Inspection on 14/01/08 for Barrington Lodge Nursing Home

This inspection was carried out on 14th January 2008.

CSCI found this care home to be providing an Adequate 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.

Other inspections for this house

Barrington Lodge Nursing Home 02/03/09

Barrington Lodge Nursing Home 20/11/06

Barrington Lodge Nursing Home 19/01/06

Barrington Lodge Nursing Home 29/06/05

Barrington Lodge Nursing Home 20/12/04

Barrington Lodge Nursing Home 28/07/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Barrington Lodge Nursing Home Cirencester Road Cheltenham Glos GL53 8DS Lead Inspector Mrs Janice Patrick Key Unannounced Inspection 4.15 14 & 15th January 2008 th 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 Barrington Lodge Nursing Home DS0000016382.V356145.R01.S.doc Version 5.2 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. Barrington Lodge Nursing Home DS0000016382.V356145.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Barrington Lodge Nursing Home Address Cirencester Road Cheltenham Glos GL53 8DS 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) 01242 263434 01242 260731 www.bupa.co.uk BUPA Care Homes (CFC Homes) Ltd Mrs Tracy Imogene Gardner Care Home 46 Category(ies) of Old age, not falling within any other category registration, with number (46) of places Barrington Lodge Nursing Home DS0000016382.V356145.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 10 residential beds for the elderly (Cat I) included within total of 46 nursing beds. To accommodate one named service user aged 57 years of age. Date of last inspection 20th November 2006 Brief Description of the Service: This Home is part of the BUPA Group and is situated on the outskirts of Cheltenham Spa Town. Near to local bus routes and shops, it sits back off the main road with its own private parking and gardens. The Home provides 24hr-nursing care/personal care for those predominantly over the age of 65 years of age. Internal accommodation is offered over numerous floor levels. There is a passenger lift, stair lifts and sloped floors that aid access to these levels. There are a small group of bedrooms that can only be accessed by people that are able to walk, therefore admissions to these rooms is very selective. All bedrooms have ensuite facilities of some sort. Communal rooms are on the ground floor. The current fee range is £750.00 to £900.00 The home does accept authority funded or health funded admissions. The home makes available information regarding previous inspections in a folder in the main reception area. Barrington Lodge Nursing Home DS0000016382.V356145.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. One inspector carried out this unannounced inspection over two days. The first day was between 4.15pm and 9.15pm and the second between 10am and 6.50pm. We (The Commission) sent questionnaires to people living in the home and to relatives to seek their views of the services provided. Thirteen of each questionnaire were returned. Any views and comments received have contributed to this report. As part of the inspection process the care of three people was selected and relevant records were inspected in detail. In addition to this many other related care records and documentation was inspected. Specific areas such privacy and dignity, individuals’ ability to make choices and have their preferences met were looked at. The degree of involvement and control over their care and inclusion in decisions made in the home was also considered. Social and recreational needs were explored along with the arrangements to meet these. The choice and standard of food was inspected. Arrangements for staff training were inspected. Staff recruitment practices were inspected. The general management of the home including all aspects of health and safety practice were explored and records inspected. The systems required to enable a home to identify shortfalls and improve on these were discussed. What the service does well: Peoples care needs are assessed thoroughly before admission. The arrangements for activities within the home are making a real difference to some peoples quality of life. It provides opportunities for staff to receive numerous training sessions, which ultimately benefits those living in the home. Barrington Lodge Nursing Home DS0000016382.V356145.R01.S.doc Version 5.2 Page 6 The company has a robust complaints procedure and makes people aware of this. There are arrangements in place that enable the service to assess its performance and improve on this. The service is very aware of peoples health and safety. What has improved since the last inspection? What they could do better: Ensure that the new care documentation is reviewed and updated appropriately and with particular frequency when people’s needs are potentially altering and deteriorating. Support some staff to be more aware of the impact of their actions on people living in the home. Ensure that all people are given the opportunity to make a choice. Ensure that care staff answer the call bell system at all times within a reasonable time period and without necessarily having to be prompted to do so by senior staff. Ensure that instructions by qualified nurses are appropriately followed. Ensure that all topical creams/ointments are used on the person they are prescribed for. Make sure staff are aware of the items expiry date. Make sure that staff have adequate time and are organised sufficiently to provide individual people with the support they may require at a mealtimes. Barrington Lodge Nursing Home DS0000016382.V356145.