Inspection on 10/08/07 for Barnetts

This inspection was carried out on 10th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Barnetts 05/06/06

Barnetts 15/11/05

Barnetts 27/04/05

Barnetts 09/09/04

Barnetts 13/04/04

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

CARE HOMES FOR OLDER PEOPLE Barnetts Barnetts Frant Road Tunbridge Wells Kent TN2 5LR Lead Inspector Gary Bartlett Unannounced Inspection 8:30 10 August 2007 th 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 Barnetts DS0000023903.V345712.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. Barnetts DS0000023903.V345712.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Barnetts Address Barnetts Frant Road Tunbridge Wells Kent TN2 5LR 01892 542983 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) www.kcht.org Kent Community Housing Trust Mrs Eileen Joyce Gilbertson Care Home 41 Category(ies) of Dementia - over 65 years of age (39), Learning registration, with number disability over 65 years of age (1), Old age, not of places falling within any other category (1) Barnetts DS0000023903.V345712.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Care for a service user with a learning disability is restricted to one person whose date of birth is 13 August 1937 Care for service users of old age, not falling within any other category (OP) is restricted to one person whose date of birth is 8 March 1926. 23rd January 2007 Date of last inspection Brief Description of the Service: Barnetts is owned and operated by the Kent Community Housing Trust. Care is provided for older people and older people with dementia. The Homes senior staffing team comprises the Manager, an Assistant Manager and some Team Leaders. The Home employs Care Services Assistants who work a roster that gives 24-hour cover. The Home also employs other staff for catering, domestic, administration and maintenance duties and Activities Coordinators. Barnetts is located on a main road on the outskirts of Tunbridge Wells where there are the usual facilities of a large town. It is a detached purpose built premises with accommodation on two floors. There are a total of 40 bedspaces with 34 single and 3 shared rooms. There are gardens to the rear of the Home for service users to use. A small day centre is run on the site. Current fees range from £458.92 to £469.61 per week. Barnetts DS0000023903.V345712.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection was conducted by Gary Bartlett, Regulatory Inspector, who was in Barnetts from 8:30 a.m. until 3:15 pm. During that time the Inspector spoke with some residents, 2 visitors, and some staff. Parts of the home and some records were inspected and care practices observed. Due to the nature of the service provided, it is difficult to reliably incorporate accurate reflections of the residents’ views of the service in the report. The Manager had completed an Annual Quality Assurance Assessment prior to the inspection. The Care Homes Regulations 2001 and the National Minimum Standards for Care Homes for Older People refer to people who use the service as “service users”. People living at Barnetts prefer to be referred to as “residents”. Accordingly this shall be done in the text of this report. The Manager and staff gave their full co-operation throughout the inspection. Residents and their visitors spoke very highly of the home. What the service does well: The Manager is experienced and has high expectations of the standards of care for residents. There is an open and friendly atmosphere with good interaction between residents, staff and visitors. Staff are kind and caring. Personal health care needs are well supported and residents’ individual preferences are catered for where practicable. There is encouragement for residents to partake in activities suited to their preferences and capabilities. Barnetts provides a comfortable environment and the standard of cleanliness around the home is good. Barnetts DS0000023903.V345712.R01.S.doc Version 5.2 Page 6 Information about the home is easily accessible and staff are good at helping residents to settle in. Staff are encouraged to undertake training and receive effective supervision. Residents and/or their representatives are regularly asked for their views about the home. What has improved since the last inspection? What they could do better: Safer access to the rear garden for residents with limited mobility must be provided. The arrangements for the reporting of incidents to senior Managers who are “on-call” should be formalised to provide better protection for residents. Barnetts DS0000023903.V345712.R01.S.doc Version 5.2 Page 7 Records of events should be more consistently detailed. The use of bedrooms for shared occupancy should be reviewed as residents are not always able to make a positive choice to share with a full understanding of the implications of this situation. 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. Barnetts DS0000023903.V345712.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 Barnetts DS0000023903.V345712.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, 4, 5 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be confident that they are appropriately placed due to good preadmission assessments and benefit from being able to visit the home prior to admission. Barnetts does not provide intermediate care. EVIDENCE: A pre-admission assessment is made of each prospective resident to ensure the home can meet his or her needs. This may include a visit to the prospective resident at their home or in hospital by the Manager or Assistant Manager. Records show that prospective residents, their families, advocates, Barnetts DS0000023903.V345712.R01.S.doc Version 5.2 Page 10 and relevant health care professionals are involved in the assessment process. Specialist advice is sought from external sources where required. Residents said they or their families had been able to visit Barnetts before moving in. A relative who was visiting confirmed this and said staff are very helpful in assisting new residents to settle in. Intermediate care is not offered at Barnetts. Barnetts DS0000023903.V345712.