CARE HOMES FOR OLDER PEOPLE
Barnfold Cottage 400/402 Blackburn Road Westend Oswaldtwistle Lancashire BB5 4LZ Lead Inspector
Mrs Pat White Unannounced Inspection 31st January 2006 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 Barnfold Cottage DS0000009428.V275728.R01.S.doc Version 5.1 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. Barnfold Cottage DS0000009428.V275728.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Barnfold Cottage Address 400/402 Blackburn Road Westend Oswaldtwistle Lancashire BB5 4LZ 01254 381348 01254 381348 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) Mrs Diann Judith Webster Care Home 14 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (13) of places Barnfold Cottage DS0000009428.V275728.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The care home may provide service for one named service user with dementia who is over 65 years of age. 05/10/05 Date of last inspection Brief Description of the Service: Barnfold Cottage is situated on the main road between Oswaldtwistle and Blackburn. There are garden areas on both sides of the building and a tarmac patio area to the rear. There is parking at the rear of the premises and on the road at the front. The home is close to local shops, and on a bus route to the town centres of Blackburn and Accrington. The home provides accommodation in 10 single bedrooms and 2 double bedrooms. There are two communal lounges, a smoking lounge and a dining room. The accommodation and facilities are on two floors which are linked by a stair lift. Barnfold Cottage DS0000009428.V275728.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and the staff and residents in the home did not know the inspector was to visit. The purpose of the inspection was to assess important areas of life in the home that should be inspected over a 12 month period, check the progress of previous legal requirements and good practice recommendations and to check other matters in the home which came to the inspector’s notice. The inspection took 9 hours. It involved talking to residents, a tour of the premises, looking at resident’s care records and other documents, and discussion with the deputy manager, Mrs Audrey Moore and the manager Mrs Diann Webster. Nine residents were spoken with, and observed in their routine daily activities. Four residents completed comment cards. The significant views expressed by all the people involved have been summarised in the report. What the service does well:
Residents told the inspectors that staff were “ very kind” and “very nice”, and that “we’re well looked after here.” Residents also told the inspectors that the home’s routines were flexible enough to suit their individual preferences. They could get up and go to bed at times of their choosing, and eat their meals when and where they chose. There was a good system of checking the care needs of the residents and whether their needs had changed. There was also a good system of assessing and reducing the risk to individuals in their routine activities, such as moving around and using the stair lift Residents praised the meals that were served, and one stated that staff went to the trouble of cooking their favourite meals. There was a good choice for breakfast including a cooked option. The residents’ medication was managed and given safely. The home was comfortable, clean and homely. The manager, deputy manager and some of the care staff had worked in the home for a number of years. This meant that a group of staff, familiar to the residents, understood their needs and looked after them. Barnfold Cottage DS0000009428.V275728.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Barnfold Cottage DS0000009428.V275728.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Barnfold Cottage DS0000009428.V275728.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 & 5 The home had suitable admission procedures, including written information pre admission assessment of needs. This meant they could determine whether or not the home could look after people and meet their needs. EVIDENCE: The statement of purpose and the service user guide contained useful information about the home, but neither documents contained the address and telephone number of the CSCI, details of the pre admission assessment process and how resident’ rights to privacy and dignity and dignity were upheld. The viewing of some residents’ records showed that the home’s admission procedures and the assessment of prospective residents’ needs had improved. Social work assessments for the two residents who had been admitted under care management arrangements, and in house pre admission assessments carried out by the deputy manager had been carried out prior to admision. This assisted staff to understand the residents’ health and personal care needs. The documentation used for in house assessments covered most of the matters listed in standard 3.3 and therefore formed an appropriate format for
Barnfold Cottage DS0000009428.V275728.R01.S.doc Version 5.1 Page 9 a comprehensive assessment. However information about mouth and foot care and about families and carers was not recorded. The residents’ needs were being met, and people would not be kept in the home if they deteriorated to the extent that staff could not look after them. Two residents had recently been transferred to more suitable homes. Three residents who completed comment cards stated that they felt “well cared for” and one said “sometimes”. Prospective residents and relatives could visit the home prior to admission and one recently admitted resident had stayed in the home on respite care prior to staying permanently. Barnfold Cottage DS0000009428.V275728.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 & 9 Residents’ personal and health care needs were met, though the recording of these needs could be improved. Residents’ medication was managed and administered safely but further improvements could be made to ensure safety. EVIDENCE: Residents had care plans generated from the assessments. Some were in more detail than others but none contained information about mouth care and foot care. There was useful detailed moving and handling risk assessments and risk assessments regarding the use of the stair lift. However there were no risk assessments with respect to the risk of falling, and evidence that at least one resident would benefit from such an assessment. Care plans were reviewed frequently but some care plans were several years old and would benefit from updating. Residents were involved in their care plans and had signed to indicate their agreement. The residents’ physical and emotional health was monitored and promoted. A resident with diabetes was having daily visits and intervention from the district nurses. There was evidence that district nurses were involved in the care of pressure areas. One resident had the use of pressure area relieving