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Barrington Lodge Nursing Home DS0000016382.V356145.R01.S.doc Version 5.2 Page 8 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 Barrington Lodge Nursing Home DS0000016382.V356145.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2&3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place for all people to receive relevant information, including that pertaining to financial responsibilities and to have their needs assessed prior to their admission. EVIDENCE: We made a requirement in the previous inspection for people who were in receipt of a contribution towards their care from a funding authority, to receive a copy of the homes Terms and Conditions. Confirmation was given during this inspection that these have been sent out to the appropriate people. Peoples’ care needs are always assessed prior to admission so that staff can be sure that they are able to meet the individual’s requirements. We saw examples of three pre admission assessments. Two were for people who require long-term care. Barrington Lodge Nursing Home DS0000016382.V356145.R01.S.doc Version 5.2 Page 10 Another person had been in the home for less than a week but was already able to say that the care in this home was much better than the previous care home. This person was also able to confirm that he received all the financial information he required at the beginning of his stay. Barrington Lodge Nursing Home DS0000016382.V356145.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although people living in this home generally have their needs met, shortfalls in assessment and the reviewing of care plans place some people at unnecessary risk by not having important areas of their care monitored. EVIDENCE: The company have introduced new care documentation, which includes a new format for care planning. It encourages assessments and the planning of care to be far more individualised (person centred). We looked in detail at three care files. Two were not being updated appropriately and in the third the nursing information was contradictory and therefore left the reader unsure as to what the situation was. The first contained very personalised care plans, which demonstrates a huge change in how care plans are being written. The content was descriptive and gave clear guidance to staff at times when it can be difficult to deliver care to this person, but care plans had not been reviewed since November 2007. Barrington Lodge Nursing Home DS0000016382.V356145.R01.S.doc Version 5.2 Page 12 It did however demonstrate that the home has involved external, specialist healthcare professionals to help advise and review this person’s health. The relative indicated that they felt that their relative was usually cared for well and that the home informs them of things they need to know. In the second care file, although there were written care plans none of these or the additional assessments that would act as ‘triggers’ for a change in the care planning and care delivery, had been updated since October 2007. This person is at high risk of easily deteriorating due to various health issues particularly a potential to lose weight and develop pressure sores. Although this person’s weight had been recorded in a separate book, because the care plan had not been reviewed since October it was not possible to determine if the plan of care was still appropriate. Our observations at teatime suggest that this person may now require more support. An out of date care plan does not give staff the appropriate guidance in how to care for someone. Because of the shortfalls in both care plans and assessment reviews the person was at increased risk of developing pressure sores. We discussed these shortfalls with the Registered Manager. We were also concerned about the assessment and monitoring of someone else’s skin. This person is also at ‘high risk’ of developing pressure sores. Although an assessment for this was completed and indicated a high risk, it failed to ‘trigger’ the appropriate action. Further records completed about the same time contradicted this assessment making the facts unclear. Although a certain type of pressure relief mattress was in place, none of the qualified nurses on duty knew the actual state of this person’s skin. When we pointed this out action was taken immediately to ascertain the facts. The company have recognised the need to integrate new guidance and legislation into their care that relates to the Mental Capacity Act 2005 and have already trained one person to take this forward. The outcome for one person having a bath at the time of this inspection was not satisfactory and we discussed this with the Registered Manager. It has to be reported that most of the comments received from people living in the home and their relatives about the care that was being provided, were positive. Three nurses over the course of this inspection were observed administering medication. On each occasion this was done safely and with good practices being adhered to. Since the last inspection