Inspection on 19/01/06 for Barrington Lodge Nursing Home

This inspection was carried out on 19th January 2006.

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

Barrington Lodge Nursing Home 02/03/09

Barrington Lodge Nursing Home 14/01/08

Barrington Lodge Nursing Home 20/11/06

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Barrington Lodge Nursing Home Cirencester Road Cheltenham Glos GL53 8DS Lead Inspector Mrs Janice Patrick Unannounced Inspection 10:20 19 January 2006 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.V269823.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Barrington Lodge Nursing Home DS0000016382.V269823.R01.S.doc Version 5.0 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 BUPA Care Homes Limited 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.V269823.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 10 residential beds for the elderly (Cat I) included within total of 46 nursing beds. 29/06/05 Date of last inspection 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. Internal accommodation is offered over numerous floor levels due to the Home having been extended several times over the years. There are two shaft lifts, stair lifts and sloped floors that aid access to these levels. There are a small group of bedrooms that can only be accessed by residents that are able to walk, therefore admissions to these rooms is very selective. There are 37 bedrooms in total all of which have ensuite facilities of some sort. Communal rooms are on the ground floor and offer separate dining space. The Home provides 24hr-nursing care for those requiring this and has good working relationships with external health care professionals. Barrington Lodge Nursing Home DS0000016382.V269823.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by one inspector between the hours of 10.20am and 2pm. The Registered Manager and her newly appointed Deputy were on duty as were other staff, all very open and helpful with the inspection process. Several residents and staff were spoken with and their views and opinions explored. Various documentation and records were examined, these included staff recruitment files, staff training records, residents’ pre admission assessments, medication records and records pertaining to residents’ personal monies. The Inspector visited several floor levels in the Home but a tour of the entire building was not planned for this visit. What the service does well: What has improved since the last inspection? There was a noticeable difference in the atmosphere within the Home. This was relaxed and professional. The Home is experiencing some consistency in its staffing at present and staff that are in key positions are supportive of the staff group as a whole and are working in a cohesive manner. The organisation of the pre assessment process has improved. Continuous and constructive monitoring and supervision of the care and nursing within the Home is resulting in residents feeling well cared for. The Home has been awarded a further Spa Award from the Environmental Health Officer in recognition of the high standards of food and kitchen hygiene within the Home. Barrington Lodge Nursing Home DS0000016382.V269823.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Barrington Lodge Nursing Home DS0000016382.V269823.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Barrington Lodge Nursing Home DS0000016382.V269823.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The assessment process used ensures that staff are aware of the resident’s needs prior to their admission and helps these needs to be met once the resident has been admitted. EVIDENCE: Pre admission assessments for three new residents were seen at this inspection, all met with the criteria laid down in the National Minimum Standards. Two assessments had been completed by the Manager when visiting the residents outside of the Home and the third, by the Deputy Manager during a visit to Barrington Lodge by the resident herself. Both the pre admission assessment and initial enquiry form are forwarded to the nurse’s office so that any preparation required for the admission can be organised. Barrington Lodge Nursing Home DS0000016382.V269823.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 8&9 Residents’ health needs are met and the processes in place for medication administration ensure that residents are protected against poor practice. EVIDENCE: Several examples were discussed where residents are receiving visits or reviews from external health care professionals. Regular communication with the Continuing Health Care Nurse enables the staff to provide up to date care and equipment for the resident. In another example, the Home’s staff are working alongside the Macmillan Services to ensure a resident has the best care possible. Two residents who are dependent on Percutaneous Endoscopic Gastrostomy (PEG) feeding, receive regular reviews from the dietician. The Community Nurse comes into the Home to apply four layer bandages to a another resident’s legs for the treatment of leg ulcers and is teaching one of the Home’s own nurses to do this. The Inspector observed some of the lunchtime medications being administered. A trained nurse followed basic principles of good practice and Barrington Lodge Nursing Home DS0000016382.V269823.R01.S.doc Version 5.0 Page 10 administered the medication safely. The storage trolleys were organised and clean and the medication records were completed appropriately. Two minor short falls were noted and reported to the Deputy Manager. These included no date of opening on eye drops and several pictures of residents, used to aid identification were missing. The Inspector was informed that these have been taken and would be placed in the folder after this inspection. The Manager had received an updated company Medication Policy, which needed to be placed in the Policy File and it was recommended that an up to date British National Formulary (BNF) be sourced as the two seen were nearly 2 years old. The Home’s supplying pharmacy has a licence, which is now required to take surplus stock away from the Home. Barrington Lodge Nursing Home DS0000016382.V269823.R01.S.doc Version 5.0 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 the following standard(s): 14 & 15 Although many residents are very dependant on the staff for their daily needs, the culture of the Home is to actively encourage residents to make choices and to have some control in their lives. The meals in the Home are good offering both choice and variety and catering for special dietary needs. EVIDENCE: The Inspector spoke with several residents during lunch and after and many confirmed that they are able to make choices on a daily basis. The activities co-ordinator explained it is the residents who choose what it is they want to do, she may offer ideas. One gentleman enjoys being the caller for House Bingo; another resident chooses not to be involved. One resident still likes to smoke and is helped to do this. One married couple prefer still to manage their own finances. One resident confirmed that if food is served that she does not like, an alternative is always available. She also explained that this does not happen often as the cook is aware of her dislikes and cooks around these. Another lady said she is served food that is soft or minced to help her manage her food. Barrington Lodge Nursing Home DS0000016382.V269823.R01.S.doc Version 5.0 Page 12 The Inspector observed several residents being given close supervision at lunchtime; others were fed in a manner that preserved their dignity. One carer in particular was extremely patient with a resident and this was passed onto her during the inspection. Barrington Lodge Nursing Home DS0000016382.V269823.