Inspection on 28/07/09 for Barnfield Manor Care Home

This inspection was carried out on 28th July 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Barnfield Manor Care Home 07/05/09

Barnfield Manor Care Home 03/06/08

Barnfield Manor Care Home 14/11/07

Barnfield Manor Care Home 09/01/07

Barnfield Manor Care Home 06/09/06

Barnfield Manor Care Home 09/05/06

Barnfield Manor Care Home 22/02/06

Barnfield Manor Care Home 05/10/05

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report Care homes for older people Name: Address: Barnfield Manor Care Home Barnfield Close Holmewood Chesterfield Derbyshire S42 5RH     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: Rob Cooper     Date: 2 8 0 7 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 Older People Page 2 of 32 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 Older People 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 Older People Page 3 of 32 Information about the care home Name of care home: Address: Barnfield Manor Care Home Barnfield Close Holmewood Chesterfield Derbyshire S42 5RH 01246855899 01246852953 jane.watson@hallmarkhealthcare.co.uk www.hallmarkhealthcare.co.uk Hallmark Healthcare (Holmewood) Ltd care home 39 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is 39. The registered provider may provide the following category of service only:- Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Dementia - Code DE Date of last inspection Brief description of the care home Barnfield Manor Care Home is located in the village of Holmewood, close to shops, a post office and local amenities. It is on a direct bus route to Chesterfield and within a short distance of Junction 29 of the M1 motorway. The home provides personal care and support for up to 40 older persons with dementia delivered from a team of care and hotel services staff and with a newly appointed acting manager. Accommodation is over two floors, providing level access throughout, together with environmental adaptations and equipment to assist those who may have mobility problems, including a shaft lift and emergency call system. There is a choice of lounge Care Homes for Older People Page 4 of 32 Over 65 0 39 0 7 0 5 2 0 0 9 Brief description of the care home and dining space and communal bathing and toilet facilities. A majority of single room accommodation is provided, with many having en suite toilet and wash hand basin. There is an enclosed patio garden area, which people can access via the rear lounge, which provides seating and planting and safe provision for people who may wander. There is also gated access to a central enclosed garden, although supervised access is required for people here given the layout of the garden, which has a large raised bordered lawn area. Car parking is also provided to the front of the home. Kitchen and laundry services are centralised with a separate single storey building located within the grounds, which provides laundry and staff facilities. The range of fees charged per week are as follows: For those who are funded via local authority arrangements £350 to £370 per week. For those who are private funded £360 to £450 per week. There are additional charges for hairdressing, private chiropody, toiletries and newspapers, which are charged by the supplier . People are provided with service information, including that relating to fees charged and what they cover in the homes service user guide. A copy of the most recent inspection report is also available in the home. Care Homes for Older People Page 5 of 32 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This key inspection has taken place as a result of serious safeguarding concerns raised by Social Services and a subsequent Management Review undertaken by the Care Quality Commission. This was an unannounced visit as part of the key inspection process, so that no one at Barnfield Manor knew that the inspection visit was going to take place. The visit took approximately seven hours through the middle of the day, with two inspectors present. In preparing for this inspection, the information that the Commission holds about this care home was reviewed, this included looking at the last inspection report, the inspection record, considering any complaints or concerns that have been made about Care Homes for Older People Page 6 of 32 the service, and reviewing any notifications made relating to incidents that affect the well being of people living at the care home. The methods used during this key inspection and visit were to visit Barnfield Manor, where a method called case tracking was used; this involved identifying four people who live at the care home and looking at their individual files and making a judgement about the quality of care they are receiving, and if their needs are being met. This was followed by a partial tour of the building, looking at the activities on offer, and talking to three people who live at the home. Due to the high level of needs that people have, and their diagnosis of dementia, the level of input that people living at the home had into the inspection process was limited, and emphasis was put onto non-verbal communication, body language and mood. We also talked to four relatives and three members of staff about the quality of the service, and their experiences of visiting and working at Barnfield Manor. We also sent out an Annual Quality Assurance Assessment (known as an AQAA), which allowed Barnfield Manor to carry out a self-assessment; and provide a range of information relating to their service. Information provided by the care home helped to form the judgements in this report. We also sent out five surveys asking for views and information to people who live at the home, five to relatives and five to staff. Of these we received no surveys from people living at the home, one survey from a relative and none from members of staff. Barnfield Manor does not currently have a registered manager. A temporary manager Andrea Morris is therefore running the home, and Andrea provided much of the information during this key inspection visit. On the day of this inspection there were eleven people living at the home. People who might want to live at Barnfield Manor can obtain information about the home direct from them, and this would include seeing previous inspection reports prepared by the Care Quality Commission. