Inspection on 15/11/05 for Barons Down Nursing Home

This inspection was carried out on 15th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Barons Down Nursing Home 28/04/09

Barons Down Nursing Home 14/05/08

Barons Down Nursing Home 22/06/07

Barons Down Nursing Home 19/06/06

Barons Down Nursing Home 21/06/05

Barons Down Nursing Home 13/10/04

Barons Down Nursing Home 10/05/04

Similar services:

Springfield House

The Shelley

Thorndene

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Barons Down Brighton Road Lewes East Sussex BN7 1ED Lead Inspector Melanie Freeman Unannounced Inspection 15th November 2005 10:00 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 Barons Down DS0000013960.V265627.R01.S.doc Version 5.0 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. Barons Down DS0000013960.V265627.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Barons Down Address Brighton Road Lewes East Sussex BN7 1ED 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) 01273-472357 01273-479104 Mr Hadi Rajabali Mrs Shehnaz Rajabali Vacant Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24), Physical disability (24) of places Barons Down DS0000013960.V265627.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. That the maximum number of service users at any one time shall not exceed twenty four (24). That service users will be sixty five (65) or over on admission. That the service users may also have a physical disability. Date of last inspection 21st June 2005 Brief Description of the Service: Barons Down is registered to provide nursing care for twenty-four service users, who are over 65 years of age and may also have a physical disability.The home is purpose built, providing accommodation on three floors, with eighteen single bedrooms with ensuite facilities, and three double bedrooms, with no ensuite facilities. A passenger lift serves all three floors. All bedrooms are of a good size and have telephone points and lockable doors. The south facing rooms have extensive views of The Downs. There is a small patio area leading off from the lounge/ dining area that service users enjoy when the weather is warm. There are car-parking facilities to the front of the premises. Barons Down DS0000013960.V265627.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term ‘service user’ to describe those living in care home settings. For the purpose of this report those living at Barons Down Nursing Home will be referred to as ‘residents’. This report should be read in conjunction with the report of the inspection that took place on 21 June 2005 for an overview of the core standards inspected over the year. This was an unannounced inspection carried out on a weekday in November. The acting manager was on duty and was able to contribute to the inspection process and received the inspector’s feedback. The inspection focussed on meeting and talking to residents and visitors to the home and in accessing the homes progress in meeting the requirements made at the last inspection. The inspector was able to speak to 2 visitors and observed staff while working in the communal areas and reviewed the care documentation of 3 residents. Other areas and documentation inspected included: the home’s Statement of Purpose and Service Users’ Guide, risk assessments, the provision of activities, the systems in place to deal with complaints and protect residents from harm, staffing levels. An inspection of the premises also took place. What the service does well: What has improved since the last inspection? The new manager has found it difficult without dedicated management time to address the requirements and recommendations made at the last inspection and many of these remain outstanding. Procedures and practice followed in the home now ensure that complaints are managed appropriately and that staff know what action to take following an allegation or suspicion of abuse. Two new beds have been provided to ensure residents and staff safety. Barons Down DS0000013960.V265627.R01.S.doc Version 5.0 Page 6 Staff training is still being arranged and re-organised and the new manager is attending relevant courses to inform good practice in the home. 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. Barons Down DS0000013960.V265627.R01.S.doc Version 5.0 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 Barons Down DS0000013960.V265627.R01.S.doc Version 5.0 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 and 4 The home provides prospective and existing residents, with a good level of information on the services and facilities provided. Residents are fully assessed prior to admission to ensure appropriate placement however care staff are not fully trained to meet all the care needs of residents living in the home. EVIDENCE: The home has a combined statement of purpose and service users guide a copy of this was found to be displayed in the entrance hall. This document still needs to be updated to include resident’s views and room sizes. All prospective residents are assessed prior to admission and these assessments are then incorporated into the care documentation. It was again noted at this inspection that a number of residents have varying levels of confusion; specific training to facilitate staff in caring for these residents has not been established. Barons Down DS0000013960.V265627.R01.S.doc Version 5.0 Page 9 Barons Down DS0000013960.V265627.R01.S.doc Version 5.0 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 and 10 Staff are not provided with clear guidance on how to meet the resident’s health personal or social care needs. The lack of risk assessment and planning of care could lead to the health needs of residents not being met. EVIDENCE: The care documentation of three residents were reviewed in depth and again identified that although they recorded a needs assessment the plans of care were poor and did