Inspection on 27/04/05 for Barnetts

This inspection was carried out on 27th April 2005.

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

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

Other inspections for this house

Barnetts 10/08/07

Barnetts 05/06/06

Barnetts 15/11/05

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 Frant Road Tunbridge Wells Kent TN2 5LR Lead Inspector Gary Bartlett Unannounced 27 April 2005 8:15am 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 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 H56-H06 S23903 Barnetts V223213 270405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Barnetts Address Frant Road Tunbridge Wells Kent TN2 5LR 01892 542983 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Kent Community Housing Trust Mrs Eileen Gilbertson CRH Care Home 40 Category(ies) of DE (E) Dementia - over 65 (34) registration, with number OP Old age (5) of places LD (E) Learning dis - over 65 (1) Barnetts H56-H06 S23903 Barnetts V223213 270405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Care for a service user with learning disabilty is restricted to one person whose date of birth is 13 August 1937 Date of last inspection 9 September 2004 Brief Description of the Service: Barnetts is owned and operated by the Kent Community Housing Trust. It is a detached purpose built premises with accommodation on two floors. The Home is equipped with a shaft lift. There are a total of 40 bed-spaces with 34 single and 3 shared rooms. All bedrooms are fitted with a staff call point and three have telephone points.Barnetts is located on a main road on the outskirts of Tunbridge Wells where there are the usual facilities of a large town. There is easy access to public transport with a bus stop near by and a main line railway station is approximately 1 ½ miles away. Space for car parking is available at the front of the building. There are gardens to the rear of the Home for service users to use. A small day centre is run on the site. The Home’s 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 24hour cover. The Home also employs other staff for catering, domestic, administration and maintenance duties and Activities Co-ordinators. Barnetts H56-H06 S23903 Barnetts V223213 270405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 7 ¼ hours. Ten residents were spoken with. Due to the nature of the service it is difficult to reliably incorporate residents’ reflections of the service in the report. Many judgements about the quality of life for residents were made from observation, inspecting parts of the premises, reading records and speaking with the two Assistant Managers, care and ancillary staff and three visitors. The tour of parts of the premises included the lounges, laundry, bathrooms, toilets and several bedrooms. The records inspected included care plans, staff rosters, staff files, training records and records of accidents and incidents. All staff were very helpful during the inspection. What the service does well: People who lived at the Home and their visitors said it was comfortable. In the areas used by the residents the Home was very clean and free from offensive odours. Residents said the staff were “friendly” and lovely”. Staff were seen to be attentive and responsive to residents’ needs as best they could. The Home maintained close links with residents’ relatives and the local community. General health needs were well recognised and managed. Staff were encouraged to undertake training and there was a comprehensive induction programme. Barnetts H56-H06 S23903 Barnetts V223213 270405 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? 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. Barnetts H56-H06 S23903 Barnetts V223213 270405 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Barnetts H56-H06 S23903 Barnetts V223213 270405 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4, 5 and 6 Prospective residents were at risk of being inappropriately placed due to inconsistent pre-admission assessments. Residents benefited from being able to visit the home prior to admission. A staff team having received training in dementia care and management of challenging behaviour would better meet residents’ needs. EVIDENCE: Barnetts H56-H06 S23903 Barnetts V223213 270405 Stage 4.doc Version 1.30 Page 9 The Inspector was informed that prospective residents were assessed prior to admission and a record was kept to help write a care plan. Two of the records seen did not reliably inform whether the Home could meet the persons’ needs or lead to a holistic plan of care. In one case some staff knew significant information that was not recorded or followed up in a care plan. More comprehensive information had been recorded in respect of the resident most recently admitted to the Home. Some staff have worked at Barnetts for a long time, others had only recently started and the Home still had to use agency staff. It was not readily clear what training in dementia and challenging behaviour had been