Inspection on 21/06/05 for Barons Down Nursing Home

This inspection was carried out on 21st June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 15/11/05

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 Announced 21 June 2005 10:00 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. Barons Down H59-H10 S13960 Barons Down V223870 210605 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Barons Down Address Brighton Road Lewes East Sussex BN7 1ED 01273 472357 None 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) Mr Hadi Rajabali (Person) Vacant Care Home with Nursing 24 Category(ies) of Old Age (OP), Physical Disability (PD), 24. registration, with number of places Barons Down H59-H10 S13960 Barons Down V223870 210605 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1. That the maximum number of service users at any one time shall not exceed twenty four (24). 2. That service users will be sixty five (65) or over on admission. 3. That the service users may also have a physical disability. Date of last inspection 13 October 2004 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 H59-H10 S13960 Barons Down V223870 210605 Stage 4.doc Version 1.20 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 will be referred to as ‘residents’. This announced inspection was carried out over 1 full day in June 2005. The inspector spent most of her time with residents and their relatives in the communal areas of the home and in individual rooms. The inspector also observed staff working and spoke informally to 3 staff members receiving general feedback. The care documentation pertaining to 2 residents were reviewed in depth along with 3 staff recruitment files. The inspector toured the home and was able to review the facilities. The inspector also ate a meal with the residents in the dining room. Comment cards were received from 3 visiting relatives and 1 General Practitioner. What the service does well: What has improved since the last inspection? The last inspection was carried out on the 0ctober 2004 and the inspector was disappointed to note that many of the requirements made at this time have not been addressed. Improvements have however been made to the menus and the food provision recently and this has been noted by the residents. The new acting manager is aware of the improvements needed and has started to look at some of the issues and is organising staff training as a priority. Barons Down H59-H10 S13960 Barons Down V223870 210605 Stage 4.doc Version 1.20 Page 6 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. Barons Down H59-H10 S13960 Barons Down V223870 210605 Stage 4.doc Version 1.20 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 Barons Down H59-H10 S13960 Barons Down V223870 210605 Stage 4.doc Version 1.20 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) 1,2,3,4 and 6 The inspector found that the home provides prospective and existing service users, 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 need of residents living in the home. EVIDENCE: The home’s combined statement of purpose and service users guide has been updated since the last inspection and was found to be displayed in the front entrance at the time of this inspection. Although this document contains resident’s views these should be presented anonymously and should also include room sizes. Terms and conditions of residency are provided to all new residents and copies of these were seen. All prospective residents are assessed prior to admission and these assessments are then incorporated into the care documentation. During this inspection it was clear 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 H59-H10 S13960 Barons Down V223870 210605 Stage 4.doc Version 1.20 Page 9 Intermediate or rehabilitative care is not provided at Barons Down Nursing Home. Barons Down H59-H10 S13960 Barons Down V223870 210605 Stage 4.doc Version 1.20 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, and 9 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 may lead to health needs not being met. Medicine administration practice ensures residents safety. EVIDENCE: Two resident’s care documentation were reviewed in depth as part of the inspection and although they recorded a needs assessment the plans of care were poor and did not reflect all the care needs of the residents. Neither of the plans addressed the social and mental health care needs and the use of risk assessments was minimal. It was noted that the documentation did not record service users or their representative’s involvement in the planning of care. Although a recognised pressure area risk assessment tool is used a clear procedure for the care of pressure areas was not available in the home. During the inspection a visiting GP was spoken to and this confirmed that the home works closely with health care professionals in the residents interest. The updated medicine policies were seen and medicine administration records were found to be accurate and complete. Barons Down H59-H10 S13960 Barons Down V223870 210605 Stage 4.doc Version 1.20 Page 11 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 and 15 Resident’s opportunities for stimulation through leisure and recreational activities are not developed in the home and therefore the individual social needs of he residents are not met. The home has made progress on improving the food and choice available to residents. EVIDENCE: During the inspection it was noted that the care documentation did not record an assessment of the residents social needs or any social care