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: As a result of this key inspection one statutory requirement remains outstanding and two new statutory requirements have been made, relating to the appointment of a registered manager, and effective record keeping. In addition fifteen good practice recommendations have also been made relating to: When a person is admitted there should be an assessment of their level of capacity, and recording of whether they have an Independent Mental Capacity Advocate (an IMCA) appointed. Both the statement of purpose and the service user guide should be reviewed and updated. Care plans should be updated and written in line with best practice. The home should acquire some sit on weighing scales to better monitor peoples healthcare and nutrition. The temperatures of the medication refrigerator should be recorded. Care plans related to medication should give details of all as required medication and the circumstances whenthey should be given. Activities in the home should be relocated to a more appropriate area. Menus in different formats should be available. Staff training techniques should be reviewed, particularly in respect of safeguarding procedures. The home should further develop its dementia strategy, particularly in respect of the environment. The carpet in the identified bedroom should be replaced. Staff training should not rely on the el box computer system, but should embrace other teaching methods as well. Regular meetings should be held for people living at the home to enable them to comment on the quality of care they are receiving. Assessments and documentation related to the Mental Capacity Act (2005) should be held in each persons file. Further assessments and documentation related to the Deprivation of Liberties safeguards should also be completed and held within individuals care files. In addition the owners and managers of the home need to show they can sustain improvements beyond the short term, when additional resources have been allocated. This particulary relates to staffing levels, record keeping and care planning, which will direct the staff in their care delivery. The relative who returned the questionnaire said in response to the question What could the service do better?: In the recent past there has not been enough personal stimulation as oppoosed to group participation. They could arrange visits to local parks, garden centres etc i.e. places of interest and fresh air. Regular maintenance of the Care Homes for Older People Page 8 of 32 garden/ lawn area. 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 Older People Page 9 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had sufficient information about the home. However information related to individuals choice and capacity was not recorded, which means that the assessment process is flawed. Evidence: The statement of purpose and service user guide contained useful information about the care home, and included the information that Care Homes Regulations (schedule 1) say they should However both documents are in need of updating, and neither was dated, or showed the date of any review, which means that the reader would not know if the information was up-to-date. The service user guide is on display in the foyer, and is in the form of a glossy brochure. There were 10 people living in the home on the day of our visit. We looked at the recorded needs assessments for 4 people. All had brief assessments of activities of daily living, plus other information about their preferred routines and lifestyle. 3 of the Care Homes for Older People Page 11 of 32 Evidence: people had assessment information from social services staff, (1 person was privately funded). All had a contract with the home detailing the terms and conditions of residence. As noted at our previous inspection, there was no assessment of the persons capacity to make decisions about their lives or to consent to their care and treatment. There were relevant forms for this in place in the care records, but none had been completed. Some improvements had been made to the care records since our previous inspection. Each person now had information about their cognitive abilities, and also about their wishes for end of life care, though the records only had brief details regarding this. There was some repeated information in the records which was not useful. We spoke with the relatives of 2 people living in the home who told us they were satisfied with the care the person received and felt their care needs were met. The Annual Quality Assurance Assessment (AQAA) completed by the homes acting manager in May 2009 said that prospective service users and their representatives were invited to visit the home prior to assessment. The AQAA said the home had improved the ground floor of the home to meet the needs of people living there. They said they planned to make further improvements and refurbishments to the home. Standard 6 did not apply to this service as there were no people receiving intermediate care. Care Homes for Older People Page 12 of 32 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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. Generally, peoples personal and health care needs were met at the home, although some peoples care plans were still lacking. Improvements had been made so that records more consistently and effectively accounted for care practice. Evidence: We looked at the care records for 4 people in the home. At our previous inspection we found that people did not have care plans in place for all of their assessed needs. At this inspection we found 3 of the people we looked at had care plans in place for all of their assessed needs. 