the medication system has altered offering more protection from potential mistakes. BUPA’s Policy for Medications and Administration has been reviewed and is extremely comprehensive. Medication Administration Records (MAR) sheets were inspected and were seen to be completed properly. There were shortfalls’ relating to creams however: Barrington Lodge Nursing Home DS0000016382.V356145.R01.S.doc Version 5.2 Page 13 A cream prescribed for one person was found in someone else’s bedroom. Apart from the legalities of a prescribed item being used for someone else, this is poor infection control practice. • Two open tubes of prescribed cream were in a person’s bedroom, with instructions not to be used 3 months after opening. There was not date of opening on either. • Two further creams were seen in bedrooms with the area of the label where the name should be, torn off. There was no care plan giving guidance for staff in the case of one person’s diabetes. The Registered Manager was going to investigate these points. We did not observe any situation that compromised peoples’ privacy, although some of the shortfalls discussed in this outcome and the next would question whether peoples’ dignity is always being maintained. One specific comment received in a survey said: ‘the home could improve by instructing some carers, to treat residents with more respect’. During this inspection one of the elderly people who lived in the home died. We visited this person on one of the numerous care visits made by the staff. All her needs were being attended to. Community Nurses were helping to administer specialised medication and the General Practitioner (GP) had visited on a regular basis. The relative’s questionnaire, which was returned to us before this inspection said: ‘nursing care superb’ that staff were ‘caring and helpful, supportive to relatives at difficult times’ and were sensitive and mindful of their relative’s time in life’. The new care planning system allows for ‘end of life’ care planning and for difficult information such as funeral arrangements and particular wishes to be discussed and recorded at an appropriate time. Some of the qualified staff have received additional training in the care of the dying and related pain control. A visiting healthcare professional confirmed that the Primary Healthcare Trust (PCT) had confidence in the staff to care for people who are in the last few weeks of their lives and will quite often refer people to the home for this type of care. • Barrington Lodge Nursing Home DS0000016382.V356145.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements for social and recreational opportunities are generally good as are opportunities to make daily choices, however staff maybe compromising the ability of more dependant people to make choices by presuming they know what the person’s preference might be. EVIDENCE: Since the last inspection in November 2006 a new activities co-ordinator has been employed. This person is very much liked by the people who live in the home; one person said ‘she is my life line’. Another said ‘she is always jolly and gives me hope’. One person told us that he had been planning regular dates to go out with the activities co-ordinator in order to get some fresh air. He said that to be able to do this was very important to him. Another person was getting ready to pay his weekly visit to the local library, where he enjoys using the computer and reference section. Another person described the activities person as her friend and someone who goes for a walk with her. Barrington Lodge Nursing Home DS0000016382.V356145.R01.S.doc Version 5.2 Page 15 The activities co-ordinator explained that this particular person is prone to walking around the home a lot on her own, so she makes a point of walking with her 3 or 4 times a day and having a chat. Several group activities and one to one activities take place, but people who wish to remain in their bedrooms have a visit if they want one. One person said he was not interested in the activities and was quite content with his own company. There were several positive comments within the surveys returned to us regarding the provision of activities within the home. Although several able people were observed to be making choices we did not observe many choices being made by those who are less able and who are in wheelchairs. We felt that there was a degree of compliance occurring and ‘fitting in’ with the homes routine. The Registered Manager specifically explained to us that certain options are given but on observing staff this was not the case. The Registered Manager felt that this could be because the staff know individuals’ preferences well and were probably automatically doing what they felt the person would prefer. An example of where choice maybe being compromised through staff meaning well, but practicing in an institutional way was seen in the lounge after tea. One of the televisions has been moved from one area in the lounge. This decision was taken in order to make a designated space for activities. The Registered Manager explained that people were asked about this and that no one had an objection. It has been recognised by staff that some people like to sit in a specific chair. The Registered Manager explained that staff always ask if they would like to watch the