plan. Although a limited amount of entertainment is provided and staff do try to engage with residents the provision of appropriate activities and entertainment was not available in the home Residents spoken confirmed that there was limited activity in the home one residents said that the residents ‘sit and do nothing all day’. Many of the residents do not come down to the communal areas as they feel there is no one to talk to. Residents confirmed that the food provided had improved since the last inspection and the acting manager said that the menus had been reviewed. Some residents eat communally in the lounge/dining room and the inspector joined these residents for lunch. The meal served was well presented and well received by residents. Staff were seen to assist residents as necessary and to promote independence with eating aids. A record of the dietary intake of residents is now being recorded. Barons Down H59-H10 S13960 Barons Down V223870 210605 Stage 4.doc Version 1.20 Page 12 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) 16,17 and 18 Although a full complaints procedure is in place the management of the home need to ensure that this is followed to ensure complaints are responded to effectively. Resident’s civic rights are promoted by the staff in the home. Clear guidance and training for staff on the protection of vulnerable adults is lacking and this does not effectively demonstrate the well being of residents is fully protected. EVIDENCE: A full complaints procedure is available in the home and a copy of this is available in the statement of purpose/service users guide. A review of the complaints records in the home identified that complaints are being recorded appropriately however these records relating to a complaint that the previous manager investigated recently did not confirm that the complainant had been responded to appropriately following the conclusion of the investigation. Discussion with residents and the acting manager confirmed that residents were facilitated in the voting process recently and advocacy services are promoted. The home’s procedure on adult protection was reviewed during the inspection and found to be incomplete and staff still need to receive formalised training on this subject. Barons Down H59-H10 S13960 Barons Down V223870 210605 Stage 4.doc Version 1.20 Page 13 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) 19,20,21,22,24,25 and 26 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. The home is clean and hygienic in most areas. EVIDENCE: During the inspection it was noted that 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 was required following the last inspection and has not been provided. As the home was purpose built it is structurally able to meet its stated purpose. The outside space is small but can provide limited seating areas. The ground floor provides a lounge/dining room, which again is rather limited in size and only has 11 chairs for comfortable sitting. The bathing facilities have been provided to a good disability standard. Barons Down has 3 double rooms and staff need to ensure that residents Barons Down H59-H10 S13960 Barons Down V223870 210605 Stage 4.doc Version 1.20 Page 14 accommodated in these rooms can have their care needs fully met in these rooms and that the equipment needed can be safely used. During the inspection it was noted that 2 bedside tables were in a poor condition and the surface they provided made cleaning impossible. The standard of cleaning throughout the home was found to be satisfactory however further deep cleaning is needed. It was noted that commodes and wheelchairs needed deep cleaning. Discussion with the manager confirmed that there was no specific person identified to clean these areas. Barons Down H59-H10 S13960 Barons Down V223870 210605 Stage 4.doc Version 1.20 Page 15 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) 27,28,29 and 30 Although the staffing arrangements during the morning are suitable the staffing provision over the whole day is variable dependent on individual changing needs and the staffing provision needs to be more flexible to respond to this to ensure appropriate staffing with appropriate skills at all times. The recruitment practice is thorough and based on equal opportunity and safety of residents. EVIDENCE: At the time of this inspection 15 residents were living in the home. At the time of inspection there was enough staff on duty to meet the care needs of the residents. Residents confirmed that they were ‘well looked after’ and their needs were responded to and that the staff ‘are very nice’ and ‘kind’. The staff spoken to said that the staffing was satisfactory unless any resident needed individual time and monitoring which often happened in the afternoon. It was also noted that there was no laundry staff and that there is no evening cook. Relatives comment cards confirmed that care staff provide ‘excellent care’ ‘continue to provide dedicated care’ although a comment card noted that attention to detail like ensuring the call bell is available and that the specialist equipment is working was sometimes lacking. Staff training continues and the new manager acknowledged the need to establish foundation training but confirmed NVQ training continues. During the inspection 3 care staff recruitment files were examined and confirmed that these were mostly completed to a good standard apart from 1 omission in relation to a Criminal Records Bureau check that was thought to be transferable at the time of this staff members employment. Barons Down