not reflect all the care needs of the residents. Some of the assessments and plans of care completed were not dated or signed and did not evidence regular review and evaluation of the care. The care documentation did not record that the resident or their representative were involved in the planning of care. All these shortfalls were discussed with the home manager. There was evidence to confirm that risk assessments are used to inform the care provided, although it was noted that they were not always completed when needed. The manager confirmed that she was seeking expert advice on the prevention and treatment of pressure sores to ensure best practice. Barons Down DS0000013960.V265627.R01.S.doc Version 5.0 Page 11 It was clear from the documentation that the home maintains good links with the community health care professionals to inform the health care in the home. During the inspection staff were seen to be polite and respectful to residents allowing them time to complete tasks independently. Barons Down has 3 registered shared rooms, and the communal space is all combined therefore an area to receive visitors in private is not always available. Barons Down DS0000013960.V265627.R01.S.doc Version 5.0 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): 12,13 and 14 Resident’s opportunities for stimulation through leisure and recreational activities are not developed in the home and therefore the individual social needs of the residents are not met. The home facilitates residents to receive visitors in the home. The control residents have over their daily life is maintained. EVIDENCE: The arrangement for regular meaningful activities in the home has not been improved since the last inspection although the manager confirmed that a Christmas shopping trip was being arranged. Three residents spoken to said they were ‘bored’ and a visitor said they were concerned about the lack of stimulation in the home. During the inspection it was noted that that those residents who chose to come to the communal area were watching the television, which was left on throughout the morning and the lunchtime. Visitors spoken to confirmed that visiting was unrestricted and that they were always warmly welcomed on arrival. While observing staff it was evident that residents were given choice in daily activities including what they wanted to eat and where they wanted to eat their Barons Down DS0000013960.V265627.R01.S.doc Version 5.0 Page 13 meals. The new chef has close and regular contact with residents promoting individual choice and direct feedback regarding the quality of the food. Barons Down DS0000013960.V265627.R01.S.doc Version 5.0 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 the following standard(s): 16 and 18 Procedures and practices in the home ensure that complaints made are managed appropriately and that staff know what action to take following an allegation or suspicion of abuse. EVIDENCE: Records in the home confirmed that since the new managers appointment complaints have been dealt with thoroughly with appropriate feedback to the complainant. The homes adult protection policy and procedure has been updated and the manager confirmed that she is attending a course arranged by Action on Elder Abuse and will in turn provide staff training. Barons Down DS0000013960.V265627.R01.S.doc Version 5.0 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 the following standard(s): 19,21 and 23 The management do not have a planned programme to improve the environment at Barons Down to ensure a homely comfortable safe and appropriate environment for residents. EVIDENCE: As identified at the last inspection Baron’s Down although decorated to a reasonable standard needs a structured commitment for improvement to provide a good general standard throughout. An annual programme of regular maintenance and renewal of the fabric of the building has been required at the last two inspections and has not been provided. As the home was purpose built it is structurally able to meet it’s stated purpose. The outside space is small and although can provide a seating area does not provide a garden area for those people who enjoy walking or gardens. Barons Down DS0000013960.V265627.R01.S.doc Version 5.0 Page 16 The bathing facilities have been provided to a good disability standard. Barons Down has 3 double rooms and staff need to ensure that residents accommodated in these rooms have made a positive choice to do so, that their care needs can be fully met in these rooms, and that any equipment needed can be used safely. Barons Down DS0000013960.V265627.R01.S.doc Version 5.0 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 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 and 30 Staffing arrangements and numbers were satisfactory to meet the needs of the residents living in the home at the time of this inspection. Co-ordinated staff training to ensure staff competencies needs to be established. EVIDENCE: At the time of this inspection 19 residents were living in the home. Since the last inspection the staffing levels have been reviewed and increased now providing 5 care staff in the morning and 4 in the afternoon evening (these numbers include the registered nurse provided). Staff spoken to confirmed that this allowed for the monitoring of a resident who has a tendency to fall. It was however noted that an evening chef/kitchen assistant is not provided so this means that one of the care staff has to complete catering duties reducing the time available for care. A review of duty rotas confirmed that regular agency staff are used in the home to maintain the staffing numbers and one agency carer confirmed they liked working at Baron’s Down. Residents and visitors spoken to complimented the staff saying they were ‘kind’ and ‘thoughtful’. Staff training for the directly employed staff is being re-organised records indicated that