Inspection on 20/11/06 for Barrington Lodge Nursing Home

This inspection was carried out on 20th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Barrington Lodge Nursing Home Cirencester Road Cheltenham Glos GL53 8DS Lead Inspector Mrs Janice Patrick Key Unannounced Inspection 3.50 20 & 21st November 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.V321171.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.V321171.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 (CFCHomes) 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.V321171.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th January 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 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 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. The current fee range is £583.00 to £700.00 (correct as from August 2006). The home does accept residents requiring some form of funding towards their fees. The home makes available information regarding previous inspections in a folder in the main reception area. Barrington Lodge Nursing Home DS0000016382.V321171.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. 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. Prior to the Inspector’s visit pre inspection surveys were sent out by the Commission for Social Care Inspection. 7 were received back from General Practitioners, 23 were received back from relatives and 12 from residents (some received help from relatives to complete these) some of the comments have been included within this report. This unannounced inspection was carried out over two days between 3.50pm and 8pm on the first day and 9.50am and 5.45pm on the second day. Several residents, one relative and staff were spoken with. The Registered Manager was present throughout the inspection process. The care of three residents was inspected in detail and formed a case tracking exercise. The Inspector spoke with each resident and in one case a close relative, inspected their care documentation and visited their private accommodation. Several other examples of care documentation was also inspected. Arrangements for the safe administration of medications were observed and a selection of records inspected. How residents make choices and how their preferences are acknowledged was inspected and included issues of privacy and dignity. Arrangements in place that help to help protect vulnerable adults were discussed and inspected. A general tour of the premises was undertaken and the cleanliness of the home assessed. The number of staff on duty and the levels of supervision afforded to the residents was inspected. A selection of staff personnel and training files were inspected along with other management and health and safety records. What the service does well: This home ensures that all residents’ needs are assessed well prior to an individual’s admission so as to ensure their needs can be met. Safe practice is followed when administering medications and residents are able to self medicate if they are assessed to be safe to do so. Residents enjoy the interaction and activities provided. Barrington Lodge Nursing Home DS0000016382.V321171.R01.S.doc Version 5.2 Page 6 The Manager ensures that robust recruitment processes are kept in place. Staff are well inducted when new to the home. The home holds many different meetings/forums to aid communication between residents/relatives and staff. Good quality assurance systems are in place, used very much as a working tool in order to improve care & services. The home is always run in a manner that aims to keep residents safe. What has improved since the last inspection? What they could do better: The valuable information within the Statement of Purpose and Service User Guide could be made more obvious to those visiting the home. Some additional information pertaining to financial entitlements now needs to be passed onto those concerned. The menus in the main lounge are very informative, but need to be at a height that an elderly person can read them. There is a need to ensure that all staff on duty at any given time have adequate communication skills/experience to interpret and in some situations, pre-empt what the needs of the residents are. This would probably solve some of the relatives’ anxieties and help avoid some of the ‘clumsy’ interactions that are being perceived as staff ‘not having time’ and ‘not listening’. A staff presence in the main lounge would ensure residents are adequately supervised, but again would improve some of the communication problems in the home. Barrington Lodge Nursing Home DS0000016382.V321171.R01.S.doc Version 5.2 Page 7 Improvements to some of the main systems in the home and its environment need to take place. The company is aware of this and work has begun and will continue in the New Year. 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.V321171.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.V321171.