television after tea and that if they wish to they will take them down to the television. Five people were seen taken from the dining room into the lounge area in their wheelchairs and none were offered the choice. They were sitting in their wheelchairs in a row with small tables placed in front of them. We asked staff why they remain in wheelchairs. One member of staff explained that the ones that go to bed with the day staff, stay in their wheelchairs after tea. These people were taken to bed between 7pm and 7.30pm. We asked one person if she was comfortable in her wheelchair and she said ‘I don’t complain, they’re all very good’. Advocacy services are advertised and the Registered Manager has also considered that one person in the home may benefit from this kind of support. We observed lunchtime and teatime in the dining room and lounge area. The tables in the dining room were attractively laid. The menu for each day is on the wall at its entrance; at a height that people can read. Each day there is a choice plus alternatives. Special diets are accommodated. Most comments received back about the food were positive indicating that people seemed to enjoy what was being provided. One person knew that she could have a drink or a snack at anytime of the day, which is what BUPA’s ‘Lite bites’ aim to provide. Barrington Lodge Nursing Home DS0000016382.V356145.R01.S.doc Version 5.2 Page 16 Barrington Lodge Nursing Home DS0000016382.V356145.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Those living in the home and their representatives benefit from the company having robust arrangements in place for investigating complaints and recognising the need to protect vulnerable people from abuse. EVIDENCE: The company have a complaints policy with procedures that are clearly displayed on the notice board. The homes complaint file was inspected and five complaints have been received since the last inspection. The first of these relates to a situation of ongoing dissatisfaction expressed by a family over a long period of time. In order to ensure a proportionate and fair investigation, this is now being carried out by one of BUPA’s external senior managers. The second relates to areas of an individual’s very specific care. The third is in connection with the moving of the televisions in the communal rooms. The fourth relates to inadequate heating in one room, which was easily resolved and areas of care. The fifth was from an external healthcare professional that we (The Commission) were made aware of at the time, this was not taken any further. There was evidence to show that all the above have been responded to and that BUPA’s complaint procedure was and is being followed. Barrington Lodge Nursing Home DS0000016382.V356145.R01.S.doc Version 5.2 Page 18 Eight out of thirteen people living in the home indicated within their questionnaire that they knew how to make a complaint and whom to speak to if they were unhappy about something. Eleven out of thirteen relatives confirmed that they were aware of the complaint procedure. The training co-ordinator confirmed that staff have been made aware of the issues surrounding elderly abuse. Records also indicated that the majority have received training on this. However, on talking to one member of staff who would be responsible for taking some kind of action if an allegation was reported, had very limited knowledge of what to do. This was discussed with the Registered Manager who will ensure that anyone who has missed the training or is not sure of the procedures to take receives this training as soon as possible. BUPA revised its Safeguarding Adults Policy in 2007, which now offers clearer guidelines to staff. The Registered Manager is planning to attend one of the ‘enhanced’ training days on this subject provided by the county’s Safeguarding Adults Team. Barrington Lodge Nursing Home DS0000016382.V356145.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s environment, which is kept clean, has been improved upon to try and make it more ‘user friendly’ and enjoyable for those living there. EVIDENCE: There has been a huge improvement in the general environment since the last inspection. All bedrooms, the reception area and all communal rooms have had new carpets and soft furnishings. Most areas have been decorated except a few corridors, which the maintenance person has an ongoing plan for. All bedrooms looked comfortable and many had height adjusting beds. One person said he was asked to move out of his room while it was decorated. He confirmed that he had no say in the décor chosen; he said he personally would not have chosen the colour scheme but it did not really bother him. He said: ‘I’m just glad to be in here really, the colour of the wall is a minor detail’. Barrington Lodge Nursing Home DS0000016382.V356145.R01.S.doc Version 5.2 Page 20 Another person said she was very happy with her room. The maintenance of the property is managed by BUPA’s Estates Team and dealt with on a day-to-day basis by the home maintenance person. Required work is obviously well planned and records are kept relating to health and safety checks. The heating boilers were changed during the refurbishment and now provide a more reliable source of heating. There have been considerable problems with the lift with many breakdowns recorded in 2007. Relatives