1 had care plans for most of their assessed needs, except for their communication and social needs. The care plans seen had good details of the persons individual preferences regarding care and daily routines. An agreement to the care plans had been signed by the persons representative. The care plans had been regularly reviewed. Two of the care plans used the now outdated term wandering when referring to people with dementia. Care Homes for Older People Page 13 of 32 Evidence: We found relevant risk assessments in place, such as the risks associated with falls, leaving the care home alone, smoking, and aggressive behaviour. Many of the risk assessments seen had been put in place since the previous inspection. We found assessments of each persons healthcare needs, including the risk of developing pressure sores and of their nutritional needs. Records of peoples weights showed that most of them had put weight on in the last month. We found that there were no scales kept in the home and staff borrowed sit-on scales from the sister care home on the same site when they needed to weigh people. There had been recent concerns that the nutritional needs of people were not well met at the home, resulting in weight loss and the risk of dehydration. We found that action had been taken to address these concerns, although it was too soon to judge how effective this would be in the long-term. The daily records seen showed that the care provided reflected the care plans, and demonstrated that healthcare concerns were followed up promptly. Separate records were maintained of each persons daily care, such as the help given with personal hygiene. We spoke with the relatives of 2 people living in the home who told us they were pleased with the care provided. They said they were kept up to date with any concerns about the person or any changes in their condition. They said the staff were kind, always friendly, and very patient. We observed that staff had a calm and respectful approach to people. We saw staff knock on doors before going in. We found there were satisfactory systems in place for the safe storage, administration and handling of peoples medicines. An auditing system had recently been introduced where the number of tablets in stock was recorded each day on the administration record. This was not consistently followed by staff and so there were gaps in recording, and 1 error found. The room used to store medication was generally clean and tidy, though the floor was sticky. The temperature of the fridge used to store medicines was recorded twice daily, though not the daily minimum and maximum temperature. All staff who administered medication had received appropriate training. However, staff had not had formal assessments of their competency in the safe-handling of medication. The acting manager said that these assessments would be carried out, Care Homes for Older People Page 14 of 32 Evidence: although none were planned. All of the care plans we saw included information about the persons prescribed medication. There were care plans and protocols in place for medication prescribed as required. 1 of the care plans for an as required medication did not have sufficient detail of the medicine and under what circumstances it would be given, although this information was included in the protocol kept with the administration records. The AQAA said the home had improved by having more detailed risk assessments and care plans and by introducing a communication book. The AQAA said the plans for improvement in the next 12 months were a robust staff training programme, but did not give any details of what training this would include and how this would improve outcomes for people. Care Homes for Older People Page 15 of 32 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. 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 were offered a range of suitable activities to meet their needs and preferences and were supported to maintain contact with their families and friends. Better monitoring of peoples nutrition has begun, and appropriate records are being kept. Evidence: The care records we saw each had the persons life story with details of their family, their childhood, work life, and interests. 3 of the 4 records we saw had a care plan covering the persons social needs. The home had an activities coordinator working between both homes on the same site. We observed that people appeared to enjoy the range of activities offered during the morning of the inspection visit, including music, a game of bingo, and a ball game. The activities took place in an area adjacent to the main lounge. As the television was on in the lounge, this created at times a noisy and distracting atmosphere. We observed that staff respected peoples wishes about staying in their rooms, moving around, and where they ate meals. We observed that people were able to move freely around the main lounge area, and could access the enclosed garden and courtyard in good weather. Access around other parts of the home was more Care Homes for Older People Page 16 of 32 Evidence: restricted due to the design of the building. As noted at our previous inspection, and in the Choice of Home section of this report, there was no assessment of the persons capacity to make decisions about their lives or to consent to their care and treatment. There was information available in the main entrance area about the Mental Capacity Act 2005 and about advocacy services. The environment of the home had some features designed to assist people with dementia. Bedroom doors were painted different colours to aid recognition and were furnished to look like a house front door. The bathrooms and most of the toilets did not have appropriate signs for recognition by people with dementia. People were able to bring in their own possessions to personalise their bedrooms, though some bedrooms seen looked a little bare. Visitors we spoke with told us they were always made welcome and were able to visit at any reasonable time. The main meals in the home were supplied from the kitchen in the other care home on the same site. Drinks and snacks were available between meals and we found sufficient stocks in the kitchen at