Inspection on 03/06/08 for Barnfield Manor Care Home

This inspection was carried out on 3rd June 2008.

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

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

Other inspections for this house

Barnfield Manor Care Home 28/07/09

Barnfield Manor Care Home 07/05/09

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 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Barnfield Manor Care Home Barnfield Close Holmewood Chesterfield Derbyshire S42 5RH Lead Inspector Susan Richards Unannounced Inspection 3rd June 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Barnfield Manor Care Home DS0000064197.V365648.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Barnfield Manor Care Home DS0000064197.V365648.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Barnfield Manor Care Home Address Barnfield Close Holmewood Chesterfield Derbyshire S42 5RH 01246 855899 01246 852953 jane.watson@hallmarkhealthcare.co.uk www.hallmarkhealthcare.co.uk Hallmark Healthcare (Holmewood) Ltd Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Vacant Care Home 39 Category(ies) of Dementia (39) registration, with number of places Barnfield Manor Care Home DS0000064197.V365648.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 The maximum number of service users who can be accommodated is 39. 14th November 2007 2. Date of last inspection Brief Description of the Service: 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 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-£370 per week. For those who are private funded £360-£450 per week. There are additional charges for hairdressing, private chiropody, toiletries and newspapers, which are charged as per vendor. Information about fees is correct as at the time of this inspection. Barnfield Manor Care Home DS0000064197.V365648.R01.S.doc Version 5.2 Page 5 People are provided with service information, including that relating to fees charged and what they cover in the home’s service guide. A copy of the most recent inspection report is also available in the home for people to access. These can be located in the reception area of the home and also from the administration office there. Barnfield Manor Care Home DS0000064197.V365648.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. For the purposes of this inspection we have taken account of the information we hold about this service. This includes our previous key inspection report of 14 November 2007, a random inspection visit by our pharmacist inspector on 12 March 2008 and the annual quality assurance assessment questionnaire, which we asked the home to complete in order to provide us with key information about the service. At this inspection there were thirteen people accommodated. We used case tracking as part of our methodology, where we looked more closely at the care and services that three of those people receive. We did this by talking with those people (in accordance with their given capacities), direct observation of staff interactions with them, looking at their written care plans and associated health and personal care records and we also looked at their private and communal accommodation. We sent out written surveys to ten residents and their relatives/advocates and also to five staff before our visit to the home. We received returns from a total of eight relatives/advocates and three staff. We spoke with staff about the arrangements for their recruitment, induction, training, deployment and supervision and we examined related records. We spoke with the regional and acting managers about their role and responsibilities for the management and administration of the home and examined associated records. All of the above was undertaken with consideration to any diversity in need for people who live at the home. At the time of our visit all people accommodated are of British white backgrounds and of Christian based religion (either practising or non-practising). What the service does well: People are reasonably informed and supported during their admission to the home and their needs are well accounted for. People’s health care needs are usually well met and in an inclusive manner. And their personhood and rights to be treated with dignity and respect are promoted. Barnfield Manor Care Home DS0000064197.V365648.R01.S.doc Version 5.2 Page 7 People receive nutritious meals and can engage in a range of social and occupational activities, which are regularly provided. People’s rights to complain and to be protected from harm and abuse are taken seriously by the home and acted upon. People’s needs are met from staff. That is effectively recruited, inducted and for the most part suitably trained. What has improved since the last inspection? What they could do better: Develop service information for people, such as the service guide so as to make it available in alternative formats, which may better assist potential service users. Ensure that where a person is admitted under emergency arrangements. That, the written care plans required are in place as soon as practicable. Barnfield Manor Care Home DS0000064197.V365648.R01.S.doc Version 5.2 Page 8 Ensure timely completion of the proposed (commenced) upgrading and development of the environment to provide for suitable aids and adaptations to better assist people with their dementia care/orientation/sensory needs in accordance with recognised dementia care practise. Make sure that they keep us informed of things that we have asked them to. In this instance written confirmation as to their compliance with the Fire Officer’s recommendations as