did acknowledge this in their comments to us. Considering the large number of breakdowns and the adverse impact that this clearly had on people over a considerable length of time, we feel the company has not been as transparent as it could have been in its notification of these issues to us. However, management of the situation within the home has included several meetings with relatives and those living in the home in order to keep them up to date with the progress. Many thousands of pounds have already been spent on its repair and a certificate for insurance purposes has still not been issued as further work is required and planned for within 2008. Several pieces of specialised equipment were seen within the home. These included specialised beds, pressure relieving mattresses and cushions, bath hoists and general moving and handling equipment. During this inspection a specialist nurse from the Primary Healthcare Trust was carrying out reassessments of people using some of this specialised equipment to ensure the correct equipment was in place. There were many comments both from relatives and people who live in the home about how clean it is kept. There were no offensive odours, which is something a visitor commented on during this inspection. Several staff completed infection control training in the past but further training is planned in 2008. We observed staff wearing tabards when serving food. Additional equipment is available such as plastic aprons, gloves and alcohol based hand gel, which also helps promote good infection control. Barrington Lodge Nursing Home DS0000016382.V356145.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Those living in the home benefit from robust staff recruitment and training arrangements, which help protect vulnerable people. However, there is a shortfall in how some peoples’ needs are being met and this may be down to a lack of staff or lack of adequate staff direction. EVIDENCE: The Registered Manager said that the home is staffed adequately. Certainly there did appear to be several staff on duty on the first afternoon of the inspection. There were four care staff, two qualified nurses and the Deputy Manager on duty. On the second day in the morning there were six care staff, three nurses and the Deputy Manager. However, there were dates on the duty roster where staff numbers had been below this. There are several pieces of evidence that may suggest there are insufficient staff to meet the needs of those living in the home or that the deployment practices/routines need reviewing. Observed shortfalls and additional comments relating to staffing are as follows: • We observed staff at teatime being extremely busy and one person not getting the support they required. • On the first evening just after teatime two call bells remained ringing for quite sometime and we commented on this. The Registered Manager answered one and told a member of staff to answer the other. Barrington Lodge Nursing Home DS0000016382.V356145.R01.S.doc Version 5.2 Page 22 • • People were left in their wheelchairs after tea because staff said: ‘they are put to bed by the day staff, we will take them to bed in one to one and half hours’. On the second day it took nine minutes for a call bell to be answered. Relative and resident survey comments include: • ‘They are short of staff at times’ • ‘When I use my call bell I would like someone to answer asp and even if they have heard me it would be a help knowing they will come’ • ‘I think they need more staff as the home looks deserted at times’ • ‘More regular checking of my relative as I have found her in wet clothes as her incontinence pad has not been changed’. • ‘I have a small concern about the difficulty in finding staff on a Sat/Sun evening (? Staffing levels), tendency for staff to take breaks together’. • ‘The home could improve by making sure that nurses/carers are in the residents lounge at all times-this isn’t always the case, particularly the late afternoon period’. • ‘They try their best but I do have to wait quite sometime on occasions when I use my bell’. In this report we have asked the Registered Manager to reconsider if there are enough staff on duty and to also examine the homes routines. It is BUPA’s expectation that care staff complete the National Vocational Qualification (NVQ) in Care. Four staff members already hold this and four are due to complete by the end of this month. Four more staff will then commence the award. We inspected the records of two staff members in order to ascertain whether good recruitment practices were in place. Before employment potential staff have to provide two satisfactory references, be able to explain any gaps in employment, be cleared by the Criminal Records Bureau (CRB) and be cleared against the list for the Protection of Vulnerable Adults (POVA). All relevant criteria within the Care Home Regulations 2001 had been met. Once employed all staff complete ‘induction training’. This covers all mandatory practices such as fire safety, safe moving and handling, health and safety awareness, food hygiene and awareness of abuse issues. Records to this effect were seen and one new member of staff confirmed that his induction had been very good and that he had had a period of being additional to the numbers on duty. The home has a training co-ordinator