Barnfield Manor to allow this. We observed that people were offered biscuits and a choice of drinks mid morning, including smoothies made with fresh fruit and ice-cream. There was a jug of squash available all day in the lounge, though we did not see anyone use this. The main dining room was clean and pleasant. Tables were attractively presented with cloths and flowers. There were no menus displayed. As noted in the Health and Personal Care section of this report, there had been recent concerns that the nutritional needs of people were not well met at the home, resulting in weight loss and the risk of dehydration. We found that action had been taken to address these concerns, although it was too soon to judge how effective this would be in the long-term. The AQAA said that there was a local minister who visited the home, themed evenings were held each month, and there was a managers surgery every month. The AQAA said well balanced nutritious meals, fresh fruit, and snacks were provided. There were few details of how the home planned to improve in the next 12 months. The mid day meal was observed, and staff were seen to offer people choice. The food was served out of a hot trolley (a bain marie) and looked and smelt both appetising Care Homes for Older People Page 17 of 32 Evidence: and nutiritious, with three different vegetables (cabbage, broccolli and onions) on offer, as well as potatoes, lamb hot pot or sausages. All of the food was available in a soft version, for people who have difficulty with chewing, and where people required assistance staff sat alongside and helped them. There was a relaxed, calm atmosphere throughout the meal, and staff were also observed helping people transfer out of their wheelchairs onto a dining chair. One relative was present, eating lunch, and people were asked where they would like to sit on entering the dining room. One person had decided not to eat in the dining room, and staff were observed making up a tray with lunch, which had a plastic cover to keep it warm, whilst being taken around the building. Evidence supplied by Social Services showed that there had been issues relating to weight loss, which had not been affectively managed within the home. Evidence seen in the office showed that since the new management arrangements came into place there was now ongoing monitoring of individuals weight and dietary intake, and advice has been sought from external dieticians to improve the nutrition within the home. Care Homes for Older People Page 18 of 32 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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 are confident that their complaints will be taken seriously and dealt with. However staff lack confidence in implementing safeguarding procedures, which may place people who live at the care home at risk. Evidence: Barnfield Manor have not received any complaints since the last key inspection in May 2009. Although Social services have raised concerns about the quality of care and placed everyone living at the home into safeguarding procedures. Social Services are still investigating their concerns, and as a result the contract to fill beds at Barnfield Manor has been suspended. However Hallmark Care limited who operate the home have recently put in additional resources to address serious management concerns at the home. The homes complaints procedure is on display in the foyer, and this has recently been updated with the new contact details for the Care Quality Commission, and also has the contact details for Social Services. In their AQAA they said: We record all complaints and inform appropriate other, i.e. relatives, senior managers, social workers CQC and POVA team as indicated. We make our complaints policy and procedure available to SU and their representatives. This includes contact details for the companys senior management team, Social Services and CQC. We have an open door policy for SU relatives and staff. Staff are trained in Abuse awareness and have a good knowledge and understanding of adult protection issues. We liaise with the POVA Care Homes for Older People Page 19 of 32 Evidence: team for advise on any issues which may cause concern. A review of the staff training records in relation to safeguarding adults showed that care staff had undertaken this training in the last twelve months. Discussions with several members of staff and a review of staff files showed that the training has been e learning on the computer, rather than direct interactive training delivered by a person. Further discussions with the staff highlighted the limitations of the e learning model, in that staff were found to be lacking in confidence about the safeguarding procedures. Care Homes for Older People Page 20 of 32 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, 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. 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. Limitations in the buildings design prevent free movement around the building for the people who live there. In addition the features designed for use by people with dementia are limited, which means that the environment does not fully meet peoples needs. Evidence: Currently the upper of the floor of the building is not being used, following concerns raised by the fire officer. These concerns have now been addressed, but with falling numbers of people living at the home, the concentration has been on the downstairs accomodation. A number of bedrooms were seen, and these were comfortable, single bedrooms, with a small number, but not all having en-suite facilities. The dining room is at the front of the building, and is comfortable and spacious, with plenty of room for people in wheelchairs or who have restricted mobility. Due to a safety issue with the open staircase next to the dining room, there is a keypad on the door to restrict peoples movement, and ensure they dont come to harm on the stairs. Similarly the rear of the property which houses the lounge, and bedrooms is also cut off from the stairs by another door with a keypad. Outside there is an enclosed