Barnfold Cottage DS0000009428.V275728.R01.S.doc Version 5.1 Page 11 equipment. However the intervention methods and the equipment used were not recorded on the care plan. Some residents had support from the mental health services. Residents’ weights were monitored but there were no nutritional assessments. Some parts of medication management and administration had improved since the previous inspection, and overall the practices and procedures were safe and ensured the health and well being of the residents. The home had comprehensive policies and procedures that covered all the necessary parts of medication management. Risk assessments had been completed for those residents managing their own medication. Accurate records of medication, entering and leaving the home and being administered were kept. However some further improvements could be made. The medication of residents being admitted to the home was not verified with the GP and the criteria for when PRN medication should be given was not recorded. Also there were examples of hand written entries and alterations on the MAR sheets (transcribing) not being double signed or dated. Not all staff who administered medication had accredited training, and there was no evidence that residents were having their medication regularly reviewed by the GP. Barnfold Cottage DS0000009428.V275728.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 & 14 The daily routines were flexible enough to suit individuals’ needs and preferences, and some leisure activities were organised which also suited residents’ preferences. EVIDENCE: The routines of daily living were flexible to suit individuals’ preferences. Residents were asked at residents meetings what leisure activities they would like, and for example there had been a Christmas meal out in Blackpool. There were regular games of Bingo. Residents confirmed that they had choices regarding meals and routines of daily living such as when to get up and go to bed. One resident stated that favourite meals were served on request. Some residents chose to spend most of the day in their bedrooms. Some of the residents’ interests were recorded on the care plans. Residents’ religious preferences were observed and at the time of the inspection a Church of England Vicar held a Communion Service in the home. Residents could bring personal possessions with them and small items of furniture to personalise their rooms. Barnfold Cottage DS0000009428.V275728.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Residents and relatives knew how to make an complaint, and who to contact regarding concerns and complaints about the home ensuring they were listened to. EVIDENCE: The home’s complaints procedure was posted on the home’s notice board and the home’s records of complaints demonstrated that relatives knew how to make a complaint. Residents who completed comment cards stated that they knew who to speak to if they were not happy about any aspect of their care. All those spoken with stated that they had no complaints or concerns. Since the previous inspection the telephone number of the CSCI had been added to the complaints procedure. Barnfold Cottage DS0000009428.V275728.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 25 & 26 The home was clean and furnished and decorated to a satisfactory standard ensuring the residents comfort. The overall safety and general maintenance of the premises had improved but further improvements must be made to ensure continued safety for the residents. EVIDENCE: The location and layout of the home was suitable for it’s stated purpose and some aspects of the premises had been improved and made safer since the previous inspection. A number of legal requirements had been met. Fire doors had been improved, though one door was still ill - fitting. Some fire doors had been fitted with automatic closure devices. Some parts of the home had been repaired and redecorated and resulted in an improved environment for the residents. However one bathroom sink was badly cracked and this was unsightly and hazardous. The grounds were well kept and accessible to residents.
Barnfold Cottage DS0000009428.V275728.R01.S.doc Version 5.1 Page 15 The chair lift operating between the two floors had been made safer since the previous inspection, and risk assessments had been undertaken on the use of the stair lift. There was appropriate equipment to assist residents in moving and transferring, including a hoist. Since the previous inspection, call bells had been extended in some bedrooms, where necessary, to make them accessible to residents. The central heating system had been immediately repaired following the last inspection and at the time of this inspection the home was comfortably warm in all areas. Portable heaters were no longer in use and residents were protected from hot surface temperatures. Pre set valves on hot water outlets protected residents from the hazards of hot water. However there was no evidence that the home’s water supply did not pose a threat of Legionella. All areas of the home that were viewed were free from offensive odours and the general cleanliness of the home was of a satisfactory standard. The laundry was situated in an “out house” at the back of the property. Laundry procedures were satisfactory. Barnfold Cottage DS0000009428.V275728.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 & 30 Staffing levels must be reassessed to ensure there are adequate staff on night duty to care for the needs of residents. Staff were developing relevant skills and competences through the home’s staff training programme to ensure they are skilled to look after people in their care. EVIDENCE: At the time of the inspection there was sufficient staff to meet the needs of the residents and to ensure that standards in relation to meals and cleanliness were maintained. However the arrangement of one waking night staff, and one on call off the premises would not be sufficient to meet the needs of residents who need two members of staff for transfer. The pre – inspection questionnaire showed that 46 of care staff were trained to at least NVQ level 2. The home’s records showed that staff had completed relevant training according to their own needs and those of the residents. Clear records were kept of what training staff had undertaken and what was outstanding. The home’s Induction training programme was in accordance with the Skills for Care specifications. Barnfold Cottage DS0000009428.V275728.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35 & 38 The home’s service quality monitoring systems did not demonstrate how the home is run in the residents’ best interests. The health and safety of residents and staff is promoted to ensure they are safe at all times. EVIDENCE: The home had basic service quality monitoring systems in place. There were regular residents meetings and the home had used resident questionnaires that were distributed in the service user guides. However there was no evidence that the results of the questionnaires had been collated and analysed. Relatives had not been involved in the surveys to date. Appropriate records were kept of the fees paid by residents. However accurate records of residents’ spending money spent and stored in the home were not kept, and the storage of this money was not sufficiently secure.
