Inspection on 11/06/09 for Barnfield House

This inspection was carried out on 11th June 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Barnfield House 20/06/07

Barnfield House 08/11/06

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: Barnfield House 9-10 Barnfield Terrace Station Road Liskeard Cornwall PL14 4DT     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Gail Richardson     Date: 1 1 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Barnfield House 9-10 Barnfield Terrace Station Road Liskeard Cornwall PL14 4DT 01579347617 01579347617 rebmill@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Rebecca Joy Miller,Michael Stephen McGillicuddy Name of registered manager (if applicable) Mrs Lynda Penney Type of registration: Number of places registered: care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is 14. The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Barnfield House is registered to provide accommodation and personal care for up to 14 people with a mental health condition. It is situated close to the local train station, bus services, shops and facilities of Liskeard. The accommodation comprises what was originally two houses, adapted to become one. Accommodation is offered in Care Homes for Adults (18-65 years) Page 4 of 35 Over 65 0 14 Brief description of the care home predominantly single rooms with 2 shared rooms provided. Stairs provide access to the upper floors. There is parking access at the side of the building. The home provides a Statement of Purpose and Statement of Intention together with a copy of the last key inspection report and complaints procedure in the main entrance to the home. Barnfield House is an established service, which came under new ownership in March 2006. The owners are Dr. R. Miller and Mr S McGillicuddy. A manager designate has been in post since August 2008 and undertaking the process of application to become the Registered Manager for the service. The home charges 364.89 pounds per week (Correct as of July 2009).This does not include toiletries, Chriopody, Hairdresser and newspapers/magazines. Care Homes for Adults (18-65 years) Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection, which took place over 1 day (7.5 hours) on the 10th June 2009 by Regulation Inspector Gail Richardson. The homes last key inspection was conducted in June 2007 and an Annual Service Review was undertaken in June 2008. No visits to the home have taken place in the interim period. The home has provided the Care Quality Commission (CQC) with a completed AQAA (Annual Quality Assurance Audit) which was completed by the Registered Provider and gives details of all aspects of the home. A tour of the home took place and a selection of the bedrooms and all communal areas were seen. There were 13 people currently residing at the home. Care Homes for Adults (18-65 years) Page 6 of 35 We spoke to seven people using the service, and four members of staff, the Manager Designate and Registered Provider were available throughout the inspection. As part of this inspection we surveyed the opinions of a random selection of people using the service, GPs, District Nurses and Care Workers. Surveys were sent to people using the service and low levels of responses were received. We spent time talking to people within the home and talked with staff we also observed care being given. All people using the service spoken to, spoke of the staff members kindness and support and confirmed that they liked living at the home. Records relating to care including three care plans, three staff files, finances and health and safety records were examined. The manager designate and registered provider advised that in their opinion the provision of an easy read summary of this inspection report would not be appropriate for the people using the service and may lead to further confusion. The focus of this inspection visit was to inspect relevant key standards under the CSCI Inspecting for Better Lives 2 framework. This focuses on outcomes for people using the service and measures the quality of the service under four general headings. These are excellent, good, adequate and poor. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Care Homes for Adults (18-65 years) Page 7 of 35 What the care home does well: What has improved since the last inspection? A requirement was made at the previous key inspection that the registered person must implement a National Training Organisation compliant induction programme for new staff. This was seen to have been implemented. It was recommended at the last key inspection that more could be done to show the involvement of the resident or, where agreed, their families in care plan reviews. The development of new care plans has included the signed agreement of people using the service with the care plan. The registered person now ensures that when instructions are transcribed onto Medicine Administration Records two initials are provided to check the accuracy of the entry. The last key inspection recommended that the breadth of areas covered by the homes policies and procedures should be reviewed to ensure the safety of residents and staff as the former care needs change and the latter roles develop. This was with reference Care Homes for Adults (18-65 years) Page 8 of 35 to staff changing roles during a shift. The staff were seen to have the appropriate clothing to ensure a clear change of role and ensuring that the health and safety of people was not compromised. What they could do better: The Registered Provider made contact with the Care Quality Commission (CQC), shortly after the inspection to confim compliance with all areas raised a the inspection. This report is a reflection of what was found on the day of inspection, the prompt action reported has been noted within the body of this report. The registered provider is recommended to include the room number in the contract between the home and the person using the service. This is recommended to ensure that people are aware of the accommodation to be provided. The registered person must ensure that each person has a care plan which identifies how each need in respect of health and welfare is to be met and that each persons care plan is reviewed and updated regularly. This is required to ensure that all staff have a clear plan to follow to ensure that the persons needs are both monitored and reviewed regularly and that changing needs are met met. The fridge was noted to contain items which has not been dated when