staff do undertake induction training, however records did not confirm that staff were receiving regular training on health and safety matters for example; safe moving and handling. Observation of staff confirmed the Barons Down DS0000013960.V265627.R01.S.doc Version 5.0 Page 18 appropriate and safe use of lifting equipment although handling belts were not being used when they should have been, this shortfall was identified to the home manager. Individual training and development assessment and profiles for staff are not recorded. Barons Down DS0000013960.V265627.R01.S.doc Version 5.0 Page 19 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): 32,33,35 and 36 The new manager needs to establish clear leadership and to ensure the home is managed in the best interest of residents tacking into account their and their representatives views along with the views of staff. EVIDENCE: The home manager was appointed in June 2005 and her application is being progressed by the CSCI. She is fully aware of the requirements and recommendations identified at the last inspection, however she has been unable to action them all, as her time has been limited by the need for her to be working in direct care. The manager needs time to establish clear management systems to ensure high standards of care and services are provided and monitored. The inspector was advised that recruitment for registered nurses and carers is taking place and the aim is to provide further trained nurse support for the manager allowing her to fulfil her management role. Barons Down DS0000013960.V265627.R01.S.doc Version 5.0 Page 20 Quality assurance measures need to be fully implemented. Resident meetings are not held and systems of gaining the residents views need to be established. Following the last inspection the homeowner did complete a visit to the home, which was recorded in accordance with Regulation 26. Residents spoken to confirmed that they appreciated this contact. Unfortunately these required monthly visits have not been maintained. During this inspection it was again noted that most of the homes policies and procedures need to be updated to underpin best practice in the home. The inspector was unable to examine the records held in respect of resident’s monies, as the homeowner was not available at the time of inspection. This standard will be assessed at the next inspection. A system for formal staff supervision has not been started although the manager confirmed that she is to complete a course on staff supervision and appraisal. Barons Down DS0000013960.V265627.R01.S.doc Version 5.0 Page 21 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 X 3 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X 3 X 3 X X X STAFFING Standard No Score 27 2 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 2 1 X X 1 X X Barons Down DS0000013960.V265627.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? NO 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 OP4 Regulation 18(1)a Requirement Timescale for action 01/03/06 2 OP7 3 OP8 4 OP12 5 6 OP18 OP19 All staff must receive training on how to care for service users with confusion and dementia.(outstanding from last 2 inspections) 15(1)(2)c That residents care plans record and reflect residents health, perosnal and social care needs. That plans of care are drawn up in consultation wth residents or their representatives as appropriate and are reviewed regularly.(outstanding from last inspection) 12(1) That risk assessments are used to inform the plan of care. That a clear prcedure and guidelines for the care of pressure areas is provided.(outstanding from last inspection) That the home provides activities 16(2)m)n) and entertainment to meet the individual needs of residents.(outstanding from last 2 inspections) 13(6) That all staff receive training on the protection of vulnerable adults. 23(2)b A programme of routine DS0000013960.V265627.R01.S.doc 01/03/06 01/04/06 01/04/06 01/03/06 01/03/06 Page 23 Barons Down Version 5.0 7 OP19 23(2)b 8 9 OP27 OP30 18(1) 18(2) 10 OP33 24(1) 11 12 OP33 OP36 26 18(2) maintenance and renewal of the fabric and decoration of the premises be produced and sent to the Commission. This should include replacement of beds and other nursing equipment.(outstanding from last 2 inspections) That all the furniture in the home is reviewed to ensure appropriate and safe.(outstanding from last inspection) That appropriate support staff are employed at all times. That staff are provided with appropriate training to equip them fully to care for residents and to work safely. That a full quality assurance system is established and used to maintain and improve the provision of care and services in the home. That all the homes policies are reviewed and updated to underpin best practice. That the registered provider visits the home in accordance with regulation 26. That a formal process of documented supervision is implemented, and provided to care staff at least six times a year.(outstanding from last inspection) 01/03/06 01/01/06 01/04/06 01/04/06 01/01/06 01/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Barons Down DS0000013960.V265627.R01.S.doc Version 5.0 Page 24 1 2 OP1 OP22 3 4 OP28 OP31 That the statement of purpose includes the number and size of the rooms in the home and the service users guide includes residents views. That an assessment of the premises and facilities should be undertaken by a qualified Occupational Therapist, to advise on the suitability of disability equipment and environmental adaptations. That a minimum ratio of 50 of care staff have achieved a NVQ in care by 2005. That the manager obtains NVQ Level 4 in Management or its equivalent by 2005. Barons Down DS0000013960.V265627.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 Barons Down DS0000013960.V265627.R01.S.doc Version 5.0 Page 26 - 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!