undertaken by the staff, although some training was spoken of. Residents said they had been able to visit the Home before moving in. This was confirmed by some of their visitors. They also said staff had been very helpful in assisting them to settle in. Barnetts H56-H06 S23903 Barnetts V223213 270405 Stage 4.doc Version 1.30 Page 10 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 standard(s) 7 and 10 The care plans were not consistently clear to provide staff with the information needed to meet all the residents’ needs. Staff treated residents with respect and maintained their privacy and dignity. EVIDENCE: Two care plans were inspected in detail. Although there was an improvement in the plans, one was completed more comprehensively than the other. In one care plan the risk assessments had not been reviewed as a result of recent incidents and were not reflective of the resident’s current needs. There were some very good examples of daily records of care. However, it was not always recorded that some things had been followed up or recorded in parts of the care plan where the information would be more readily available to staff. From observation, it was apparent that staff would have benefited from the information in the care plans being more comprehensive. It was important that necessary and current information is recorded and readily available, especially in view of the large number of agency staff being used at the Home. Barnetts H56-H06 S23903 Barnetts V223213 270405 Stage 4.doc Version 1.30 Page 11 From observation and discussion with residents and visitors it was clear that staff treated residents with respect and promoted their privacy and dignity. Residents could meet with visitors and make telephone calls in private. Adequate privacy screening was provided in all shared bedrooms. Barnetts H56-H06 S23903 Barnetts V223213 270405 Stage 4.doc Version 1.30 Page 12 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 standard(s) 12, 13 and 14 Residents benefited from routines of daily living and activities that were flexible and varied to suit their preferences but their experiences at breakfast were poor due to delays in being served once seated. Where practicable, residents could participate in local community activities and their autonomy and choice was promoted. EVIDENCE: Staff spoken with were aware of the rights of residents to have the opportunity to have choice in daily routines and activities. This was seen to be generally achieved. The Inspector was concerned to see that there was still an over-long delay between seating residents and the serving of breakfast. This caused a number of residents to become agitated. Given that the service is directed at caring for people with dementia the Inspector again strongly recommended that this be addressed as a priority. The Home had a visitors policy which stated visitors were welcomed at all reasonable times. During the inspection a number of visitors were seen in the Home and the visitors book recorded regular visits by families, friends and others. Barnetts H56-H06 S23903 Barnetts V223213 270405 Stage 4.doc Version 1.30 Page 13 Residents could meet with visitors in a designated visitors room, various lounges or in their bedrooms. Staff, residents and visitors described how visits to and from the local community were arranged according to residents’ wishes and taking account of their needs. Staff said residents could handle their own financial affairs although most lacked the capacity to do so and were supported by their families. Staff also mentioned people were available who could act in an informal advocacy role. It was seen that residents could bring in personal possessions. A senior staff member stated that residents could have access to records held about them but few would have a wish to do so. Barnetts H56-H06 S23903 Barnetts V223213 270405 Stage 4.doc Version 1.30 Page 14 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 standard(s) These Standards were not inspected on this occasion. EVIDENCE: Barnetts H56-H06 S23903 Barnetts V223213 270405 Stage 4.doc Version 1.30 Page 15 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 standard(s) 19, 20, 21, 22, 23, 24 and 26 Residents enjoyed a clean and comfortable environment. Residents would benefit from facilities being better identified, and appropriate storage space for equipment. Residents were put at risk by poor infection control. EVIDENCE: It was seen that repair work was carried out where required although investment in the longer-term maintenance of the building was tailored to the intention of rebuilding the Home at a new site. As far as the Inspector was aware, there were no outstanding issues from the Fire Safety Officer or Environmental Health Officer. Residents said they considered their bedrooms and the lounge rooms to be large enough and comfortably furnished. Barnetts H56-H06 S23903 Barnetts V223213 270405 Stage 4.doc Version 1.30 Page 16 Residents were pleased with the availability of assisted baths. Staff thought