detailed in our correspondence to the provider. Determine the ratios of care staff to residents according to peoples’ assessed needs (rather than purely on the number of people accommodated). And operate a system for calculating staff numbers required, in accordance with guidance recommended by the Department of Health, which is applied in a timely manner. Ensure that all staff receive recognised training in responding to and dealing with challenging behaviour/aggression from any service user. So residents and their representatives may be secure in the knowledge that staff will be confident, consistent and safe in their practise in this area. Also to develop the home’s rolling programme for staff training to ensure this includes training for staff in respect of Human Rights and Mental Capacity Act 2005. The acting Manager, who has been in post since beginning of November 2007 must apply to the Commission for her registration under the Care Standards Act 2000 as manager for the home. Continue to develop quality assurance and monitoring systems in consultation with people and by publishing/making available the results of any satisfaction surveys for people. Also to establish an annual development plan for the home base on reflecting aims and outcomes for service users. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can Barnfield Manor Care Home DS0000064197.V365648.R01.S.doc Version 5.2 Page 9 be made available in other formats on request. Barnfield Manor Care Home DS0000064197.V365648.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Barnfield Manor Care Home DS0000064197.V365648.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 5. NMS 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are well informed and supported during their admission to the home and their needs are well accounted for. EVIDENCE: At our last key inspection of the home we judged that peoples’ needs are reasonably well accounted for. We made one requirement that the home’s service guide/brochure must be available for people to access and provide key service information, including that relating to fees charged and what they cover. Barnfield Manor Care Home DS0000064197.V365648.R01.S.doc Version 5.2 Page 12 This is complied with at this inspection. In the annual quality assurance questionnaire that we asked the home to complete they say that that prospective service users and their representatives are always invited to visit the home, are provided with key service information and that a full pre-admission assessment of individual’s needs is always carried out by a suitably experience staff member, before they choose whether to live at the home. They say they have improved by securing specialist dementia care advise and as a result are redesigning the home’s environment to better meet people’s dementia care needs. They say that they aim to improve further by providing key service information in alternative formats for people and to continue with their refurbishment programme. Four of the five survey returns we have received tell us that people’s representatives usually receive sufficient information about the care home to help them make decisions. A comment was made that there are considerable improvements in this area since the changes in management arrangements for the home. (See management section of this report). At this inspection we looked at the home’s statement of purpose and service guide, the content of which had been revised since our last key inspection. We observed that there are copies of these on display in the main entrance to the home. The guide is a brochure type folder with inserts, which includes photographs and a copy of their monthly newsletter. It gave detailed key service information for people. Including a statement as to how fees are determined, although the actual range of fees was not specified. However, this was clarified and updated details were produced by the administrator during the course of the inspection and inserted into the service guides. The manager also told us of their plans to produce this information in alternative format, which may better assist/be more suitable for the people they care for. The recorded needs assessment information for the three people we case tracked, were examined. They were comprehensive, holistic and person centred accounting for all aspects of individual needs, and included preadmission assessment information. People’s known preferred daily living routines were accounted for, as was that relating to personal safety and risk, which were consistently recorded and regularly reviewed. Staff told us that it is usually the acting manager who undertakes preadmission needs assessments, but always involving senior experienced staff and that people are always invited and encouraged to visit the service before admission there, including for the purposes of any proposed plan for respite care. Barnfield Manor Care Home DS0000064197.V365648.R01.S.doc Version 5.2 Page 13 The Inspector was unable to hold in depth discussions with people about their needs due to their mental capacities. However, discussions with staff and close observations of staff interactions and approaches to people’s care, did clearly show us that staff is wholly conversant with people’s assessed needs. There were no relatives or representatives present during our visit. Barnfield Manor Care Home DS0000064197.V365648.R01.S.doc Version 5.2 Page 14 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s health care needs are usually well met in an inclusive manner, which promotes their personhood and rights to be treated with dignity and