CARE HOMES FOR OLDER PEOPLE
Barnhaven Barnhay Bampton Devon EX16 9NB
Lead Inspector Annie Foot Unannounced 7th April 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Barnhaven Version 1.10 Page 3 SERVICE INFORMATION
Name of service Barnhaven Address Barnhay, Bampton, Devon, EX16 9NB Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01398 331566 Devon County Council Christine Barbara Williams Care Home 15 Category(ies) of OP Old Age [15] registration, with number of places Barnhaven Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 11.08.2004 Brief Description of the Service: Barnhaven is a care home providing personal care and long stay accommodation for up to 15 older people. The home is owned and managed by the local authority, Devon County Council. The home is centrally located, in Bampton, a small market town, close to local shops, pubs, post office and other amenities.The home first opened in 1997, and comprises a two-storey purpose built building. All the home’s bedrooms are single. There are shared bathrooms and toilets. There is a passenger lift to the first floor, and a call bell system is installed throughout the home. There are three lounges in the home for communal use and a dining area. The home has outdoor seating to the front of the building and there is a grassed area to the rear. Barnhaven Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was the first of the year. Not all of the standards were inspected on this occasion, although most of core areas were covered. The inspector arrived at 8.35 a.m. and spent over 5 hours at the home. 5 service users were spoken with at some length. At the time of the inspection assistant manager was on duty, with 2 care staff, 2 domestics and 1 cook. The inspector also spoke to the district nurse who was visiting the home during the day. A tour of the building was made, but not all service user rooms were seen on this occasion. Care plans, service user files, medication records/procedures, and maintenance records were examined. There have been no changes to the management of the home since the last inspection. One complaint has been received by the home, during this time. Details of the investigation and procedures followed were thoroughly recorded. What the service does well:
All of the residents spoken with were positive about the home. There was a relaxed restful atmosphere in the home, during the inspection, despite a number of service users being unwell which was adding to the staff’s workload. The home is well organised, records are fully completed and there are systems in place to ensure that documentation is regularly reviewed and kept updated. Residents said that their health needs are quickly attended to and that “a doctor is called is sent for quickly when required”. The staff team is stable and turnover is low. Most of the staff live locally and have worked at the home for several years. The staff know the residents well. Residents spoken to felt they “get on well with the staff and often had a laugh and a joke together”. Relationships between residents and staff are positive and communication easy. A letter from a resident’s relative commented that they “were very impressed by the care provided” and also “the professionalism and courteousness shown”. Staff were said to “encourage independence and encourage service users to make life choices” Residents say that the food is consistently good and a varied, wholesome menu is offered. There are always choices available. Barnhaven Version 1.10 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Barnhaven Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Barnhaven Version 1.10 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12-month period. JUDGEMENT – we looked at outcomes for standard(s) 1 3 Service users receive clear information about the home and its facilities and services. The initial assessment procedure does not always ensure accurate information is provided prior to people moving into the home. Without detailed information assurance cannot be given that care needs can be met. EVIDENCE: The statement of purpose and service user guide has recently been updated and improved. The admission information is often not sufficient to provide staff with enough detail to know whether or not the home can meet a service users needs. The assistant managers rely on assessment information from provided through Social Services or the district nurse. Staff feel that the district nurse is very familiar with the home and will always ensure that the home has the capacity to meet service user needs. Assessments through other sources are considered variable and often detail is inadequate. Assessments are not carried out by the home until the service user arrives at the home, when a care plan is developed. Barnhaven Version 1.10 Page 9 Barnhaven Version 1.10 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12-month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 10 Continued improvement has been made to the content of individual care plans. Health and personal care needs are well met. Medication administration at the home is well managed, promoting good health. EVIDENCE: Five care plans were inspected which all contained detailed information regarding the health and welfare of individual service users. Details of action taken are recorded and records are kept up to date. Care plans are reviewed monthly and service users sign care plans wherever there are significant changes. Residents said that their health care needs were promptly met. Contact with the local surgery and health care team is regular. A visiting district nurse was met. She provided advice to the staff team regarding infection control procedures to be followed during the current outbreak of diarrhoea and vomiting. Care plans are well informed and are consistent. Staff have a good understanding of the health and personal care needs of each resident. Medical treatment and examination is undertaken in the privacy a service users room.