H59-H10 S13960 Barons Down V223870 210605 Stage 4.doc Version 1.20 Page 16 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) 31,33,34,36 and 38 Although it is acknowledged that a new manager has just been appointed the home has lacked complete and effective management with no system for monitoring the quality of care based on residents views, and a lack of environmental risk assessment, to promote residents and staff safety. EVIDENCE: The registered manager has recently left and the deputy manager has just been appointed as the new manager. Residents spoken to confirmed that they were happy with this appointment and feel able to communicate well with her. An application for her registration has not been received by the CSCI yet. On speaking to residents it was clear that they were disappointed that they did not have regular contact with the homeowner. Two residents said they had not seen him for a number of years. A comment card received said that there was a lack of communication and that there had been no notification about the change of manager. The homeowner confirmed to the inspector that he would Barons Down H59-H10 S13960 Barons Down V223870 210605 Stage 4.doc Version 1.20 Page 17 carry out regular visits to the home in accordance with regulation 26 and meet and seek resident’s views at these visits. Quality assurance measures need to be fully implemented. Resident meetings are not held and systems of gaining the residents views need to be reestablished. A current insurance certificate was seen in the home and business and financial planning is maintained by the homeowner. A system for formal staff supervision has not been started. During the inspection it was noted that environmental risk assessments had not been completed recently and that 1 window on the first floor opened fully posing a possible risk to residents. An immediate requirement form was left with the acting home manager at the time of the inspection and she has confirmed in writing that all windows have been checked and that they are restricted to a safe opening. A fire risk assessment was not available at the time of this inspection. Barons Down H59-H10 S13960 Barons Down V223870 210605 Stage 4.doc Version 1.20 Page 18 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 3 3 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 2 2 3 2 x 2 3 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 3 1 1 x 2 3 x 1 x 2 Barons Down H59-H10 S13960 Barons Down V223870 210605 Stage 4.doc Version 1.20 Page 19 No 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 4 Regulation 18(1)(a) Requirement Timescale for action 1.9.05 2. 7 3. 8 4. 12 5. 16 6. 18 All staff must receive training on how to care for service users with confusion and dementia.(outstanding from last inspection) 15 That residents care plans record (1)(2)c) and reflect residents health, persnal and social care needs. That plans of care are drawn up in consultation wth residents or their representatives as appropriate. 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. 16(2)m)n) That the home provides activities and entertainment to meet the individual needs of residents.(outstanding from last inspection) 22(4) That complaints are investigated fully and the complainant is given feedback on the conclusion.(outstanding from last inspection) 13(6) That an adult protection procudure providing clear guidiance to staff is available in the home and staff training is H59-H10 S13960 Barons Down V223870 210605 Stage 4.doc 1.9.05 1.9.05 1.10.05 1.8.05 1.8.05 Barons Down Version 1.20 Page 20 7. 19 23(2)(b) 8. 22 and 24 23 9. 10. 11. 24 26 27 23 23 18(1) 12. 29 19 13. 30 18(2) 14. 33 24(1) 15. 36 18(2) provided to all staff.(outstanding from last inspection). A programme of routine 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 inspection) That risk assessments are completed to ensure residents are accommodated in appropriate rooms and on an appropriate beds. That all the furniture in the home is reviewed to ensure appropriat and safe. That a cleaning schedule is provided that covers all areas in the home. That the staffing provision is reviewed to ensure suitable staffing to meet residents needs at all times. That all the necessary checks are completed on all employees in accordance with regulation 19 (outstanding from last 2 inspections). That all staff receive NVQ induction and foundation training which meets National Training Organisation (NTO) specifications within the time limits specified in NMS 30.2 & 30.3. That a full quality assurance system is established and used to maintain and improve the provision of care and services in the home. Tha all the homes policies are reviewed and updated to underpin best practice. That a formal process of documented supervision is implemented, and provided to 1.9.05 1.8.05 1.8.05 1.9.05 1.8.05 1.8.05 1.11.05 1.11.05 1.11.05 Barons Down H59-H10 S13960 Barons Down V223870 210605 Stage 4.doc Version 1.20 Page 21 16. 38 23 care staff at least six times a year. That appropriate risk assessments are completed in relation to health and safety issues and responded to as necessary. 1.8.05 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 1 22 Good Practice Recommendations That the statement of purpose includes the number 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. 3. 4. 28 31 Barons Down H59-H10 S13960 Barons Down V223870 210605 Stage 4.doc Version 1.20 Page 22 Commission for Social Care Inspection 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. 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