opened. This is recommended to be monitored and the appropriate action taken to ensure the safety of people using the service. The registered person is required to ensure that all medications procured into the home which then go on to be given to the person to self administer be recorded when handed to the person using the service. This requirement ensures that there is a clear audit path of medications available for staff to follow. It is also required that any person who wishes to self administer medication has a risk assessment in place and that risks are monitored and reviewed and appropriate action taken. The manager designate must also review the practice of secondary dispensing into travel boxes when people leave the home for periods of time. This may place both the person and staff at risk of error in administration. The registered person is recommended to include in staff policies instructions for staff, precluding them form being involved in the making or benefiting from people using the services Wills. This is recommended to support both parties by having a clear understanding of boundaries of practice. The registered person is recommended to update the homes complaints and whistle blowing policies to include the correct contact details for any external bodies. It is also recommended that the registered person ensure that all staff have received training in abuse awareness to ensure the protection of people using the service. Whilst it is understood that currently an extension is being built onto the home, some of the areas are also in need of maintenance and repair.The registered person is recommended to ensure that the rolling program of maintenance is continued to all areas of the home which require repair/replacement. The registered person is required to ensure that all staff have two references prior to commencing employment at the home and that these reference are stored in the Care Homes for Adults (18-65 years) Page 9 of 35 prospective staff members file. The registered person is recommended to ensure that a detailed employment history for each prospective staff member is obtained. This is recommended to include dates of employment and explanations for any gaps.This will ensure that recruitment procedures are complete and protect people using the service. The registered person is recommended to include further visiting health professionals to the homes Quality Audit to achieve a wider review of quality audit. It is recommended that the declaration for the Rehabilitation of Offenders Act contained in the homes staff application form be expanded to explain that all previous convictions must be declared to ensure the safety of people using the service. The registered person is recommended to update the staff training matrix and include copies of certificates in the individual staff files to confirm training completed.It is also recommended that the recording of staff supervision is formalised to ensure an ongoing record is available. Accident records are recommended to be audited monthly to promote accident prevention. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 35 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the service is thorough in ensuring that prospective people using the service will have their needs identified prior to admission, to ensure all needs can be met at Barnfield House. Evidence: The home has a comprehensive Statement of Purpose and Service User Guide, this is provided to prospective people prior to admission. The homes Statement of Purpose states that one of the aims of the service is To provide accommodation and support for those who do not require in-patient treatment in a mental hospital, but may nevertheless have difficulty participating fully as an independent member of the community. One of the aims of the service is To provide enough support and assistance to allow people to achieve maximum happiness by participating in both their own welfare and participation in the community, as much or as little as his or her potential will allow. The statement of Purpose states that We do not accept emergency admissions, however, we do provide respite facilities. The home has had very little change in the people using the service. In the time since Care Homes for Adults (18-65 years) Page 12 of 35 Evidence: the last key inspection there has been one admission to the home and one discharge. The Manager Designate feels this contributes to the feeling of close community at Barnfield House. Significant time and effort is spent making admission to the home personal and well managed. The management of the home operates a three step approach to admissions. Initial inquiries are reviewed and discussed, further information is received in the form of assessment processes and relevant input from other health professionals. The second stage is the initial escorted visit to the home and the third stage is a visit to the home by the person, unescorted, to give the prospective person the opportunity to test run the service. Pre admission information and assessments are completed on these visits. Before agreeing admission the registered person carefully considers the needs assessment for each individual prospective person and the capacity of the home to meet their needs. The lifestyle of the other people living at the home is taken into consideration to ensure a successful admission is managed. Staff at the home receive an ongoing training program to support their development and ensure that they can provide the skills to meet the needs of people using the service. One staff member told us that the home does well by Listening to service users. Another said that This is the most caring and well run home I have worked in . One contract was seen, the contracts contain the details of terms and conditions or residency and are signed by both the person using the service and the registered provider. The contract does not include the number of the room to be used and this is recommended to be included to ensure that people are clear about the accommodations they will be receiving. Care Homes for Adults (18-65 years) Page 13 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans were seen to be under development. In some areas the care plans did not contain sufficient information to ensure that staff were aware of the plan of care required to meet the risks identified. The knowledge of the staff group ensures that the needs are being met but insufficient recording and monitoring may place people at risk. Evidence: Three care plans were reviewed, these included the most recent admission to the home. We met each of the people and discussed care provided with the staff at the home. The care plans are under development and required further work to ensure that they provide a clear plan of care so that staff can identify each need and how to provide the care for that need. Risks are currently identified and recorded in a box system all on one page. The risks recorded do not state the level of risk. The next page record identifies the aims and objectives to meet the persons needs. We discussed with Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: provider and manager designate that risks and needs identified should have clear plan of care with instructions for staff. By not providing a clear plan of care for staff to follow, short and long term care needs are not clearly monitored and reviewed and this may place people at risk. The manager designate has confirmed that the development of these care plans will be a priority with the highest risk care needs being undertaken first. Within a very short period of time the registered provider confirmed by e-mail and telephone call that the care plans had been updated and completed. There are records of input from visiting health professionals and monitoring records for weight and personal care given. There is also a daily record maintained. There is no current regular or monthly review of care plans taking place, the manager designate plans to implement a key worker system to be involved with the reviewing of care planning. People using the service are involved in the identification of areas of need and sign the care plan to agree the content. All records are stored securely in line with the Data Protection Act 1998. Management and staff demonstrate a clear understanding of the care of the people using the service, they understand the importance of people being supported to take control of their own lives. They encourage and enable them to exercise their rights and make their own decisions and choices. We looked at the minutes of a recent residents meeting . This demonstrated how people are supported with the information, assistance and communication support needed to make choices and also have some control over the running of their home. One staff survey told us The home provides a safe and stable environment for all the residents, they support the residents different needs and views. Another commented that The home cares for the residents and makes them feel secure. The homes Service User Guide told us that each person has a lock on their door and a lockable wardrobe to secure items within their room. We saw that some people choose to keep their rooms locked and some do not, the manager designate told us that people have a key if they want one. The homes Service User Guide told us that Residents have the opportunity to vote in elections and to brief themselves fully on the democratic options. The manager designate has also accessed the opportunity for people to have an independent advocate should they want or need one. The homes Service User Guide told us that The main smoking area is the large lounge in No. 10 and the outside recreation area adjacent to the conservatory. It was observed that there is no signage to identify the smoking lounge, however both people using the service and staff are aware of the areas provided and alternative non Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: smoking recreational area both inside and outside of the home is provided. Some people have tea making facilities in their rooms and all have access to making hot and cold drinks in the kitchen. Manager confirmed that the people currently using the service have no spiritual interests but would be supported if they did. There are both male and female members of staff and we were advised that peoples preference of gender of carer is respected but not recorded. Care Homes for Adults (18-65 years) Page 16 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Choices are available for people to take part in age, peer and culturally appropriate activities and participate in the local community. Appropriate personal and family relationships are promoted and supported. People are encouraged to help plan menus and a healthy diet is promoted Evidence: Staff spoken with at the home and staff surveys received show that staff recognise the individuals right to a life of their choice, both in the home and in the community. People living at the home told us that they choose how they spend their day; the activities they undertook were individual and based on their own needs and requests. Several people told us how they go shopping in the community, using the bus to independently travel around. People leave the home to visit and stay with family and friends and take holidays. Activities at the home are chosen at residents meetings or by request. Choices and options for activities are organised by the home to support Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: that choice. The registered provider told us Whatever wants facilitating - happens. Staff surveys however did comment that They could provide more activities for the residents, and The home could do better by providing activities/day trips for residents. The home promotes community links and development of family relationships but will also protect the person when needed. Currently nobody is working or attending educational development courses. The homes Statement of Purpose states that Residents are free to come and go as they please, however, the house is secured at 10pm and access is by ringing the front door bell, preferably by prior arrangement with care staff. People using the service told us that this happens and that action is taken to minimise risk by them telling staff when they are leaving and plan to be back. The manager designate explained that currently nobody using the service has any request to practice any specific faith, however should that situation change, access is available within the community and people would be supported with that access. The menu is arranged by the preferences of people using the service and is altered to reflect seasonal changes and also availability. On the day of inspection , Lunch was a choice of two soups and a variety of sandwiches with the main meal of the day being served in the evening. People came to the kitchen to choose and then ate in the dining room. Tables were set with condiments, napkins and