courtyard at the rear of the property where people can sit out in fine weather. There are a number of bathrooms, with different types of bath, so that people with differing levels of independence can bathe safely, and with the level of assistance they require. An attempt has been made to make the building suitable for people with dementia, Care Homes for Older People Page 21 of 32 Evidence: however the feely boards attached to the walls lack imagination, as they consist of different types of door handles screwed to a board. Staff were seen cleaning throughout the building during the inspection visit, and were spoken with about cleaning regimes, the building was clean, and there was evidence of a planned approach to cleaning. however one particular bedroom (currently unoccupied) has an odour of stale urine. This was discussed with the cleaning staff, who said the carpet had been shampooed several times, but the smell persists, despite their best efforts. The home does have a carpet shampooer, and this was seen being used in one of the bedrooms. Care Homes for Older People Page 22 of 32 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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. Staff have been recruited professionally, and are being trained to understand and meet the needs of people living at the home. Evidence: The staffing rota was reviewed and this showed that since the last key inspections staffing levels had been increased. this meant that instead of there being two staff per shift during the daytime, working hands on with the people in the home, there were now three. In addition there was a supernumery manager and domestic staff. Discussions with staff members and visitors highlighted that this had made a big difference, and had improved things considerably with regard to the staff being able to meet peoples needs. The care industry considers National Vocational Qualifications (NVQ) to level II in care to be the basic qualification for staff working in residential care. In their AQAA they said that there are five care staff at the home with NVQ level II in care. The National Minimum Standards suggest that at least half of a staff team should be NVQ qualified. In their AQAA they said: Staff receive a comprehensive induction upon commencement of employment and are supported by mentors they are encouraged to start NVQs in Care and also the companys El box electronic on line learning. We pride ourselves in delivering excellent care to our client group by maintaining none use of agency. Care Homes for Older People Page 23 of 32 Evidence: The files of five members of staff were seen, to check that they contained all of the information that would show that staff at Barnfield Manor had been recruited in a safe manner, namely that applicants had filled out an application form, provided two written references and had had a Criminal Records Bureau check. The documentation showed that the homes recruitment policy and procedure had worked to protect the people living there. Discussions with three members of staff about their recruitment showed that they had gone through all of the pre-employment checks. The staff training records for five members of staff were seen. These showed that the staff had been through a training programme, and had received the training to help them to do their jobs, including the mandatory areas of moving & handling, fire and safeguarding. However much of this training was e learning on the companys El Box, and discussions with three staff members identified flaws in this method of learning, in that it relies on an individuals responses to a computer programme with no other outside human influence. Care Homes for Older People Page 24 of 32 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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. There are management issues affecting how well the home is run, and how well people living at the home are having their needs met. Evidence: Currently Barnfield Manor does not have a manager who is registered with the Commission, and has not had one for well over twelve months. Hallmark Care limited who operate the home have put in additional resources to address serious management concerns at the home. The AQAA was very brief, and there were very few details of how improvements will be achieved, or details regarding timescales for delivery of those improvements. The Mental Capacity Act (2005) became fully implemented in April 2009, as mentioned elsewhere within this report: There was no assessment of peoples capacity to make decisions about their lives or to consent to their care and treatment. There were relevant forms for this in place in the care records, but none had been completed. People who live at Barnfield Manor are restricted in their free movement around the Care Homes for Older People Page 25 of 32 Evidence: home by the use of key pads and doors which they cannot open. There are currently no assessments or any documentation within care files to show that decisions about restricting individuals movements have been taken in their best interests in line with the Deprivation of Liberties safeguards (part of the Mental Capacity Act 2005). Barnfield Manors quality assurance system relies on questionnaires being filled in by service users, relatives and visitors. The whole process is managed by Hallmark Care (the homes owners) at their Head office. The results of the questionnaires are the evaluated, and the results are passed down to the homes manager. Barnfield Manor do not currently hold meetings for the people who live there. Regulation 26 visits (these are monthly audits by a representative of the owners management team) are taking place, with copies of reports seen; these also form part of the homes quality assurance system. Barnfield Manor has a system for peoples small cash needs. This is operated on their behalf by the staff, and particularly the homes administation person. Four peoples finances were checked at random. All of the cash tallied with the records, and receipts were seen, which enabled a clear audit trail of the