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The Home’s robust Policies and Procedures help to protect residents from harm or abuse, although ensuring that staff receive up dated training in Adult Protection and Elderly Abuse will help reinforce this. EVIDENCE: BUPA’s insistence that all Policies and Procedures are adhered to helps protect the vulnerable residents within the Home. A designated Policy for Adult Protection reinforces this. A culture of zero tolerance towards residents is filtered down through the staff group. Residents spoken to confirmed that staff were very kind and they felt quite safe within the Home. Two new members of staff had evidence within their staff file showing they had completed Abuse training within their previous BUPA Home, but for others it has been some time since they received dedicated training on this subject. The Manager has tried to access this training locally but had been informed that new training and guidance was being implemented for the County. The Inspector explained that this is to be launched in April of this year. The reasons behind the Whistle Blowing Policy and the Protection of Vulnerable Adults (POVA) list was reiterated with the staff meeting held on the day of this inspection. Barrington Lodge Nursing Home DS0000016382.V269823.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Although the layout of the Home is not ideal it is well maintained and clean, providing residents with a pleasant environment to live in. EVIDENCE: The Inspector saw different levels of the Home during the Inspection. Several bedrooms were inspected and all areas seen were clean and free of offensive odours. The lounge area, that has looked very tired and cluttered in the past looked inviting and tidy. The dining room was laid attractively for lunch with coordinating tablecloths and napkins. The laundry was inspected and was found as usual to be organised and clean. The Inspector noted that all staff wore plastic aprons when serving food and those actually dishing the food out, wore plastic gloves. Barrington Lodge Nursing Home DS0000016382.V269823.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 29 & 30 Good recruitment practice leads onto a well-inducted and trained workforce, which is able to provide the residents with the standard of care they require to meet their needs fully and safely. EVIDENCE: Due to a lot of staff movement in 2005 the Home is below its required 50 of NVQ trained staff, only two part-time staff hold the NVQ Award in Care at the present time. However, three commenced the Award in November 2005 and five or six are due to commence in March of this year. All staff, even those transferred from other BUPA Homes, partake in a very structured induction training. As well as this staff are expected to keep their skills well updated. All staff receive structured supervision and are appraised to help identify deficiencies in this area. The company’s system called ‘Personal Best’ is constantly asking staff to reflect and review their practice and performance. Five staff files were inspected and all contained the appropriate criteria to demonstrate that good recruitment practices were in place. Only one minor shortfall was noted, that of two character references as opposed to one of these being from the individual’s last employer. This was to be followed up after this inspection. Barrington Lodge Nursing Home DS0000016382.V269823.R01.S.doc Version 5.0 Page 16 Barrington Lodge Nursing Home DS0000016382.V269823.R01.S.doc Version 5.0 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 & 35 Processes in place ensure that the Manager constantly evaluates the effectiveness of her management and the care and services, which are provided to the residents. Robust Policies and Procedures again ensure that residents can feel reassured that their financial interests are safe guarded. EVIDENCE: The Manager has managed the Home for four years, is a Registered Nurse and is registered with the CSCI. She has completed the Registered Manager’s Award and keeps herself updated in relevant areas. An internal applicant has been successful in being offered the post of Deputy Manager and has just begun in this role. Barrington Lodge Nursing Home DS0000016382.V269823.R01.S.doc Version 5.0 Page 18 The Home adheres to the BUPA Quality Assurance System, which is linked to the initiative called ‘Personal Best’. This constantly demands that care practices are improved and that this is done in conjunction with consultation with residents/relatives and other visitors to the Home. The last Relatives Forum was held in December 2005. A residents’ survey to ascertain their views on various services within the Home is shortly due. The system for ensuring that residents’ private monies are protected was inspected. The new administrator for the Home was introduced to the Inspector. The electronic system used for recording monies used by the residents was behind. However, receipts demonstrated that two items had been purchased for a resident; the signature of the carer accompanied this transaction. The administrator had a good understanding of whom she would allow money to be given to and who had Power of Attorney. The arrangements for Power of Attorney for a newly admitted resident were seen documented within her file. One resident prefers to still manage his own financial affairs and organise payment of his care fees, but many residents have family support to do this. During this inspection the Manager and Deputy Manager were asked to review with staff if any bedroom doors were being wedged open. This was in response to a recent fire in a care home attended by the Inspector. The Manager reiterated this in the staff meeting at the time of this inspection and will be ordering some automatic closures for some bedroom doors. This is where the resident does not like their door closed. Further health and safety practices within the Home were not specifically inspected on this occasion. Barrington Lodge Nursing Home DS0000016382.V269823.R01.S.doc Version 5.0 Page 19 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 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 2 3 x x x x x x x STAFFING Standard No Score 27 x 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 4 x 3 x x X Barrington Lodge Nursing Home DS0000016382.V269823.R01.S.doc Version 5.0 Page 20 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 OP9 Regulation 13(2) Requirement The Registered Manager must ensure that each resident has an updated photograph that can be used for identification on drug administration. The Registered Manager must ensure that all staff are updated in Adult Protection and Elderly Abuse. The Registered Manager must ensure that a reference is obtained from an individual’s last employer or a reason why they left that employment if the job was with vulnerable adults or children. Timescale for action 28/02/06 2 OP18 13(6) 28/02/06 3 OP29 19 28/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations Eye drops should be dated on opening and an up to date BNF should be provided for staff reference. DS0000016382.V269823.R01.S.doc Version 5.0 Page 21 Barrington Lodge Nursing Home Barrington Lodge Nursing Home DS0000016382.V269823.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Barrington Lodge Nursing Home DS0000016382.V269823.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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