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Inspection on 17/02/09 for Barons Park Nursing Home

Also see our care home review for Barons Park Nursing Home for more information

This inspection was carried out on 17th February 2009.

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

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Barons Park Nursing Home Desford Lane Kirby Muxloe Leicester Leicestershire LE9 2BE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Keith Charlton     Date: 1 7 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Barons Park Nursing Home Desford Lane Kirby Muxloe Leicester Leicestershire LE9 2BE 01162387337 01162387976 info@baronspark.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Barons Park Nursing Home Limited care home 44 Number of places (if applicable): Under 65 Over 65 0 0 dementia mental disorder, excluding learning disability or dementia Additional conditions: 44 44 The maximum number of people to be accommodated is 44. To accommodate service users over 18 years with a primary diagnosis on admission of Dementia - Code DE or Mental Disorder - Code MD Service users aged 18-65 to be accommodated in The Lakes wing. Date of last inspection Brief description of the care home The last key inspection of the home was on 9/2/07. Barons Park is a nursing home registered for 44 service users of both sexes. It is registered for people with mental health and dementia care needs. The home has established links with the Alzheimers society and is staffed by registered mental health nurses and care staff. Situated in a rural area close to the village of Kirby Muxloe Leicestershire it is within a short distance of Junction 22 on the M1. The home is owned by Mr. and Mrs. L. Warren. The property has been developed and offers accommodation on two floors, which are served by a passenger lift. The home has Care Homes for Older People Page 4 of 28 Brief description of the care home large mature gardens and a patio area and has pleasant views of the countryside. It has comfortable lounges and the main lounge has a dining area. Adequate parking facilities are available and the home is situated on a main road. The home has a website at www.baronspark.co.uk Fees range from #750.00 to #1800.00 per week, dependant on care needs. The Statement of Purpose and Service User Guide (information about the service provided) is currently available. A copy of the Commission of Social Care Inspection report is available and is displayed in the foyer of the home. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection included a visit to the service. We (the CSCI) visited Barons Park on the 17th February 2009. The Registered Manager, Responsible Individual and staff in the home helped us during the visit. The main method of inspection we used was case tracking. This means looking at the care given to people in different ways. We did this by, - talking to the people who live in the home, as far as possible and their relatives, - talking to staff and management, Care Homes for Older People Page 6 of 28 - watching how people are given support, - looking at records. As well as this, we looked at information that had come to our attention since the last key inspection in February 2007. Because of the nature of residents mental health needs we were not able to speak to many residents though we managed to speak to two people plus five relatives during our visit. People told us that staff were very friendly and caring and did a good job. One person said: staff are kind and caring and spend time with my relative. We spoke with three members of staff during our visit to the home who told us about working in the home and gave us their views. They all were very positive about working at Barons Park and wanted to provide the best care to people living there. One staff member said: We work as a team and residents come first here. We sent out surveys to relevant parties and so far we have received two - one from a GP and one from a staff member. Both were very positive about the standard of care supplied to residents. We checked all the standards that the Commission for Social Care Inspection has decided are key standards during this inspection. The information below is based only on what we checked in this inspection. We have kept details about individual people out of the report to make sure we respected their confidences. What the care home does well: What has improved since the last inspection? What they could do better: All aspects of residents lives should be included in the assessment and staff need to read all care plans to ensure all residents needs are met. Medication always needs to be kept securely and all potentially serious accidents to residents quickly referred to medical services to protect residents health. Residents should be free to persue their own activities (e.g. wandering) without staff intervention if they are safe to do so so they are not restricted. The Provider needs to ensure staff know all the relevant Agencies to refer to if they suspect abuse has taken place. Care Homes for Older People Page 8 of 28 The Provider is recommended to undertake another review of the home to determine whether improvements to signing can be made to further meet the needs of people with dementia living at Barons Park. Fire doors should not be propped open unless there are proper systems in place, to protect residents from fire risks. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Barons Park have had their needs assessed before moving into the home so that staff can provide care that meets these needs. Evidence: Relatives spoken with said they had enough information at the time of the admission to make up their minds about the home. Yes, I can remember getting information when I enquired about a place, one relative said. We case tracked a person living in the home who had moved into Barons Park in the past year. We checked that her family had received information to help with the choice of home, and the relative said he had received enough information. We also checked that this person had her needs properly assessed prior to moving in, to ensure that the staff at the home could meet their needs and we found that the assessment system was detailed recorded needs though not all sections had been completed, e.g. a social Care Homes for Older People Page 11 of 28 Evidence: assessment for one resident, and there was no specific information as to health checks - optical, dental, hearing checks etc so as to prompt a check to improve the health of residents. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Barons Park receive good health and social care practice. Evidence: Relatives said that staff provided excellent personal care to residents: staff are so patient. I have never had a problem with how they treat my mother, was one of the many very positive comments that relatives made. A GP said in a survey - that residents are well looked after, the weekly GP visit is managed efficiently and advice is appropriately sought from the GP service. Some relatives spoken with could recall that their relative had a care plan and were involved in reviews to ensure that the care supplied by staff was right for their relative. We checked the care plans of four people living at the home who were case tracked. Plans showed detail regarding the support required by staff to ensure the physical health of people living at the home, and there was information to inform staff of the Care Homes for Older People Page 13 of 28 Evidence: residents personal history though no information of preferred daily living routines of residents to fully ensure their wishes are fully followed. Accident records were checked and medical services had been contacted when a resident had a potentially serious injury, though this was not always the case. The Manager said this would be followed up. We checked the medication records, and found that there was accurate recording of the administration of the medicines in the home. Staff confirmed that only the qualified nursing staff administer medication to residents. Medication was seen to be supplied to residents, which was seen to be done correctly except that two tablets were left in a cup on top of the medication trolley when a resident was given his medication nearby, making this medication potentially accessible to residents. Management said that this was an unusual incident and would not be repeated. The medication trolley was kept secured and controlled medicines storage was in a secured cabinet. The Manager said she would check that this storage conformed to the latest legal requirements. We spent time watching staff interaction with people living at Barons Park. We saw staff being friendly and caring to people throughout the day to meet the needs of people living at the home except when staff were often seen to tell residents with dementia to sit down when they wandered, even though residents appeared to be fully mobile and able to wander without risk. If they are at risk then this indicates that more staff may be needed on the floor to supervise residents. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are lots of opportunities for people to take part in activities and have a stimulating lifestyle. Evidence: As all residents have dementia/mental health needs so it was not easy to find out residents satisfaction with activities, though one resident said she was satisfied with the current activities. A relative said: The staff often do activities with my mother, which I think is good as people need to be stimulated and not bored. We saw that there are activities, including musical entertainment, reminiscing, beauty therapy, religious services etc. Staff said that they are encouraged by management to do activities with residents and sit down and talk with residents. We saw evidence of this by staff playing cards, doing craft activities, massaging hands and legs and reminiscing by going through photo albums with residents. There are activity plans for residents and an activity questionaire so that relevant activities can be provided. Various activities are displayed on the noticeboards. There are one-to-one activities such as walking around the garden, taking residents outside if they want to go, reminiscing with people, communal activities such as music, dancing, singing, chair Care Homes for Older People Page 15 of 28 Evidence: exercises and games etc. Staff said that some residents visited the day care unit for activities as well. Visitors are welcomed at Barons Park and we were informed by visiting relatives that they could come at any reasonable time and they were always warmly greeted by staff. Relatives said that residents appeared to enjoy the food and this was confirmed by a resident: the food is good here, he said. We observed lunch being served. There was a choice of a hot dinner or alternative. Food was well presented and looked appetising, with good portions being served to each person, with two fresh vegetables served showing a good regard for healthy eating, followed by dessert. The Cook has information displayed in the kitchen giving detail of food preferences and special diets, displaying a regard for the importance of proper nutrition and individual need so that food relevant to residents needs is supplied. There was a displayed menu to provide information to residents. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints and properly followd up and residents protected from abuse. Evidence: Relatives said that they had no complaints but if they did they thought the staff or management would quickly get it sorted out. A relative said, I have every confidence that if I raised anything it would be sorted out. We have only been contacted by one complainant since the last key inspection in February 2007 and the management followed up these issues to deal with the points in the complaint. We saw that there had been no complaints in the past year. One was recorded previously though there was no detail to see how this had been resolved. There was a good complaints procedure though no option to go directly to the lead agency, rather than the home, if the complainant chose to do so.The Provider said these issues would be followed up. We talked to staff to find out how much they knew about protecting people in the home from abuse. Records showed they had received training about safeguarding adults from abuse, and they knew the in house procedure, though not all Agencies to whistle blow to if the in house procedure failed. We looked at the staff recruitment records to see whether all the proper checks had Care Homes for Older People Page 17 of 28 Evidence: been made on staff before they started employment at Barons Park. We found records which showed staff had started work with written references and legal checks in place to help management reach the judgement that people were safe to start employment. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Barons Park live in a homely and well maintained environment. Evidence: All relatives spoken with said that they thought the bedrooms were kept clean and personalised to make them homely: My mothers bedroom is well decorated, we were encouraged to bring in any of her things so she is as comfortable as she can be, one relative said. We saw people at Barons Park living in a clean and well maintained environment. The furnishings in communal areas are homely, and people are encouraged to bring their personal possessions into their bedrooms. We discussed the idea of having an environmental assessment of the home to further assist residents with dementia, e.g. colour coding toilet doors, pictures of residents/favourite scenes on all bedroom doors etc to orientate residents to go to their own bedrooms etc. Management said they would consider this though they had already taken advice from dementia specialists and encorporated signing into the home already. Records show that the home is well maintained, and good measures are in place to Care Homes for Older People Page 19 of 28 Evidence: keep the home hygienic. There were no odours. The Provider said there are radiator covers as needed where residents were assesssed to be at risk of burning themselves. The Provider was asked to review risk assessments again to ensure that residents are fully protected from burn risks. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are met by a well trained and competent staff group. Evidence: All relatives and staff except one said that there were enough staff to meet residents needs regarding personal care. Staff are there as quick as they can be, one relative said. There was one comment that with the number of residents needing close monitoring then sometimes there appeared a shortage of staff. Management did not agree with this comment and said staffing levels are currently sufficient to meet the needs of residents and are regularly reviewed to ensure this is the case. The management stated that most residents needed assistance with their personal care from staff. We spoke with the Manager about the staffing - excluding the Manager there are seven staff (care and nursing staff) on duty in the day in one wing for thirty residents and usually four staff on duty in the other wing for fourteen residents, though this sometimes dropped to three staff for PM periods. The Manager said she thought this met residents needs. Records evidenced that staff had training on essential care practice and that over fifty per cent of staff had attained at least NVQ 2 with a number of staff being enrolled on this course at present. A staff member said that although she had only been working at the home for a year she had been encouraged by management to do the course and Care Homes for Older People Page 21 of 28 Evidence: had already done this and passed it. There is a detailed Company Training Plan and we found that staff have been on a number of training events to help update their practice on areas such as Moving and Handling, Fire Safety, Infection Control and Dementia, and residents conditions such as Stroke, Parkinsons Disease etc. Staff records showed that proper checks had been carried out to protect residents from unsuitable staff. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management maintain a high quality of life for people at Barons Park. Evidence: Janet Stanley is the registered manager of the home. Janet is a Registered Nurse and has completed the accredited management training. She has been updating the staff with training, and this was confirmed by the staff spoken with. Staff said that they were well supported by management. Satisfaction questionnaires were sent around the home last year and completed by relatives, which were seen to be very positive. They contained an analysis of the results to see if improvements in the service were needed. Written records regarding finances are not needed for residents as the Manager stated that no monies are handled by the home - relatives/representatives deal with these. There was evidence of relatives meetings discussing relevant issues though this did Care Homes for Older People Page 23 of 28 Evidence: not always include all relevant ongoing issues - e.g. staff, activities, food etc, which would then show that relatives are involved in the running of the home for the benefit of residents. Staff informed us that they were able to tell management of the problems they were facing and there were regular meetings to support them. There was no evidence of ongoing one to one staff supervision to further help support staff, though there is an appraisal system for new staff to ensure they have the appropriate skills to deliver good care to residents. Proper fire records were in place though the Manager was asked to carry out unannounced fire drills to properly test staff. A kitchen door was propped open and had no closure device, unlike other fire doors, which could have impaired fire safety. Management said that this issue would be followed up. Staff were asked re the fire drill and they knew what to do. There was a Health and Safety folder with Risk Assessments. The Manager was asked to do review the Risk Assessments on radiators which do not have covers on them to ensure residents are protected from burns. Hot water testing is regular and temperatures above the National Standard are highlighted so that hot water can be turned down to approx 43c - the National Standard, to protect residents from scalding. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 3 3 7 8 All care needs of residents need to be detailed in their assessment so that staff are able to meet these needs. Staff need to read all care plans to ensure they fully meet residents needs. If residents appear to be injured following an accident them medical services need to be referred to by staff at the earliest opportunity. Medication always needs to be kept securely to ensure that it is not accessible to residents - this will protect their health. Risk assessments need to be in place so that residents can wander if they are not at risk of falling without staff then needing to instruct them to sit down. The Provider needs to ensure staff know all relevant Agencies to refer to if they suspect abuse has taken place to fully safeguard people living at the home from poor and abusive practice. That staff receive one to one supervision so that support, identification of training needs etc can take place. It is recommended that unannounced fire drills take place Page 26 of 28 4 9 5 10 6 18 7 8 36 38 Care Homes for Older People to test staff (though not with evacuation of residents) and give them a good grounding of what to do if a fire happens. Fire doors need to be kept closed unless they are on approved closures or a thorough risk assessment deems that there is no risk to people in the home. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - 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!