individuals financial expenditure to be followed. Barnfield Manor has a formal staff supervision system in place, in which staff receive supervision, either with the manager or with one of the other senior members of staff. This is usually in a one to one meeting. A review of the records showed that this has not been achieved regularly, or in line with the National Minimum Standards, although the new management structure at the care home has re-focussed on staff supervisions and five of the six staff records that were checked showed that staff had received formal supervision during July 2009. Discussions with three members of staff showed that they thought that things were improving, and that they were feeling much better supported than they had previously. Documentation relating to all aspects of the homes management were see, and these showed, that while there had been some improvement, although these were only in recent weeks following the additional management resources being brought into the home. There was clear evidence that poor record keeping had contributed to a break down in the quality of care for people, particulary in relation to the lack of guidance in care plans for staff, more specifically in relation to meeting peoples dietary needs. A range of different health & safety records were seen, including the fire safety records, water temperature checks and the Control of Substances Hazardous to Health (COSHH) records, all were found to be correct and up-to-date, which shows that Care Homes for Older People Page 26 of 32 Evidence: people are living and working in a safe environment. The homes handyman has responmsibility for carrying out the necessary health & safety checks, and a discussion identified that all of the unused taps upstairs are being flushed through on a regular basis, and recorded, to prevent a build up of potentially harmful Legionella. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 30 18 Training must be provided for care staff in respect of care planning and records and record keeping. So as to ensure that staff receive the training they need appropriate to the work they are to perform. In this instance with regard to their responsibilities for determing and completing peoples needs assessment and care planning records. 31/08/2009 Care Homes for Older People Page 28 of 32 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 31 8 A permenant manager must be recruited and registered with the Care Quality Commission as soon as possible. It is an offence under the Care Standards Act (2000) and Care homes regulations for an unregistered person to manage a care home. 06/02/2010 2 37 17 There must be effective 30/11/2009 management arrangements in place to ensure effective record keeping in respect of individuals needs assessments and care plans. So as to effectively underpin, determine and account for the care to be delivered to any person as may be necessary to promote their health and welfare. Care Homes for Older People Page 29 of 32 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 1 1 Both the statement of purpose and the service user guide should be reviewed to ensure that the information is accurate and up-to-date. Both documents should also be dated to allow the reader to judge how current the informaton is likely to be. The admission processes should include recording if the person has made an advance decision on receiving medical treatment, has a lasting power of attorney (LPA), or has an Independent Mental Capacity Advocate (IMCA). This will ensure that peoples rights and wishes are protected and promoted. Care plans should be written in line with current good practice so that outdated terms are not used. This will ensure that the care of people in the home is up to date with current best practice. The home should have sit-on scales provided to ensure people can be weighed as part of ongoing monitoring of their nutritional state and healthcare needs. The care plans should include details of all as required medication, in what circumstances it should be given, and any alternatives to offer. This will ensure that people are given medication as prescribed. The minimum and maximum daily temperatures of the fridge used to store medicines should be recorded. This will help to ensure that people are given medicines that are stored correctly. Consideration should be given to using other areas of the home for activities to ensure noise levels and distractions are kept to a minimum to enhance the atmosphere for people living in the home. There should be menus available in suitable formats so that people are fully informed about the choices available to them. Staff training in safeguarding procedures should be reviewed, so that the emphasis is not on e learning but more leaning towards interactive training delivered by a person. The home should be further developed to provide an environment that meets the needs of people with dementia and the individual preferences of people living in the home. Page 30 of 32 2 3 3 7 4 8 5 9 6 9 7 12 8 15 9 18 10 19 Care Homes for Older People 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 11 12 26 30 The carpet in the identified bedroom should be replaced to remove the smell of urine from that bedroom. Staff training should not rely solely on the el box computer programme, with other training methods used to ensure staff understanding and competence. Assessments and documentation should be completed in relation to the Deprivation of Liberties safeguards (Mental Capacity Act 2005) particularly in relation to restrictions placed on the free movement of individuals around the home. Doumentation relating to peoples capacity, as outlined within the Mental Capacity Act (2005) should be completed and kept within individuals care files. Regular meetings should be arranged for the people who live at the home, to enable them to have a formal voice in the way that the home is run. 13 33 14 33 15 33 Care Homes for Older People Page 31 of 32 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). 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