drinks. The meal appeared hot and appetizing. All meals are cooked by staff and all staff have undertaken Basic Food Hygiene training. People have access to the kitchen to make hot and cold drinks and are supported as needed. One person told us that they are supported to cook for themselves. The manager designate does not currently use a nutritional assessment tool to monitor adequate nutrition, however weights are monitored monthly and actions taken as needed. The kitchen environment is is need of refurbishment and is planned to be refurbished as part of a rolling programme of refurbishment. The fridge was noted to contain items which has not been dated when opened. This is recommended to be undertaken to ensure the safety of people using the service. Care Homes for Adults (18-65 years) Page 18 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service receive the personal support they require. Records of visiting health professionals reflect that their health needs are assessed and the appropriate action taken. Systems are mostly in place to promote safe management and administration of medications. Further development is required to ensure that safe systems supports peoples independance. Evidence: People using the service told us that they receive the care they need in the way they want. The home provides little personal care and acts mostly in a support and supervising role to promote peoples independence. Staff are knowledgeable about the people they care for and provide a flexible service to ensure that peoples choices and preferences are respected. Staff were seen to speak respectfully to people and to knock on doors before entering a room. Care plans are being developed to promote a clearer system of recording peoples Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: identified needs. The plans are needed to include actions to be taken to evidence and promote the person centered care which was observed as being provided. People are supported to visit their Doctor or the Doctor will come to the home, other services such as the Dietitian, Chiropodist and Diabetic Nurse are involved in the care provided and the records of input are clearly documented within the care plan. Medications are mostly well managed but some areas require further development. People are supported to self administer their medication when they choose to. It was noted that two people who self administer medications do not have a risk assessment in place. This is required to ensure that the risks are monitored and reviewed to promote safety and minimise risk. It is required that all medications procured into the home which then go on to be given to the person to self administer be recorded. This will support both people using the service and staff to have a clear audit of medications in the home. Clear records are maintained by staff of medications given by the staff and all staff have had training in the care of medicines. There are clear protocols in place for staff to follow when giving PRN (as Required) medication. It was identified that when people leave the home for visits and holidays the current systems in place mean that staff are secondary dispensing into travel boxes. This practice must be reviewed to ensure that there is no risk to people using the service or staff of medication error. Care Homes for Adults (18-65 years) Page 20 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service and their representatives have access to the homes complaints procedure. Complaints are taken seriously and addressed quickly. Policies, procedures and staff training are in place to protect people using the service from abuse. Evidence: No complaints or safeguarding action has been taken since the last inspection. We spoke with people using the service who were confident that if they had any issues or concerns they could approach the manager designate and staff and the issues would be dealt with. Minutes of recent residents meetings noted that this had been an opportunity to go over the complaints procedure with people using the service. We spoke with three staff members who were all clear about the procedure to be followed if a concern was raised with them or if they wish to make a complaint. Staff told us they were confident that any concerns raised would be acted upon appropriately by the management of the home. One staff survey told us Staff and residents can always approach the manager and owners with any concerns. The homes whistle blowing and complaints policies contain all relevant information for people who may wish to make a complaint, however, the contact details for external bodies who may also be contacted need to be updated. The provider has confirmed that whilst the home has protocols for the safeguarding of vulnerable adults they are ensuring that the procedures and contact details are the same as the Social Services for Cornwal Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: Safeguarding Vulnerable Adults protocols and will update as needed. All staff have received a CRB (Criminal Record Bureau) and POVA (Protection of Vulnerable Adults) check prior to commencing employment at the home. As part of the induction, information and policies about protection from abuse are provided. All staff undertaking an NVQ also address this issue within that training. Further formalised training is recommended to ensure that all staff have received training in abuse awareness. The systems in place for peoples personal monies are well managed and all records were up to date and stored securely. People using the service are supported to manage their own personal money where possible. There are policies in place for staff about the acceptance of gifts, it is recommended that this is developed to include instructions for staff precluding them form being involved in the making or benefiting from people using the service wills. Care Homes for Adults (18-65 years) Page 22 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Barnfield House provides a homely, comfortable and safe environment. The home provides equipment as identified and the standard of hygiene is good. Evidence: Barnfield House is a large converted older building. It provides accommodation over two floors with some bedrooms having en-suit facilities. Upper floor access is by stairs only. Most bedrooms, communal areas, kitchen and laundry were visited during the inspection. The living areas include two communal lounges one of which is a designated smoking area. This area is not signed to state