respect. Care planning arrangements in respect of emergency admissions are unclear, which may not be in people’s best interests. EVIDENCE: At our last key inspection of this service we judged that - overall peoples’ health care needs were being met, although that personal dignity was not always best promoted. We made three requirements and one recommendation at that inspection. To ensure people’s care plans detail as to the support people need in respect of their confusion; to ensure a list of staff signatures is in place for those Barnfield Manor Care Home DS0000064197.V365648.R01.S.doc Version 5.2 Page 15 responsible for the administration of people’s medicines and to provide up to date medicines information for those staff. We also recommended that staff take care to ensure that people wear their own clothes at all times. These are complied with at this inspection. Since our last key inspection an allegation was made that two named people accommodated in the home had not always received their medication as prescribed. This was investigated via social services joint agency safeguarding procedures. Arising from this, our pharmacist inspector carried out a random unannounced visit to the home on 12 March 2008 to inspect the arrangements for the management and administration of peoples’ medicines. The overall findings of this inspection were that the systems for medication management were mostly satisfactory. Two new requirements were made regarding policy and procedural guidance for staff in terms of obtaining supplies of people’s medicines and in ensuring staff respond promptly to changes in instruction for people’s medicines. As stated above, these are achieved at this inspection. In the annual quality assurance questionnaire that we asked the home to complete they say that they now ensure that people’s written care plans detail their actual needs relating to their confusion and that these are reviewed on a monthly basis and with daily evaluation records maintained. They say they aim to improve by ensuring that all staff shall receive additional care planning training to that already provided. Also, to further develop staff policy guidance regarding the administration of medicines that people may take only as required. Surveys returned from people’s representatives tell us that people usually receive the care and support they need. At this inspection the home’s care planning documentation was further developed. Care plans we looked at for those who were permanently residing at the home were comprehensive and reflective of recognised guidance concerned with the care of older people with dementia. They also had regularly recorded reviews and a record as to people’s capacity to make informed decisions. People who were able had signed their agreement to their care plans and their known daily living routines and preferences were also recorded. Staff was conversant with these. However, for one person, case tracked, who was recently admitted as an emergency for a second period of respite care in the home, their care plans did not fully account for their needs. This particularly related to managing their aggression and agitation and also in terms of safeguarding issues identified as part of the reason for their admission. Discussions with staff indicated Barnfield Manor Care Home DS0000064197.V365648.R01.S.doc Version 5.2 Page 16 variances in their confidence and knowledge (generally in accordance with their level of experience), regarding the possible care interventions that may be required to assist this person in respect of managing their aggression. (See also the Staffing section of this report in respect of training). The manager advised that she currently writes and oversees people’s care plans due to further training being necessary (planned) for care staff in this area. She also advised that these would be provided. People’s health care needs were generally well accounted for and regularly reviewed in conjunction with people or their representatives as applicable, including for the purposes of routine healthcare screening. We observed people being given their medicines. This was suitably conducted and staff responsible undertook this in a sensitive manner. Medicines records for one person we case tracked indicated there had been a recent failure of persons responsible to ensure that further supplies of a specific medication were obtained. This had resulted in a twenty-four hour period where this medicine was not available at the home to administer that person as prescribed. However, management had taken satisfactory action in respect of this, including a review of their policy guidance for staff in respect of the arrangements for ordering people’s medication. We closely observed staffs’ interactions with people accommodated. Staff took time and demonstrated care and personal attention in their interactions with people, which they undertook in a calm, sensitive and reassuring manner. One carer demonstrated empathy, patience and understanding whilst reassuring one resident who expressed significant feelings of anxiety and who responded positively to this approach, which also included subtle and effective engagement of that resident towards a diversionary occupation. People’s representatives told us that the home usually meets people’s needs and provides people with the support they need. Many commented on the recent positive changes and the noted determination of management to improve the quality of care and service provision. One person surveyed indicated that improvements could perhaps be made in respect of meeting people’s needs relating to individual episodes of any disinhibited behaviour. However, staff that we observed and spoke with demonstrated an understanding in terms of ensuring people’s privacy and dignity and one of the people we case tracked had a written care plan in place in respect of such needs. Information regarding advocacy is available for people in the home and they are encouraged to bring in their own personal possessions with them. Barnfield Manor Care Home DS0000064197.V365648.