The cook was taking sick leave. The owners’ of the Home called in and chatted to both staff and residents. All had an excellent relationship with residents and spent time chatting and joking. Barna House DS0000004209.V324619.R01.S.doc Version 5.2 Page 23 Some of the comments made by residents regarding staff are detailed below: “staff are always friendly and kind, they help you out whenever you need it” “staff on duty today are particularly nice” “staff help you with everything you need” “we all get on well, its like a big family here”. “I don’t have any problems with my health but staff help me with anything like that” The Home has a very low staff turnover and only one new member of staff has been employed within the last four years. Five staff have undertaken National Vocational Qualifications (NVQ) in Care. The deputy manager is currently undertaking NVQ level 3 and the manager NVQ level 4. One other member of staff is interested in starting the NVQ training on the next available course. Two staff files were reviewed, one of which was the most recently employed staff member and the other a long-term employee. Both contained sufficient details to demonstrate that the recruitment process is robust and protects residents from harm. Criminal records bureau and protection of vulnerable adult checks are undertaken on all staff. Written references, Curriculum vitae’s, application forms and photographs of staff were available on file. Training details are kept separately. A training matrix is available. Documentation seen did not demonstrate that staff receive regular mandatory training. A video is used to provide fire safety training for staff. The training matrix recorded that nine staff have received this training in either 2004/05 or 2006. This is not satisfactory. Staff should undertake fire training on at least an annual basis. Manual handling training has not been undertaken since 2003 and only a few staff undertook this training. A majority of residents do not require assistance with mobility, however some require support. Moving and handling training must therefore be provided. The manager reported that this training along with dementia training is planned for 2007. There was no evidence that the newly employed staff member has undertaken any induction training in line with the skills for care council. The Home has a very brief induction process that had been completed. The manager was aware of the need for induction training to be undertaken and stated that she would obtain the information as soon as possible. Barna House DS0000004209.V324619.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The Home has an experienced manager who has an in depth knowledge of the needs of those under her care. There are systems in place to ensure that the quality of the service provided meets the needs and expectations of the Service users who live at the Home. Procedures are in place to manage residents’ monies and valuables so their interests are safeguarded. Not all health and safety issues have been addressed to ensure that residents live in a safe environment. This puts residents at risk of harm. Barna House DS0000004209.V324619.R01.S.doc Version 5.2 Page 25 EVIDENCE: Management systems and practices are satisfactory. The manager is aware of any issues to be addressed and has plans in place to address them. The manager is currently undertaking her NVQ level 4. Quality assurance systems are in place. The manager feels that the process is too detailed, time consuming and in depth for the size of the Home and plans to amend it. Satisfaction surveys will be sent out every six months and a report completed which details results, comments and any action to be taken by the Home. This will be made available for residents and relatives to review. Surveys have been completed by staff, residents, relatives and stakeholders such as GPs, District Nurses, and Hairdresser etc. Staff sit with residents when completing their questionnaires and record any comments made. Other processes involved in the quality assurance system relate to an annual food and medication audit. The manager has just started reviewing policies and will go through all ensuring that they are reviewed on an annual basis and updated as necessary. There was no evidence of any other audits taking place i.e. care plan audits, environmental or health and safety audits. Financial records were reviewed to evidence whether appropriate storage and recording of resident’s spending money takes place. The manager has recently changed the system and now a receipt book is kept to record expenditure. Records seen were up to date and in good order and funds held balanced with records. Records were reviewed to demonstrate that the health and safety of residents and staff is promoted. Legionella water safety records were reviewed, details were available on the premises regarding the checks undertaken in 2005. Both the owner and the manager confirmed that checks have been undertaken in 2006 and that a copy of the report would be forwarded to the inspector. Fire records were reviewed and found to be satisfactory, fire drills are undertaken on a regular basis and emergency lighting, fire alarm system and fire extinguishers are all being checked in accordance with legislation. A fire officer had recently visited the Home and had asked for the Fire Risk Assessment to be updated. This has been completed as requested. As previously mentioned in this report fire training and other mandatory training is not up to date. Staff should undertake fire training on at least an annual basis, moving and handling, first aid and food hygiene training all needs to be undertaken by some staff. Barna House DS0000004209.V324619.R01.S.doc Version 5.2 Page 26 Portable appliance test records did not demonstrate that annual checks are being undertaken. The last check was undertaken in July 2005. The Home owner has undertaken training and plans to undertake portable appliance tests in future. Some doors were noted as being wedged open. When doors are required to be left open devices should be fitted or advice sought from the fire service regarding the safest method of holding open these doors. Radiators still present a risk of burns to residents. The manager has not yet monitored temperatures to ensure that they do not rise above 430C. The owner has obtained quotes for changing radiators to low surface temperature type or for the fitting of radiator guards. Work should apparently commence to make radiators safe in the near future. Hot water temperature records are not kept. There is therefore no way to ensure that water temperatures do not rise above 430C and present a scald risk to residents. Risk assessments have been undertaken regarding the risk of injury from radiators and hot water. These are available in care files. Other servicing records such as chair lift, hoist etc were all up to date. Barna House DS0000004209.V324619.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X X X 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Barna House DS0000004209.V324619.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP25 Regulation 13(4) Requirement The registered provider and manager must provide evidence that radiator temperatures are monitored and that temperatures do not exceed 430C. Where temperatures are in excess of this, a plan is to be forwarded detailing the action to be taken to remove the risk of burns to residents from hot radiators and exposed pipe work. Details of hot water temperature monitoring must also be forwarded with the action plan of this report. (Outstanding since 26 September 2005) The registered manager must be able to demonstrate that staff receive 3 paid training days per year. (Outstanding since 27 February 2006) Updates in training in mandatory areas such as fire, moving and handling and first aid must be undertaken on a regular basis. DS0000004209.V324619.R01.S.doc Timescale for action 10/02/07 2 OP30 18(a)(c) 10/02/07 3 OP38 13 18(a)(c) 10/02/07 Barna House Version 5.2 Page 29 (Outstanding since 27 February 2006) Health and safety issues identified within the main body of this report such as hot water and radiator temperatures which could cause injury, portable electrical appliance testing, mandatory training, wedging open fire doors etc, must be addressed as a matter of priority. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Barna House DS0000004209.V324619.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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 Barna House DS0000004209.V324619.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!