who plans and provides some ‘in house training’, the record of which was seen. This demonstrated that some staff have also received distance learning in dementia awareness and infection control. The Care Home Support Team from the Primary Healthcare Trust (PCT) are involved in the home and are used as a resource for advice. The home will also Barrington Lodge Nursing Home DS0000016382.V356145.R01.S.doc Version 5.2 Page 23 benefit from external training being supplied through the Partnerships for Older People Projects (POPPS). We did comment that it was important that one member of staff receive training on a certain subject as soon as possible and not have to wait until that subject was due to be provided again within the rolling programme. This is sometimes seen in fire safety updates also. Night staff had not had a recent fire drill. Barrington Lodge Nursing Home DS0000016382.V356145.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed in a proactive way in order to safeguard those living there and improve upon the services available. EVIDENCE: The current Manager of the home is registered with the Commission for Social Care Inspection (CSCI) and is a Registered Nurse. She has also completed the Registered Managers Award and is an experienced person in the field of elderly care. The Registered Manager now has a Deputy Manager to support her and there are various heads of departments. The homes Quality Assurance System covers all the main services within the home and BUPA are very proactive in planning to improve standards and identifying shortfalls. Each member of staff Barrington Lodge Nursing Home DS0000016382.V356145.R01.S.doc Version 5.2 Page 25 is responsible for this and there are various internal schemes that foster ownership and loyalty. We also receive, as part of this process a monthly report following an unannounced visit to the home by an outside BUPA Manager. This complies with Regulation 26 of the Care Homes Regulations 2001. Arrangements regarding the safe keeping of people’s personal monies have not altered since the last inspection. The home does not hold separate amounts for security reasons but all have the opportunity to open an ‘in house’ account and small amounts of money can be accessed which in turn is deducted from a separate ‘residents monies account’. Invoices for hairdressing and chiropody are issued separately. Records were not inspected on this occasion as BUPA had recently carried out an audit of the whole system. Various health and safety audits are carried out on a regular basis. Records of these were inspected. These include checks on the hot water temperatures in order to keep the hot water within a safe range, checks on all emergency lighting, visual and contractual maintenance for all moving and handling equipment and the same on all equipment and additional areas relating to fire safety. We noted that the visual checking of all fire exits, escape routes and equipment had been increased to a daily check. This is a decision taken by BUPA. Specific risks for individuals are assessed and a plan of action put in place to help reduce these. We are also aware that the company have arranged for further maintenance work to be carried out on the lift by an external contractor. Barrington Lodge Nursing Home DS0000016382.V356145.R01.S.doc Version 5.2 Page 26 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 X 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X X 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Barrington Lodge Nursing Home DS0000016382.V356145.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 15(2b) Requirement The Registered Manager must ensure that staff keep service users’ care plans appropriately reviewed. The Registered Manager must ensure that proper provision is made for the care, treatment and supervision of service users where it is assessed as required. This is with particular regard to pressure sore assessment & care and nutritional support. The Registered Manager must ensure that prescribed creams and ointments are only used on the person they have been prescribed for and that staff are aware of the expiry date of each product. The Registered Manager must ensure all staff practice in a manner that upholds service users dignity at all times. The Registered Manager must ensure that staff take into account the feelings and wishes of service users who are dependent on staff for their care and welfare. DS0000016382.V356145.R01.S.doc Timescale for action 01/03/08 2 OP8 12(1b) 01/03/08 3 OP9 13(2) 01/03/08 4 OP10 12(4a) 01/03/08 5 OP12 12(3) 01/03/08 Barrington Lodge Nursing Home Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP18 Good Practice Recommendations Someone from the home should attend the ‘enhanced level Adult Protection’ training and cascade information back to other staff in the home. Staffing numbers and how staff are deployed and directed should be reviewed to ensure there are sufficient on duty to meet the needs of the service users at any given time and to explore why call bells are not being answered promptly at all times. 2 OP27 Barrington Lodge Nursing Home DS0000016382.V356145.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Barrington Lodge Nursing Home DS0000016382.V356145.R01.S.doc Version 5.2 Page 30 - 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!