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. Residents’ personal health needs are assessed and maintained through their individual care plans and with good liaison with relevant health care professionals. Residents are protected by staff adhering to good practice guidelines in the storage and administration of medicines. Staff treat residents with respect and maintain their privacy and dignity. EVIDENCE: Each resident has a care plan and three were inspected in detail. There are clear improvements to care planning. Those seen are up to date and comprehensive. The standard of daily record keeping is generally better. The Barnetts DS0000023903.V345712.R01.S.doc Version 5.2 Page 12 Manager is aware that some records need to be more consistently detailed to accurately reflect care given and incidents and is addressing this through the regular review of records and by staff training. Risk assessments are being improved and written/reviewed in response to incidents and accidents. There is a key worker system to ensure a good exchange of information about residents’ health and welfare. Visiting relatives said staff are very good at keeping them informed. The medicines room is clean and well maintained. The Manager stated it is intended to refurbish the medicines-room in the near future to maintain health and safety standards. Records show that all staff administering medications have been trained and signed off as being competent to do so. The Medication Record Administration Record (MAR) sheets inspected had been completed appropriately and medicines were seen to be given in accordance with good practice guidelines. The home has a good working relationship with the specialist and local health care professionals. This greatly assists in supporting residents in their health care needs. Residents feel that staff are kind and gentle, this was confirmed by observation and discussion with visitors. Staff are considerate of the age and dignity of residents and treat them with courtesy. Barnetts DS0000023903.V345712.R01.S.doc Version 5.2 Page 13 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. Residents can enjoy a fulfilling lifestyle with good outside links maintained and have as much choice and control over all aspects of their lives as their individual abilities allow. Dietary needs of residents are well catered for with a balanced and varied selection of food that meets their tastes. EVIDENCE: The Manager described how residents are supported to manage their own affairs for as long as they wish and are able. Due to the nature of the service, most residents are dependant on support. The home is canvassing residents and their relatives with a proposal to enable residents to participate in the daily routine of the home as much as they wish and are able. Already some residents are helping prepare vegetables for lunch. It is intended to extend this to domestic activities they would usually have undertaken in their own homes, for example, the cleaning of their bedrooms, their laundry etc. Barnetts DS0000023903.V345712.R01.S.doc Version 5.2 Page 14 Equipment such as a washing machine, tumble dryer, cooker, floor sweepers etc have been purchased. This is being carefully risk assessed and staffing levels will be amended to reflect the increased 1:1 support residents will need. The Manager is aware that this is going to be a significant change in culture through which staff will have to be offered guidance and training. Two Activities Co-ordinators are employed and the availability and diversity of activities and outings continues to be improved. Some residents are particularly proud of two paintings they have done together and that are to be displayed in the home. Family and friends feel welcome and know they can visit at any reasonable time. During the inspection a number of visitors were seen in the home and the visitors book records regular visits by families, friends and others. The design of Barnetts provides seating areas within the communal areas where residents can entertain their visitors, in addition to the privacy of their own room. There is a visitors room should they choose to not meet with guests in their bedrooms. The Home encourages individuals and groups from the community to visit. Meal times are set for practical reasons but can be flexible to accommodate activities when necessary. Residents are complementary of the food served and say their tastes are met as best possible with a choice of menu always being offered. There are increased healthy options offered at mealtimes, with a salad trolley and fresh fruit. The meals are generous in portions and look appetising. Mealtimes are relaxed; staff are patient and helpful and allow residents the time they need to finish their meal comfortably. Hot and cold drinks are available through out the day, as well as snacks. Barnetts DS0000023903.V345712.R01.S.doc Version 5.2 Page 15 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. Residents and their relatives know their complaints are listened to and acted on. There are systems to protect residents from abuse. EVIDENCE: The complaints procedure is readily available to residents and their relatives. They said they feel confident that they would be listened to and any necessary action would be taken. A visitor said: • “I know I can always speak with someone in the office”. The home keeps a record is of all complaints received by them. There has been one formal complaint received by the home in the last 12 months. This was dealt with within a good timeframe and not upheld. The Commission has not received any complaints about the home in that time. There are procedures for responding to suspicion or evidence of abuse or neglect to ensure the safety and protection of residents. The Manager and other staff spoken with have a sound understanding of adult protection Barnetts DS0000023903.V345712.R01.S.doc Version 5.2 Page 16 procedures. Any allegation of abuse would be referred to the concerned agencies without delay. There was some discussion about the need to ensure that staff consistently recorded incidents clearly and accurately. Staff are made aware that the Manager and Assistant Manager are contactable by mobile ’phone when they are off duty. The Manager is intending to make sure this arrangement is better communicated to the Team Leaders to provide protection for residents. Barnetts DS0000023903.V345712.