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 11, 12, 13 & 14. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Developments, both introduced and planned in respect of people’s daily living arrangements and activities are positive and are in peoples’ best interests. People receive nutritious and wholesome meals. EVIDENCE: At our last key inspection we judged that opportunities for people to engage in activities and to maintain their family contacts were reasonably well promoted. Although their individual capacity to exercise choice and control over their lives is not best accounted for. We also judged that people receive nutritious, wholesome food. Barnfield Manor Care Home DS0000064197.V365648.R01.S.doc Version 5.2 Page 18 In our annual quality assurance questionnaire completed by the home, they say that aim to provide people with access to a range of activities and also with balanced and nutritious meals. They say they have recently recruited to the vacant post of activities coordinator and that activities are regularly organised that people can engage in. They say they aim to improve over the next twelve months by developing their activities programme in line with recognised dementia care practise, by seeking to further engage relatives in terms of people’s social support networks and also by offering more outdoor activities. At this inspection the activities co-ordinator told us about the existing arrangements and planned development in relevant activities and occupation for people. A flexible programme of key activities was introduced and the home had begun put together information for people about these in a suitable format. Examples, include reminiscence, gentle exercise and soft ball, spiritual care, throwing, board games, music and movement, walks, ‘Lets get talking groups’ focusing memories of past times, photos, assisting with baking, food tasting with recent exotic fruit tasting and fruit smoothie making and drinking, painting, newspapers, war-times song and dance. Two residents had been out onto the Five Pits Trail the day before and to see/stroke a horse. One resident particularly enjoyed cleaning and had her own safely stored cleaning box with materials, which she was supported to safely engage in. Some residents were due to visit a summer fayre at the local community centre. Individual records are kept of activities provided and people’s engagement in these. All people accommodated are British white of Christian based religion and this is individually recorded within their care records, including as to whether they are practising or non-practising and relevant arrangements. The activities co-ordinator had recently attended training relevant to dementia care and photographs of residents engaging in recent activities are also displayed. There were also plans in hand to considerably develop the provision of materials and also the environment to promote activities and reminiscence, including a library and post office area with old-fashioned post box. Lifestyle profiles were also recorded for each person and survey returns told us that the home usually supports people to live their life as they choose. People tell us that they enjoy the food provided. Lunch served, was done so by the cook in an unhurried manner. Tables were attractively set and people were offered an alternative to each course. Staff assisted people discreetly and sensitively and suitable aids and equipment were provided for people as necessary to assist their independence in eating and drinking. The daily menu was also displayed in the dining room. Barnfield Manor Care Home DS0000064197.V365648.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s rights to complain and to be protected from harm and abuse are taken seriously by the home and acted upon. EVIDENCE: At our last key inspection of this service we judged that peoples’ rights to complain and to be protected from abuse are suitably promoted. We made a requirement for the home’s complaints procedure to be amended to provide the correct contact details of the Commission. This is complied with at this inspection. In our annual quality assurances questionnaire completed by the home, they say that people are provided with the information about how to complain and also the contact details of the Commission and social services. That they take complaints seriously, record and investigate them thoroughly and liaise with other authorities as necessary. They say that staff are properly trained in respect of safeguarding procedure and know their responsibilities in this respect. They feel they have improved their response time and thoroughness in investigating complaints since over the last 12 months and aim to maintain Barnfield Manor Care Home DS0000064197.V365648.R01.S.doc Version 5.2 Page 20 staff training and to promote the company’s policy and procedures in respect of complaints and protection. Since our last inspection the home has received two complaints. The home has taken the necessary action in respect of these, including one, which they referred to social services for investigation via local joint agency safeguarding adults’ procedures. At this inspection information about how to complain is provided for people in standard and large print format. This is displayed and also provided within the home’s service guide. It is not currently available in simple or picture format, although the manager advised us that they are reviewing all service information with a view to developing this in alternative formats, which may be more suitable to assist people. Survey returned told us that people know how to complain and that any concerns they raise are usually responded to appropriately. Staff spoken knew their responsibilities in respect of handling any complaints and recognising and responding to any suspicion or witnessing of the abuse of any resident. Comments made under the Healthcare section of this report concerning care planning in respect of dealing with aggression apply here also. There is some policy guidance in place in the home regarding dealing with challenging behaviours/violence and aggression, although only 17 of staff has received training in this area. This is highlighted on the home’s training plan and the acting manager advised that this is to be organised. Barnfield Manor Care Home DS0000064197.V365648.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The programme of environmental upgrading and repairs, including action taken to date, should better ensure that the home suits people’s needs and also promotes their safety. EVIDENCE: At our last key inspection of this service we judged the environment to be clean and comfortable, but not safe and well maintained, which placed people at unnecessary risk. We made one requirement that adequate precautions must be taken against the risk of fire and for the review and maintenance of fire precautions and equipment, in accordance with matters raised in Fire Officers report Barnfield Manor Care Home DS0000064197.V365648.R01.S.doc Version 5.2 Page 22 (Derbyshire Fire Authority) for the home dated 28 February 2007. And we wrote to the home following that inspection to tell them about our serious concerns regarding fire safety in the home. The home wrote to us and told us that they would ensure that they would take the necessary action by 14 January 2007 and we responded in writing on 10 December 2008 advising them that this was satisfactory in principle and to tell us in writing when these were completed. The home has not provided us with this written confirmation. We also made two requirements under the management section of that report relating to environmental health and safety in the home and we recommended that the environment should provide for suitable aids and adaptations to better assist people with their dementia care/sensory needs in accordance with good dementia care practise. At this inspection we are advised by the acting manager, that a different fire officer from the same authority has visited the home and carried out a full reinspection relating to fire safety there. That he has produced an additional report giving extended timescales in respect of some of their recommendations still outstanding and with regard to the accommodation of people, which is currently restricted to the ground floor until works to the first floor are completed. We are advised that he has stated that the home must comply with matters by 01 June 2008, although has not re-visited the home to date of our inspection. There was no copy of the report of his visit available at our inspection. The provider has written to the fire officer advising that all the necessary works appertaining to fire safety in the home are now completed to the ground floor and confirming that residents will not be admitted to be accommodated on the first floor of the home until all works are completed there. The Commission has had sight of this letter at our inspection visit. Work has also commenced on the ground floor for the refurbishment and redecoration of the home. This includes environmental aids to orientation, including the use of colour schemes. We are advised that this is part of a total plan for the whole home, to include bathrooms (which are in desperate need of redecoration and making more homely and inviting). Bathroom 3 on the ground floor has a sink which is coming away from the wall and which requires attention. This bathroom was locked and is not used. However, there are a number of residents bedroom located there for which this bathroom is the nearest to them. They currently use an alternative to the ground floor. All external windows and doors in the home have been replaced with new since our last inspection. All areas of the home that we saw kept reasonably clean and free from hazards to people’s safety. Bedrooms were personalised and well furnished and equipped. Barnfield Manor Care Home DS0000064197.V365648.