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Standards inspected include 1, 2, 3, 4, 5 & 6 The home provides information for the visitor to the home and for those trying to make a decision about their future care at the home, however this would be more helpful if it were more obvious within home. Financial information is clear and easy to understand, some further arrangements are now required to ensure all persons are receiving the information they should have. Residents are only admitted once staff are aware of their needs and are sure these can be met. Staff are provided with training to obtain the skills they require to meet the needs of the residents, however basic communication shortfalls maybe causing basic needs not to be fully understood. Barrington Lodge Nursing Home DS0000016382.V321171.R01.S.doc Version 5.2 Page 10 Visitors are welcome at any time in order to spend time with residents or view the facilities. EVIDENCE: There is information for residents and visitors, such as the Statement of Purpose and Service User Guide but as you enter the home this wealth of information is not obvious. Consideration should be given to raising its profile and adding other useful information, of which ideas were explored during this inspection. On a visitors initial visit to the home some of the above information is given along with the home’s brochure. The Service User Guide is placed within each bedroom in a file called ‘Useful Information’. This was seen in some bedrooms; in others it was thought that residents or their families had placed them in their cupboards. None of the residents spoken to could remember this information, but this was felt to be either due to their frail health or because their relatives dealt with this for them. In this home the majority of residents have their families or a representative dealing with their monies and payment of fees. Each appropriate person receives a statement stating the amount payable. For those residents self-funding the Registered Nurse Care Contribution (RNCC) or commonly called ‘free nursing contribution’ was seen indicated on the invoice as a reduction. It is now necessary however for those who receive funding from a local authority to be aware of what the RNCC amount is within the funded amount. The company is at present deciding how best to give this information without causing confusion. Residents are only admitted following an assessment of their needs. The Manager usually visits the resident prior to admission. If this is not practicable to do then as much information as possible is sought. This would include an assessment of needs by the funding authority if appropriate. During this inspection a new resident was transferring from a hospital to the home for convalescence. It was not possible for staff from the home to assess her earlier so this was carried out on the morning of the admission. Following admission in the afternoon every effort was made to help the resident settle. The resident herself said ‘they have been popping in and out all afternoon making sure I am OK’ ‘ I have been made to feel very welcome’. Another resident could remember the Manager coming to assess him in hospital. The relevant documentation to this assessment was inspected. Existing qualified staff in the home have appropriate skills to meet the residents’ needs as do the care staff. Where a member of staff is new there are Barrington Lodge Nursing Home DS0000016382.V321171.R01.S.doc Version 5.2 Page 11 adequate arrangements in place to provide basic skills. If specific skills are required staff are provided with training. Some basic shortfalls in the delivery of individualised care were discussed as these had been raised within relative and resident surveys and are possibly thought to be due to communication difficulties that some staff maybe having and their interpretation of what the residents’ needs are. Although several overseas staff are provided with English Language tuition, the Manager is aware of some problems and will explore this further. The ‘Gold Standard’ palliative pathway initiative was also discussed and maybe a way for the home to improve further its ‘End of Life’ care. Visitors are able to visit as they choose, one visitor spoken to confirmed that she usually visits in the evenings, another said he visits two or three times a week. Several residents said they receive regular visitors. This home does not provide designated rehabilitation care. Barrington Lodge Nursing Home DS0000016382.V321171.R01.S.doc Version 5.2 Page 12 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Standards inspected were 7, 8, 9 & 10 Written care plans are in place however, they are often not personalised and in some cases are not reflecting the actual situation for the resident. The home does utilise the skills of external health care professionals/experts to help meet the health needs of the residents. Medication is administered in a way that is safe and meets with good practice. Residents’ privacy is upheld but interaction between staff and resident could improve in order to help the resident feel valued and respected. EVIDENCE: The care planning of three residents was inspected in detail along with a selection from other residents’ files. One of the three residents above was spoken to; he was very repetitive and confused at times, however he looked relaxed and was interacting well with Barrington Lodge Nursing Home DS0000016382.V321171.R01.S.doc Version 5.2 Page 13 staff. When asked if he liked where he was he said ‘they couldn’t be better’ pointing to the staff ‘love it here’. On talking with one of the qualified nurses who cares for him both during the daytime and at night, she was able to describe his needs very well. On reading the written care plans however, these did