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23 and 26 Quality on this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents live in a clean, comfortable and homely environment, which would be enhanced further by safer access to the back garden area for those with restricted mobility. EVIDENCE: The parts of the home inspected are commendably clean and free from unpleasant odours. Some areas have been redecorated and refurbished since the last inspection. Fresh flowers are now placed around the home, adding to the ambience. Barnetts DS0000023903.V345712.R01.S.doc Version 5.2 Page 18 The gardens are well maintained and access to the areas with uneven paving has been restricted. Residents enjoy using the parts of the well-maintained garden they have access to. However, access via the door near the lift area has a too small, side-sloping ramp without grab rails. Safer access to the rear garden for residents with limited mobility must be provided. The sluice rooms are being refurbished to provide better facilities and promote infection control. The commode washer on the ground floor is being re-sited to a more appropriate location and an additional commode washer is being fitted on the first floor. There is now less obstruction being caused by the storage of equipment such as wheelchairs, lifting hoists etc. Some bedrooms are used for shared occupancy. The use of shared bedrooms should be reviewed in view of the mental and physical frailty of the residents and their associated behaviours and care needs. Those who share bedrooms are not able to make a positive choice to share with full understanding of the implications. Barnetts DS0000023903.V345712.R01.S.doc Version 5.2 Page 19 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. Recruitment processes are robust and offer protection to people living at the Home. Training is available to the staff so they have the skills to meet the needs of the residents. EVIDENCE: Resident’s and their relatives speak very highly of the staff, saying they are hard working. There has been some successful recruitment of staff, reducing the reliance on agency staff, but the recruitment and retention of staff continues to be problematic for the Trust. Records seen indicate that robust recruitment procedures are used and the home directly employs only staff that have been properly vetted. The Manager is making progress in getting the agencies to provide evidence of the training undertaken by the staff they provide. Barnetts DS0000023903.V345712.R01.S.doc Version 5.2 Page 20 Staff are required to undertake an induction programme. There is also an induction programme for agency staff to complete on their first shift at the home. Each staff member has a “staff training analysis sheet” to record training courses they have attended and a training matrix is used to give a management overview of staff training needs. It is recommended the management team familiarise themselves with the content of the training courses staff undertake. This will make an accurate identification of training needs easier. For example, it was not initially clear what the component parts of the dementia course are. The staff rosters seen indicate staffing levels are geared to peak times of activity. Barnetts DS0000023903.V345712.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Home benefits from a Manager who is experienced, accessible and supportive. Residents’ financial interests are protected. The home regularly reviews aspects of its performance through a programme of self-review and consultations, which includes the opinions of residents and relatives. Barnetts DS0000023903.V345712.R01.S.doc Version 5.2 Page 22 EVIDENCE: The Manager has been at Barnetts for a number of years. She has extensive experience in residential care and demonstrates a commendable commitment to delivering a high quality service. The Manager has arranged to study for the Registered Manager’s Award. Residents, visitors and staff speak highly of her. There is a sound system of holding and recording service users’ cash, which is checked by the Trust as part of their audit process. The home is regularly audited by the Trust and residents and their representatives or relatives are asked for their views. The Manager is monitoring the quality of records made by staff with the aim of achieving a high level of consistency. Records seen are kept in a manner that preserve confidentiality. There are arrangements to ensure all staff receive the supervision necessary to ensure good standards of care practice and those spoken with have a sound understanding of emergency procedures. The standard of cleanliness in the kitchen and surrounding area is satisfactory. An Environmental Health Officer has inspected the kitchen recently and awarded the local Environmental Health Department’s Clean Food Gold Award. There are records of fire systems checks and fire drills/training. The Manager believes all records of maintenance and safety checks are up to date. These were not inspected on this occasion. The Trust regularly reviewes policies and procedures to ensure they comply with current legislation and good practice advice Barnetts DS0000023903.V345712.R01.S.doc Version 5.2 Page 23 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 3 3 X X 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 3 3 X 3 3 3 3 Barnetts DS0000023903.V345712.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? 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 OP19 Regulation 13(2) Requirement “The registered person shall having regard to the number and needs of the service users ensure that the physical design and layout of the premises to be used as the care home meet the needs of the service users” in that safe access to and from the garden must be available to all service users including those with restricted mobility. To be completed by the given timescale, if not sooner. Timescale for action 31/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP9 OP7 Good Practice Recommendations It is strongly recommended the proposed refurbishment of the medicines room is completed as son as possible. It is recommended records of events are more consistently detailed to accurately reflect care given and incidents. DS0000023903.V345712.R01.S.doc Version 5.2 Page 25 Barnetts 3. 4. OP18 OP23 5. 6. OP28 OP30 It is recommended the arrangements for the reporting of incidents to senior Managers who are “on-call” should be formalised to provide better protection for residents. The use of shared rooms should be reconsidered with service users offered a single room or sole use of the shared room unless they have made a positive informed choice to share. It is recommended a minimum ratio of 50 of staff are trained to NVQ level 2 or equivalent, including staff used from agencies. It is recommended the management team familiarise themselves with the content of the training courses staff undertake. This will make an accurate identification of training needs easier. Barnetts DS0000023903.V345712.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Barnetts DS0000023903.V345712.R01.S.doc Version 5.2 Page 27 - 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!