Barnfold Cottage DS0000009428.V275728.R01.S.doc Version 5.1 Page 18 The health and safety of the residents and staff were promoted. Members of staff had the necessary health and safety training and the home’s fire precautions and records were satisfactory. The electrical wiring in the house had been made safer since the previous inspection and the gas appliances had been appropriately tested. Accidents were recorded appropriately and showed that at last one resident was prone to falling and would benefit from a risk assessment to improve her safety (see standard 7). Barnfold Cottage DS0000009428.V275728.R01.S.doc Version 5.1 Page 19 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 2 X 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 x 2 X 2 3 X X 2 3 STAFFING Standard No Score 27 3 28 2 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 2 X X 3 Barnfold Cottage DS0000009428.V275728.R01.S.doc Version 5.1 Page 20 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 OP1 Regulation 5(1)(e) & (f) Requirement The service user guide must include a summary of the most recent inspection report and state the address and telephone number of the CSCI The registered person must ensure that the in house assessment contains all matters listed in standard 3.3, including oral and foot care. The manager must ensure that all relevant details regarding the health, personal and social care needs are recorded on the care plan, including mouth and foot care (previous timescale of 11/11/05 not met) The manager must ensure that care plans are updated as necessary The manager must ensure that the risk of falls is identified and recorded on the care plan and that a risk assessment undertaken to assist in the prevention of falls. The risk of pressure sores must be assessed and the intervention and preventative measures must
DS0000009428.V275728.R01.S.doc Timescale for action 09/03/06 2 OP3 14 (1)(a)(b) 09/03/06 3 OP7 15(1)17 (1)(a)sch 3 16/03/06 4 5 OP7 OP7 15 (2)(c) 13 (4)(b)(c) 09/03/06 09/03/06 6 OP8 15&17 (1)(a)sch 3,3n 09/03/06 Barnfold Cottage Version 5.1 Page 21 7 OP9 13 (2) 8 OP9 13 (2) 9 10 11 12 OP9 OP9 OP9 OP19 13 (2) 13 (2) 13 (2) 23 (4)(c) 13 OP25 13 (3)(4)(a) (c) 18 (1) 24 (2) 14 15 OP28 OP33 16 17 OP35 OP35 17 (2) 16 (2)(l) be recorded on the care plan. Medication must be verified by the GP on admission and listed in the care home’s records (Previous timescale of 14/10/05 not met) The criteria for the administration of PRN medication must be clearly defined and recorded on or with the MAR sheets. All transcribing on the MAR sheets must be double signed and dated. The residents must have their medication reviewed by the GP at least 6 – monthly. All staff who administer medication must have accredited training. The faulty fire door identified must be repaired (previous timescale of 11/11/05 not met). The registered person must ensure that the home’s water supply does not pose a threat of Legionella. The registered person must ensure that 50 of care staff are qualified to at least NVQ level 2. The registered person must ensure that the results of the quality surveys are collated, analysed and the results made known to the residents and the CSCI Accurate records must be kept of all the money received, held and spent on behalf of residents. Residents’ money given to the registered person for safekeeping must be stored securely. 31/01/06 09/03/06 31/01/06 31/01/06 30/06/06 09/03/06 30/04/06 30/06/06 30/04/06 31/01/06 02/03/06 Barnfold Cottage DS0000009428.V275728.R01.S.doc Version 5.1 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations The statement of purpose should include details of the pre admission assessment procedures, emergency admission procedures and examples of how residents’ privacy and dignity are respected. It is recommended that nutrition assessments are undertaken. It is highly recommended that the cracked bathroom sink identified be replaced. It is recommended that relatives and visiting professional be involved in the quality monitoring exercises. 2 3 4 OP8 OP21 OP33 Barnfold Cottage DS0000009428.V275728.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Barnfold Cottage DS0000009428.V275728.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