not reflect this individualised knowledge. The care documentation did demonstrate that his next of kin had made a health decision on his behalf and that the staff had adhered to this. Health and safety related needs such as problems with walking were well documented and risk assessed. Another resident’s care plans were very detailed in the clinical sense as she required a lot of nursing and personal care, but again were not overly individualised. This resident was unable to speak but was able to indicate in other ways that she was following what the Inspector was asking. Nurses said that they are able to come to some simple agreements with this resident when they are caring for her purely by knowing her ways of communication. A close relative of this resident had insisted that she be involved in a care plan review every six months. The third resident had care plans which covered some of her needs but again on speaking in detail with her, about what she can achieve for herself and what she says she has problems with, the care plans were not ‘person centred’ and missed out on a lot of this information. The company are aware through auditing that care planning needs to be more ‘person centred’. This home is not alone and has recently received documentation from BUPA on the first steps of an initiative being taken to help staff write more accurate and individualised care plans. A requirement in this area has not been made as the shortfall has already been identified and the company have put arrangements in place in order to improve this. There are many other records/assessments within the residents’ care files that are kept well. External healthcare professionals/specialists are involved in various aspects of residents’ health care and visit the home regularly. The home also has a visiting Chiropodist. The home’s medication system was not inspected in detail on this occasion as the provider has in place arrangements for regular auditing of the system. The administration of some medications however was observed with safe practice seen to be in use. The medication administration records (MAR) for all three residents case tracked were inspected. Residents were spoken to about how they feel staff preserve their dignity and privacy. One resident was able to confirm that during bathing although staff keep the door shut, they tend to speak over him and this makes an already disliked process even worse. Barrington Lodge Nursing Home DS0000016382.V321171.R01.S.doc Version 5.2 Page 14 Another resident said that care staff are very good and help her wash in a manner that does not make her feel embarrassed. Residents were spoken to in a polite manner during this inspection, although one resident said that staff can be impatient or a little abrupt when busy. This was also a comment raised within a couple of pre inspection surveys. One carer who had responded to a call bell was very busy at the time; the verbal response to the resident was rushed and the recipient could have felt that she had been a nuisance. These findings were discussed with the Manager who felt that the staff are well meaning but felt the problems maybe around basic communication skills. Barrington Lodge Nursing Home DS0000016382.V321171.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Standards inspected were 12, 13, 14 & 15 Residents are supported to make choices on a daily basis and to be included in social and recreational events if they want to be. Arrangements are in place to include and notify relatives/visitors of events and management decisions within the home. The food being provided is generally enjoyed by the residents, but care must be taken to ensure that those requiring alternative diets receive them. EVIDENCE: During this inspection planned works on the lift were taking place. This means that many residents are not able to leave their bedrooms for a three-four week period. All residents or in some cases their representatives, were informed. This obviously has had an impact on their ability to make choices on a daily basis. The work is unavoidable and the home is trying to help residents through a restrictive time. Barrington Lodge Nursing Home DS0000016382.V321171.R01.S.doc Version 5.2 Page 16 The activities co-ordinator explained that she is trying to visit each resident on a daily basis if they cannot get to the communal lounge. Some she just chats with, others like her to read and for some she is leaving something for them to do each day. She explained that one lady still wanted to be involved in making a soft toy for Christmas so she has been left with the materials to do this and has a visit from the activities co-ordinator every so often to see how she is getting on. One resident said she is not particularly enjoying staying in her room, but realised the lift has to be mended. ‘It has broken down so many times it has to be mended’. Another resident who was able to get to the lounge said ‘I have to get out and get fresh air’. She confirmed that usually someone will take her for a walk around the garden or she goes up to the shop with the activities co-ordinator. Another resident was playing cards on a special frame that held them in place. He said ‘I have to be doing something’. The more frail and confused residents who were not able to get to the communal areas were being seen by a carer every half hour in order