that there were adequate washing and toilet facilities available. It was seen that there was nothing to identify some toilets to residents, the toilet doors looked very similar to nearby bedroom doors. Other toilets were appropriately signed. There was limited storage space for equipment such as lifting hoists. A lifting hoist was being stored and recharged in the bedroom of a resident. As the resident did not use the hoist and a staff member said the hoist was used during the night and day, the Inspector advised the hoist must be stored in a more appropriate area. Adaptations were provided around the Home and staff were seen to respond promptly to the call system. The bedrooms inspected were of adequate size and generally well decorated. Some bedrooms were shared and fitted with privacy screening. The use of shared bedrooms should be reviewed in view of the mental frailty of the residents and the associated behaviours. Residents said they were always warm enough and there was always hot water when they wanted it. The hot water felt by hand from a number of hot water taps was of an acceptable temperature. Water temperature tests were carried out regularly by staff. Those parts of the Home inspected were clean and free from unpleasant odours. Except for the laundry. The area behind the equipment was dirty. The paint of the walls and window frames was flaking and there were areas of bare plaster. Infection control was further compromised by a staff member who was seen to place dirty towels in a wheelchair and then suggest putting them into the baskets used for clean laundry. There were two washing machines and two tumble dryers. The Inspector questioned whether this was adequate to meet the needs of a much higher dependency group than the laundry was originally designed for. In several residents’ bedrooms, it was observed that hairbrushes and combs needed cleaning and some hair-combs were stored in the same plastic mug as the toothbrush. Some toothbrushes were seen to be caked with dried toothpaste and several tubes of toothpaste and creams had been left without lids on. Some tubes of creams with expired use by dates were in bedrooms. Personal toiletries labelled for one resident were found in another resident’s bedroom. A Team Leader acknowledged that this situation was not of an acceptable standard. Barnetts H56-H06 S23903 Barnetts V223213 270405 Stage 4.doc Version 1.30 Page 17 Barnetts H56-H06 S23903 Barnetts V223213 270405 Stage 4.doc Version 1.30 Page 18 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 30 The specialised care needs of the residents could not be reliably met by the Home due to it’s continued reliance on the use of agency staff and the resultant difficulty in providing a staff group with the skills required. Residents could benefit from increased staffing levels at peak times of activity. Staffing levels at peak times of activity should be reviewed. EVIDENCE: Staff rotas inspected and staff spoken with indicated the Home was still dependent on agency staff to maintain adequate staffing levels, despite ongoing attempts to recruit staff. Staff retention continued to be a problem. This was detrimental to the Home’s efforts to provide a staff group with the specialist training in dementia and associated skills necessary. A central training matrix was not held so it was difficult to readily identify individual staff training requirements. Staff spoken with were not specific about the nature of any training in dementia that staff might have received and were not aware of any external training sources used. Records and staff confirmed NVQ training was encouraged within the Home. Barnetts H56-H06 S23903 Barnetts V223213 270405 Stage 4.doc Version 1.30 Page 19 It was seen that staff were busy at 8.15 a.m. assisting residents from bed and taking them to the lounges for breakfast. One staff member served breakfast from a trolley. Residents were observed to be unsupervised during this time for lengthy periods. This was potentially dangerous as some residents were seen to become agitated as they had to wait for what they perceived to be a long time for residents. In one incident a staff member was not available to reassure a resident that they had already had their breakfast, as indicated by their used cup, plate etc. Accordingly, the Inspector strongly recommended that staffing levels be reviewed at peak times of activity. The Inspector also recommended the method of having one staff member serve breakfasts between widely separated lounges be reviewed. As mentioned elsewhere in this report, the areas of the Home used by the residents were commendably clean taking into account the time of day. Barnetts H56-H06 S23903 Barnetts V223213 270405 Stage 4.doc Version 1.30 Page 20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 The protection of the residents’, and staffs, health, safety and welfare was not consistent potentially putting both at risk. EVIDENCE: The requirements for improved risk assessments and infection control are described