Barnhaven Version 1.10 Page 11 Medication records are consistent and accurate. Residents sign their agreement to administer their own medication where they have capacity to do so. The systems for the administration of medication are clear and comprehensive ensuring that service users medication needs are met. Residents said that they are treated with respect and that “nothing is too much trouble” for the staff. Call bells are responded to promptly. All staff are trained in first aid, which is kept updated. Staff are updated at the start of each shift in the condition of each of the service users. Barnhaven Version 1.10 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12-month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13 15 Social activities are organised on an informal and daily basis taking account of service users interests. Meals are wholesome and nutritious, taking account of the likes and dislikes of individuals. EVIDENCE: Many of the residents said that they liked “a game of cards or scrabble” during the afternoon. Another resident said they preferred to spend time with letters and books on their own. Residents’ involvement in activites is recorded on file. Service users said that during the morning they like to read the paper (which is delivered) or to have a quiet time on their own after breakfast. Most of the residents are local and contact with the local community through their families and friends. Residents said that their visitors were welcome at any time. Many have relatives living in the community who pop in and out of the home at all times. Two visitors arrived during the inspection, but due to illness in the home, did not stay for long. All of the residents said how good the food is and how much they enjoy meals. They like the range of choices offered at each meal. Lists of individual “likes and dislikes” are displayed in the kitchen or a need for special diet. Menus are
Barnhaven Version 1.10 Page 13 balanced and interesting, with the cook being flexible about what is provided to meet individual preferences. Meals are taken around small tables in the dining room. Linen napkins are provided and changed daily, which are appreciated by the residents. Each service user has a named napkin ring. Barnhaven Version 1.10 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12-month period. JUDGEMENT – we looked at outcomes for standard(s) 16 18 The complaints procedure is robust and there are systems in place to ensure that investigations are undertaken. Staff are aware of the procedure to follow to protect service users from abuse. EVIDENCE: Records show that complaints are investigated and followed through although a clearer outcome would make the conclusion explicit. Residents know who to talk to if they have any issue of concern. Staff are aware of who to speak should in the event of an allegation of abuse. Staff receive training in the protection of vulnerable adults. This is arranged centrally and not all staff have yet received full training. Barnhaven Version 1.10 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12-month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20 26 People living at the home have clean, safe and comfortable surroundings. The arrangements for dealing with soiled linen potentially place vulnerable people at risk. EVIDENCE: The property was purpose built by the local authority. Some parts of the home are somewhat institutional in design and layout (corridors, layout of communal seating areas). The size of the home and friendly informal atmosphere compensate for these deficits and a comfortable environment created. Despite an outbreak of diarrhoea and vomiting there were no unpleasant odours in the home at the time of the inspection. The domestic staff clearly explained the procedures to be followed in the event of illness and infection. A number of notices are displayed throughout the home with instruction regarding infection control. However, despite previous requirements to remove the sluice to an alternative location, it still remains in situ and in use. Although staff follow strict
Barnhaven Version 1.10 Page 16 procedures, there continues to be a risk of cross infection to vulnerable people e.g. clean garments hanging up in the laundry alongside the sluice/washing machine. Maintenance records inspected are up to date. Unfortunately no changes have been made to be outside areas to enable residents to gain access to the back garden, which is a pity. Barnhaven Version 1.10 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12-month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28 30 The staff are familiar and experienced in meeting the needs of older people. Staff demonstrate an awareness of their roles and responsibilities. Staff receive planned ongoing training to support the needs of people living at the home. Open interaction and positive relationships exist between staff and management EVIDENCE: The staff team is stable and turnover low. Sufficient staff are on duty to meet the needs of service users. Care, domestic and catering staff said they work together well as a team and are supported by an assistant manager on duty at all times. There is an annual staff training programme with the majority of training undertaken and coordinated centrally through Social Services. The district nurse will also provide staff with training as required e.g. infection control procedures. 6 care staff have achieved NVQ level 2 and 2 others are undertaking a course. Domestic and catering staff have also achieved NVQ qualifications. New members of staff undertake a TOPPS induction training. Barnhaven Version 1.10 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12-month period. JUDGEMENT – we looked at outcomes for standard(s) 32,35 38 The manager is supported well by the senior staff team in providing clear leadership. Resident’s benefit from the continuity and stability of the management and staff team. The health and safety of service users is protected by the systems and procedures in place. EVIDENCE: There has been no change in the management team of the home during the last year. The manager and 2 assistant managers are extremely experienced and competent in their knowledge and understanding of older people. Staff and resident meetings are regularly held. Both are encouraged to put forward their views, suggestions and comments.
Barnhaven Version 1.10 Page 19 Residents’ personal monies held on site are safely stored. All financial transactions are recorded and countersigned by two people. A new suspense account for service users monies is to be implemented. Maintenance records seen are up to date. Safe working practices and risk assessments are recorded. All staff undertake fire training at least twice a year. Barnhaven Version 1.10 Page 20 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 3 2 x x x x x 1 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 x 3 x x 3 x x 3 Barnhaven Version 1.10 Page 21 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP26 Regulation 23 Requirement Timescale for action 30.6.05 2. OP26 13 (3) The registered person must, having regard to the numbers and needs of the service users, ensure that any necessary sluicing facilities are provided. The sluice should be removed from the laundry and relocated. (Timescale of 30.7.04 not met) The registered person shall make 8.4.05 suitable arrangements to prevent infection, toxic condidtions and the spread of infection at the home. The sluice in the laundry should not be used as there is risk of cross infection to vulnerable people. Infected soiled linen should be put into alginate dissolvable bags and straight into the washing machine, using the sluicing cycle twice if necessary. 3. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Barnhaven Version 1.10 Page 22 No. 1. Refer to Standard OP3 Good Practice Recommendations To review the assessment procedure to ensure that you have sufficient information in advance of a service users admission, to ensure that the home has the capacity and understanding to meet service users needs. To ensure that the outcome to all complaints investigated is clearly recorded. To provide a level area which is accessible and safe to the back garden To ensure that all staff (care, domestic and catering)have a full awareness and understanding of current infection control procedures. 2. 3. 4. OP16 OP20 OP26 Barnhaven Version 1.10 Page 23 Commission for Social Care Inspection Exeter Office, Suites 1 & 7 Renslade House Bonhay Road Exeter, EX4 3AY 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 Barnhaven Version 1.10 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!