to receive some interaction, but also to ensure their safety (staff have been asked to record this as being carried out by the Manager, records were seen). One relative explained that the activities co-ordinator makes every effort to include her relative in activities even though she is unable to move much or communicate verbally. Forthcoming events are advertised in the home’s newsletter. Holy Communion is held monthly. One resident who is Roman Catholic goes out to church. She was not sure if she was going to be able to continue doing this as she found it very tiring on the last visit. The Manager explained that arrangements would be made for a priest to visit her if that were the case. The home has a pay phone, but residents have the option of installing their own telephone line if they wish. Residents said they enjoyed the food, although very few could remember that they have two options at lunchtime. Menus for the day are placed on the wall. Consideration should be given to lowering these and making it easier for residents to read as it was noted that one resident was having problems looking up to these whilst discussing them with the Inspector. This resident said that the hot pot at lunchtime had been very tasty. The Inspector noted in one resident’s care plan that a soft diet was needed, this was also written on the kitchen diet board, however this is not what was served hence very little was eaten. It was noted that the staffs’ knowledge about available supper options was poor until the Inspector ascertained what these were. The dining room tables were attractively laid and the food on each tray going to bedrooms was covered. Barrington Lodge Nursing Home DS0000016382.V321171.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Standards inspected were 16 & 18 There are arrangements in place, which ensure that each complaint is dealt with appropriately and that any required action is taken. Staff do receive training on adult protection, however the overall arrangements could be more robust. EVIDENCE: The home has a complaints policy and procedure, which is prominently placed on the hall wall. It is also referred to within the ‘Information Pack’. The majority of relative surveys received back indicated that visitors were aware of the complaints procedure. BUPA audit complaints robustly and keep a record of their responses and the action taken. The home’s pre inspection information indicates that two complaints had been received since the last inspection. The outcome of each was discussed during this inspection and records were being held on both. One relative said she has raised several concerns, which were very specific to her loved ones care. These were discussed with the relative and Manager. Each concern had been individually responded to by the Manager, of which evidence was seen within the care file. Barrington Lodge Nursing Home DS0000016382.V321171.R01.S.doc Version 5.2 Page 18 BUPA has a policy with written procedures on Elderly Abuse & Adult Protection. The company has not reviewed this since 2003. Since this policy/procedure was written action on elderly abuse has become far more prominent and robust and the advice to staff within the procedure requires a review. This is currently being carried out; therefore a requirement has not been given. Some ‘in house training on abuse issues has been given to some staff, consideration should be given to senior staff attending the enhanced ‘alerters training’ being held by the county’s Adult Protection Team in order to broaden knowledge and to be aware of the countywide perspective. Barrington Lodge Nursing Home DS0000016382.V321171.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Standards inspected were 19, 20, 24, 25 & 26 The home has a rolling programme of major refurbishment for both communal and private accommodation, which will help to enhance the environment of the home and make it a more safe, clean and pleasant place to live. EVIDENCE: The home has purchased new equipment and some furniture since the last inspection. This includes a large moving and handling hoist with several sizes of slings. There have been new pieces of equipment for the kitchen, which includes a hot trolley. Eight electric beds have been purchased and some pressure relief mattresses. Seven bedrooms have received new sets of furniture. Several bedrooms have been recently re-carpeted except those done already in the last 12 months. Barrington Lodge Nursing Home DS0000016382.V321171.R01.S.doc Version 5.2 Page 20 The lift was having planned works carried out on it at the time of this inspection and was due to be out of action until early/mid December. Some works on the main heating boilers had commenced, but this will recommence when the weather gets warmer next year. The Registered Manager explained that major refurbishment is due to start early next year and should all be completed within six to eight weeks. This has been long overdue, delayed by failed planning applications, which have now been abandoned. The main lounge, which was refurbished this year and is the only communal area apart from the dining room, is spacious and overlooks the garden. Individual bedrooms vary in size and to what degree they have been personalised. All are furnished appropriately and a rolling plan of refurbishment is slowly replacing the furniture in each room. Bedrooms due total refurbishment next are those in the original house. The home was warm, well lit and ventilated during this visit. Health and safety checks and servicing is regularly carried out on the main utilities and windows have restricted openings. The home appeared clean and arrangements are in place to ensure good infection control is practiced. It was observed that alcohol gel was available for staff use in between hand washing. Plastic aprons and gloves are readily supplied. Barrington Lodge Nursing Home DS0000016382.V321171.