elsewhere in this report. Staff were seen to be diligent in ensuring COSHH requirements were adhered to except in that a used sharps bin had been left in a resident’s bedroom. This would have most likely been done by a community health care professional. Staff spoken with had a sound understanding of emergency procedures, including a staff member who had been working at the Home for only one week. Barnetts H56-H06 S23903 Barnetts V223213 270405 Stage 4.doc Version 1.30 Page 21 Dinner plates seen to be used to serve lunch were too hot for staff to handle and posed a danger of burning to residents. A staff member demonstrated a very good knowledge of food hygiene standards. Records of maintenance and safety checks were not inspected. Barnetts H56-H06 S23903 Barnetts V223213 270405 Stage 4.doc Version 1.30 Page 22 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 x COMPLAINTS AND PROTECTION 3 3 2 2 2 3 x 1 STAFFING Standard No Score 27 1 28 3 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x 2 Barnetts H56-H06 S23903 Barnetts V223213 270405 Stage 4.doc Version 1.30 Page 23 Yes 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 OP3.1, Regulation 14(1)(a) Requirement The registered person shall not provide accommodation to a service user at the care home unless, so far as it is practicable to do so the needs of the service user have been assessed by a suitably qualified or suitable trained person in that the pre admission assessment must be in sufficient detail to identify whether needs can be met in the Home and to inform the initial care package and risk assessments. This was a requirement in the previous inspection report. The registered person shall, having regard to the size of the care home, the statement of purpose and numbers and needs of service users ensure that at all times suitably qualified and competent and experience person are working at the home in such numbers as are appropriate for the health and welfare of service users in that staff must demonstrate a sound understanding of the specific needs of older people with dementia and the skills Timescale for action To be done by 30 May 2005 2. OP4.1 OP30 18(1) Action plan to be received by CSCI by 30/05/05 Barnetts H56-H06 S23903 Barnetts V223213 270405 Stage 4.doc Version 1.30 Page 24 3. OP7 14(2)(b), 15(2), 17 Schedules 3&4 4. OP22.8 12(4)(a) 5. OP26 12(1), 13(3)(4)( c) 16(2)(j) 6. OP38 13(4) necessary to provide good care. This was a requirement in the previous inspection report. “The registered person shall maintain records as specified in Schedules 3 and 4. The registered person shall keep the service user’s plan under review in that: service users’ individual plans and records must be reflective of their care needs and daily records must evidence how identified care needs had been met and monitored. Although being addressed, this remains a requirement from three previous inspections The registered person shall make suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users in that equipment designated for general use must not be stored in service users’ bedrooms. “The registered person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home”, in that: 1. The laundry must be made good and kept clean 2. Soiled laundry must be separated from clean 3. Service users personal toiletries and equipment must be kept in a hygienic manner 4. Creams must not be used or kept after their expiry date. “The registered person shall ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated” in that: 1. Sharps bins must not be left where residents can be injured Action plan to be received by CSCI by 30/05/05 To be completed by 30 May 2005 Action plan tobe received by CSCI by 30/05/05 Action plan tobe received by CSCI by 30/05/05 Barnetts H56-H06 S23903 Barnetts V223213 270405 Stage 4.doc Version 1.30 Page 25 2. Residents must not be put at risk of injury through the use of very hot crockery 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 OP12.2 Good Practice Recommendations It is strongly recommended that an alternative method of serving breakfasts be explored to reduce the time that some service users have to wait and reduce the risk of agitation. It is again recommended that toilets should be easily identifiable to service users 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 strongly recommended that a review be undertaken to determine if the exiting laundry facilities are adequate for the Homes needs. It is strongly recommended that a review of staffing levels at peak times of activity be undertaken 2. 3. OP21.1 OP23.7 4. 5. OP26 OP27.4 Barnetts H56-H06 S23903 Barnetts V223213 270405 Stage 4.doc Version 1.30 Page 26 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 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. Extracts may not be used or reproduced without the express permission of CSCI Barnetts H56-H06 S23903 Barnetts V223213 270405 Stage 4.doc Version 1.30 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. 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