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 27, 28, 29 & 30 Quality in this outcome area is adequate Overall people’s needs are met from staff. That for the most part is effectively recruited, inducted, trained and deployed, although further development of the staff-training programme may better assist staff in consistently promoting peoples’ rights and best interests. EVIDENCE: At our last key inspection for this service we judged that peoples’ needs were met by staff, which are properly recruited, inducted and trained, although not always effectively deployed in people’s best interests. We made one requirement, that there must be staff sufficient cover provided for teas, together with an adequate staff skill mix). We also recommended that ratios of care staff to residents be determined according to peoples’ assessed needs and that a system is operated for calculating staff numbers required, in accordance with guidance recommended by the Department of Health. Barnfield Manor Care Home DS0000064197.V365648.R01.S.doc Version 5.2 Page 24 In our annual quality assurance questionnaire completed by the home they say that they have improved their staff deployment arrangements and staff morale and that they ensure staff is properly recruited, inducted and trained. They have also identified areas to improve over the coming months in respect of staff training, which includes increasing the percentage of staff that have NVQ 2 and 3. Survey returns we have received from representatives of residents tell us that staff usually has the right skills and experience to look after people properly. Staff spoken with at this inspection described satisfactory arrangements for their recruitment, induction and most aspects of their training. They said that care staffing numbers for the morning shift had been increased at the beginning of the week to provide three care staff during the morning for the thirteen people accommodated. Two care staff was provided during the afternoon and two at night. However, they were all concerned that two care staff during the afternoon was insufficient to meet with people’s needs as this compromised either people’s choice of care/personal daily routines or potential safety. All staff said they had voiced their concerns to management. Minutes of a recent staff meeting, held on 08 May 2008 also detailed these views/concerns. Four relatives told us in written survey returns that the home could improve by ensuring there is always sufficient staff numbers. They also told us that staff, usually have the right skills and experience to look after people properly, although one person said that they sometimes do. Staff rotas we looked at confirmed staffing arrangements. We discussed these with the acting manager who advised that she was in the process of increasing staffing for the coming week to provide three care staff during the afternoon as well as the morning and that a further resident was due to be admitted for respite care at the home. We are provided with final staff rotas for the four weeks following our inspection visit, and they detail the provision of three care staffing throughout the day. We also discussed the planning of rotas and determination of staffing levels with the acting manager, including hotel services. We are advised that current company policy determines staffing levels against the number of people accommodated, not their dependency needs. We are advised of temporary catering arrangements, which are also notified to the Environmental Health Officer, which are satisfactory. We asked the home to notify us in writing when the kitchen re-opens to full operation again. There is a training plan in place, which is regularly audited and reviewed via external management arrangements. Sixty-six percent of staff has achieved at least NVQ level 2 with six signed up to commence. Two staff has achieved NVQ level 3 and 90 of staff had undertaken recognised dementia care Barnfield Manor Care Home DS0000064197.V365648.R01.S.doc Version 5.2 Page 25 training. The home’s training analysis and plan is comprehensive and includes all core health and safety training although does not include training in respect of Human Rights or the Mental Capacity Act 2005. A first aid training session was organised for staff at the home to be held the following day. Care staff, has not undertaken training in dealing with challenging behaviour/aggression. (Also referred to under the Healthcare and Complaints and Protection sections of this report). The manager advised that she was aware that this requires attention. Staff records that we looked at held the required information relating to their recruitment, induction and training. Barnfield Manor Care Home DS0000064197.V365648.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements for the management and administration of the home have significantly improved, which better promotes people’s safety and best interests. EVIDENCE: At our last key inspection of this service we judged that peoples’ health, safety and welfare was not adequately promoted and that the home was not consistently managed and run in their best interests. Barnfield Manor Care Home DS0000064197.V365648.R01.S.doc Version 5.2 Page 27 We made three requirements relating to areas where people were placed at unnecessary risk to their health and safety. We also wrote the provider about our serious concerns and we asked them to tell us in writing what they were going to do to ensure people’s safety in the home. (One of these is specifically referred to under the Environment section of this report). The provider wrote to us to tell us what they were going to do and when they were going to do it by. For two of these, they also told us when this was completed. At this inspection we have confirmed that we are satisfied with the action they have taken in respect of two of these (repairs to windows and hot water temperatures from bathing outlets). We also made a requirement that they provide us with written notification about management changes in the home. This is also complied with. In our annual quality assurance questionnaire completed by the home they say that the home is now better managed with quality monitoring and assurance and improved communication systems in place. They say they have improved staff core health and safety training access over the last twelve months and that there is greater management stability in the home. They say they intend to continue to improve their management systems including staff supervision and mentoring introduced. At this inspection people’s advocates/representatives told us about the noticeable management improvements in the home. One person said ‘last autumn the running of the home became very haphazard which was not helpful to residents. This situation is much improved now with a new manager and the retention of some good staff.’ Another said ‘the home is making good improvements under the new manager.’ The acting manager has been in post since 05 November 2007. She has not yet submitted a manager’s registration application to the Commission. Quality assurance and monitoring systems we looked at are developing well. These include systems and services auditing and monthly reports of visits from a representative of the registered provider. There are also a number of methods in place whereby the home seeks peoples’ views about their services, including satisfaction questionnaire, although the results of these were not available or published. Arrangements for the management and handling of people’s personal monies, where applicable are satisfactory. Staff confirmed satisfactory arrangements to ensure safe working practises, including the provision of core health and safety training (with the exception of training in dealing with violence and aggression – see Staffing section of this report). They said they are provided with the equipment they need, although Barnfield Manor Care Home DS0000064197.V365648.R01.S.doc Version 5.2 Page 28 two staff surveys, which we received after our inspection visit, told us that a review of moving and handling equipment would benefit with a view to replacement. Staff spoken with is also conversant with their roles and responsibilities in the event of accidents and incidents in the home and appropriate records are kept in respect of these. Barnfield Manor Care Home DS0000064197.V365648.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 2 X 3 3 X 2 Barnfield Manor Care Home DS0000064197.V365648.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement Where a person is admitted under emergency arrangements to the home, it must be ensured that written care plans are in place, as soon as is reasonably practicable, as to how that persons needs are to be met in respect of their health and welfare. (In this instance with regard to the provision of an initial care plan concerned with management of their aggression and related safeguarding needs). This is to promote people’s protection from unnecessary harm or risk. Adequate precautions must be taken against the risk of fire and for the review and maintenance of fire precautions and equipment. You must ensure that matters raised in the Fire Officer’s report of their said visit to the home in March 2008 are complied with as stated. Barnfield Manor Care Home DS0000064197.V365648.R01.S.doc Version 5.2 Page 31 Timescale for action 31/07/08 2. OP19 23(4)(a) & (c) 31/07/08 (Original timescale 30/11/07 – extended to 30/06/08 due to additional information re fire officer’s visits). You must send us a copy of the Fire Officer’s report from March 2008 and tell us directly in writing when you have completed the work required. This is to ensure that people are not placed at unnecessary risk and that you provide us with the information we asked for in our letter of 10 December 2007. Staff must receive recognised training in responding to and dealing with challenging behaviour/aggression from any service user. To ensure that staff may be confident and consistent in dealing with violence and aggression from any service user and so as not to place people at unnecessary risk of harm or abuse. The acting manager must submit an application for registration under the Care Standards Act 2000 to the Commission. 3. OP30 13(6) & 18(1)(c) 01/09/08 4. OP31 Sec 3 CSA 2000 03/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP1 OP7 Good Practice Recommendations The service guide should be made available in alternative formats as may be suitable for intended residents. The home’s admission’s policy and procedures in respect DS0000064197.V365648.R01.S.doc Version 5.2 Page 32 Barnfield Manor Care Home 3. 4. OP30 OP19 5. OP27 6. OP33 of emergency admissions should determine an agreed standard timescale for ensuring the provision of initial key care plans for people. The staff-training plan should include Human Rights and Mental Capacity Act 2005 training for all care staff. The environment should provide for suitable aids and adaptations to better assist people with their dementia care/orientations/sensory needs in accordance with good dementia care practise. (As work to the environment had recently commenced we will assess this standard at our next key inspection). The ratios of care staff to resident should be determined according to peoples’ assessed needs and a system operated for calculating staff numbers required, in accordance with guidance recommended by the Department of Health. The home should continue to develop its quality assurance and monitoring systems in consultation with people and by publishing/making available the results of any satisfaction surveys to relevant parties. And, in establishing an annual development plan for the home based on reflecting aims and outcomes for service users. Barnfield Manor Care Home DS0000064197.V365648.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Barnfield Manor Care Home DS0000064197.V365648.R01.S.doc Version 5.2 Page 34 - 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. 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