its use but is clarified in the homes Statement of Purpose. There is also an accessible kitchen area and designated dining room. The home is currently undergoing a rolling renovation program and incorporating a new build extension. Some areas of the home have furnishings and decor which are in need of repair/replacement. The registered provider has confirmed that this is included in the rolling program. Bedrooms and en-suites had adaptations to meet the mobility needs of their occupants. Each bedroom was individual and the decor reflected the interests of the Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: occupant. All bedrooms have a lockable facility and some people were seen to keep their rooms locked. The home was maintained in a clean condition throughout. Protective equipment and materials were observed for the control of spread of infection. Hazardous substances are safely locked away and COSHH sheets are in use for all relevant substances. The home does not employ cleaning staff and this domestic role is included in the care staff role. Staff surveys told us that the home Provides a clean safe environment and Creates a relaxed homely atmosphere. It was noted that in some bathrooms there appeared to be toiletries in communal use. These toiletries included bars of soap, shampoo and talcum powder. This may pose a risk of cross infection and is recommended that the bottles be removed. It was observed that some people had toiletries of their choice in their bedrooms, however this was not always the case. It was noted that some upper floor windows did not have restricted access and may place people at risk of injury. There was also noted to be wardrobes in bedrooms which were not risk assessed and secured to prevent any risk of injury to people using the service. The registered provider confirmed at inspection a realistic date for this action to be completed and has confirmed since inspection that all windows have now been appropriately restricted and all wardrobes have been risk assessed and the appropriate action taken. The outside and garden areas are maintained and there is an inner courtyard in development which will included raised beds and level access. One staff member told us that the could do better by Making the garden more attractive and sensory . Care Homes for Adults (18-65 years) Page 24 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a staff team who know the people using the service well. Staff are trained and feel appropriately supported. The recruitment procedures are not all completed and may place the people using the service at risk. Evidence: On the day of inspection there were three members of staff on duty which included the manager designate and two care staff. The registered provider is also available on an on call basis. Staff members were on duty, from 08:30am to 4:00pm, 2 different staff were on duty from 4:00pm to 9:00pm. Overnight there is one waking staff. The registered provider is available on call overnight and when not available a sleeping staff member is available within the home. We discussed with the registered provider how the level of staffing was calculated and the registered provider and manager designate were confident that the level of staff used was sufficient to meet the needs of people using the service. No agency staff have been used. All the people using the service spoken with at inspection were very happy with the staff at Barnfield and spoke in complementary terms about the kindness and helpfulness of the staff. Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: We spoke with staff on duty. They showed a good knowledge of operations in the home, of their role and that of others. All staff showed a good understanding of peoples needs and it was observed that staff interacted well with people using the service. Staff appeared relaxed and confident in the management of the home. One staff member told us We are like one big happy family here the staff member went on to say that the manager designate is approachable and very nice. All staff spoken with told us that they have received a good induction and sufficient training in all mandatory areas. The manager designate stated that the induction is based on the Skills for Care Common Induction Standards. There is a staff training matrix that enables the manager designate to identify any staff whose training is out of date. It is recommended that the registered provider who is included in the staff rota be included in the staff training matrix. Staff training records available to us were incomplete and copies of certificates were not all available to confirm that training had taken place. It was noted that extended training has been taking place in specialist areas relevant to the care provided. The manager designate confirmed that out of the eleven staff employed, six staff have completed the NVQ training. The majority of training is done in-house. Staff surveys received told us that the home Could be better by more training for staff/courses/NVQs put into place. Another told us, Although we are getting some training, it seems to be a slow process. Staff told us that supervision and appraisal takes place regularly and is an opportunity to discuss training needs and any issues they may have. Staff supervision is currently an informal process with no records maintained of when , how often and topics covered. It was discussed with the manager designate that records of supervision are important to reference changes identified and improvements in care provision. Staff meetings take place every month and staff told us that this is a good opportunity to discuss any issues. Recruitment procedures were not all in place. We looked at three staff files for people recently employed at the home. One staff member had only one reference available . The registered provider has confirmed that the second reference cannot be found but has requested a replacement. A second staff members had two references but one was not from the previous employer, this is good practice and promotes the safety of people using the service. In two cases employment histories were not completed. It is recommended that they be completed to include dates of employment to ensure that a clear audit trail is available. All staff have CRB (Criminal Record Bureau) and POVA (Protection of Vulnerable Adults) checks prior to commencing employment. Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: It is recommended that within the staff application form, the declaration for the Rehabilitation of Offenders Act be expanded to explain that all previous convictions must be declared. The registered provider advised us since inspection that this has now been adjusted to reflect a full statement of detail. Recruitment procedures must be robust and all checks in place prior to people commencing employment at the home to ensure the safety of people using the service. Care Homes for Adults (18-65 years) Page 27 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has submitted an application to the Care Quality Commission for a registered manager. People using the service benefit from the current management approach of the home. The home makes use of quality assurance questionnaires to ascertain the views of the people using the service and uses this to change practices at the home. The health, safety and welfare of residents is promoted and protected. Evidence: The manager designate has been employed at the home since August 2008 and has applied for registration as manager with the Care Quality Commission (CQC). The process is currently ongoing. The current management systems of the home support and promote positive outcomes for people using the service. One staff member told us that The manager designate is excellent at keeping staff up to date with individual peoples needs. The home has undertaken a quality assurance audit and has sent surveys to each person using the service. The information has been audited and compared to previous Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: audits to reflect on any changes. The results of the audit are used to make any changes needed to care provision at the home. The audit format was very clear and easy to follow.The registered person is recommended to include further visiting health professionals to the audit to achieve a wider review of quality audit. Accident records are in place and are recommended to be audited monthly to promote accident prevention. Health and safety records inspected included the fire log, servicing and checking of fire equipment and systems, gas and electricity and of portable electrical equipment. All records seen were well organized and up dated. The home has recently had a fire safety inspection and advised us that compliance with requests are underway. Staff seen undertaking multiple roles, cook, cleaner/ carer were seen to use protective clothing and change this clothing between tasks to reduce any risks of cross infection. Care Homes for Adults (18-65 years) Page 29 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 The registered person is required the ensure that each persons care plan is reviewed and updated regularly. This is required to ensure that all care is monitored and reviewed and changes are reflected in the plan of care. 17/07/2009 2 6 15 The registered person must 10/07/2009 ensure that each person has a care plan which identifies how each need in respect of health and welfare is to be met. This is required to ensure that all staff are have a clear plan to follow to ensure that the persons needs are met. 3 20 13 The registered person is required to ensure that any person who wishes to self administer medication has a 24/07/2009 Care Homes for Adults (18-65 years) Page 31 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action risk assessment in place which is regularly reviewed This is required to ensure that all risks are identified and minimized 4 20 13 The registered person is 24/07/2009 required that all medications procured into the home which then go on to be given to the person to self administer be recorded This is required to support both people using the service and staff to have a clear audit of medications 5 34 19 The registered person is required to ensure that all staff have two references prior to commencing employment at the home. Recruitment procedures must be robust and all checks in place prior to people commencing employment at the home to ensure the safety of people using the service. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 24/07/2009 1 5 The registered provider is recommended to include the Page 32 of 35 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations room number in the contract between the home and the person using the service. This is recommended to ensure that people are aware of the accommodation to be provided. 2 17 The fridge was noted to contain items which has not been dated when opened. This is recommended to be undertaken to ensure the safety of people using the service. The registered person is recommended to update the homes complaints and whistleblowing policies to include the correct contact details for any external bodies. The registered person is reccomended to ensure that all staff have received training in abuse awareness. The registered person is recommended to include in staff policies instructions for staff precluding them form being involved in the making or benefiting from people using the service Wills. Standards 24, 26 and 27 .The registered person is recommended to ensure that the rolling program of maintenance is continued to all areas of the home which require repair/replacement. It is recommended that the declaration for the Rehabilitation of Offenders Act be expanded to explain that all previous convictions must be declared to ensure the safety of people using the service. The registered person is recommended to ensure that a detailed employment history for each prospective staff member is obtained. This is recommended to include dates of employment and explanations for any gaps. The registered person is recommended to ensure that a reference is received from the prospective staff members most recent employer to promote the safety of people using the service. The registered person is recommended to update the staff training matrix and include copies of certificates in the individual staff files to confirm training completed. The manager designate is recommended to formalise the recording of staff supervisions. 3 22 4 5 23 23 6 24 7 33 8 34 9 34 10 35 11 36 Care Homes for Adults (18-65 years) Page 33 of 35 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 12 39 The registered person is recommended to include further visiting health professionals to the quality audit to achieve a wider review of quality audit. Accident records are recommended to be audited monthly to promote accident prevention 13 42 Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 35 of 35 - 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!