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Standards inspected were 27, 28, 29 & 30 Residents are not being supervised or having their needs fully met in the evenings. A review of how staff are deployed at this time of day needs to be undertaken to ensure this is rectified. Although care is delivered by staff who have received basic training the home is making arrangements to improve the numbers of staff who hold a national recognised qualification in care, so that residents will benefit from being cared for by staff who have a good degree of underpinned knowledge. Robust recruitment processes help to protect vulnerable residents. New staff receive support and guidance in order to carry out their jobs competently. EVIDENCE: Although this outcome has been assessed as adequate shortfalls around the supervision of residents in the main lounge during the evening must be rectified to ensure their needs are met and to maintain their safety. The timing of this inspection visit incorporated the evening time in order to ascertain if residents were being adequately supervised in the main lounge, Barrington Lodge Nursing Home DS0000016382.V321171.R01.S.doc Version 5.2 Page 22 however this was not possible as the work on the lift had begun and very few residents were able to get to the lounge. These concerns were however discussed. The Manager is confident that the staffing numbers are adequate. How the staff are deployed during this time was also discussed. The Manager was going to explore this further following this inspection and ensure residents in the lounge area in the evening receive adequate supervision and help. There are no plans to increase the numbers of staff during the time of the lift being out of action as the home has purposely not filled some of its vacancies for this period of time and was therefore reduced in number. However some call bells were taking in excess of 5 minutes to answer and staff said that the needs of the residents were high. Three residents spoken to said they have to wait for sometime for staff to arrive after they have pressed the call bell. One said ‘ I just get up myself after a while, that’s my problem I am OK once I am up’ another said ‘I now try to avoid using it’. Staffing levels in this home has been raised as a concern by the Inspector before and has always been thought by the Manager to be adequate. Either way it continues to be raised as a problem by residents/relatives and requires a review by BUPA. As discussed in this report it may well be ‘how’ staff are deployed. It was noted that one of the residents, requiring half hour checks due to the lift being out of action, rang her bell and this was answered immediately. The home’s percentage of staff holding the National Vocational Qualification (NVQ) is low at present due to several staff changes. BUPA has its own arrangements for training staff in this qualification but the system is slow in getting staff started. Currently three staff hold the qualification at Level 2. Two staff on night duty are in the process of completing the training and another four are waiting to be allocated an assessor. The staff recruitment process is robust and personnel files for four staff were inspected. All contained the required criteria. New staff complete initial induction training in basic skills and then start work at the home in a supervised capacity. They continue with the induction process until assessed to be competent. Records of this training are held within each staff file including that of additional trainings. Barrington Lodge Nursing Home DS0000016382.V321171.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards inspected were 31, 32, 33, 35, 36 & 38. The home is managed by a competent person who is able to communicate effectively with residents and staff. Arrangements are in place to identify improvements that need to be made to care practice or the service as a whole. Records of residents’ pocket monies are organised and well managed. Staff usually receive adequate supervision, there is a need for some groups of staff to catch up in this. Arrangements are in place to keep residents safe. Barrington Lodge Nursing Home DS0000016382.V321171.R01.S.doc Version 5.2 Page 24 EVIDENCE: The Manager has managed this home for several years; she is registered with the Commission and holds the Registered Managers Award. Apart from keeping herself updated in basic mandatory trainings she regularly attends management meetings and training sessions within BUPA. Currently there is not a Deputy Manager, however some of the qualified nurses are taking a particular lead within the home. This helps with auditing medications; care plans and helps to co-ordinate training. Regular meetings are held within the staff group, the minutes of the last nurses meeting were available to staff who did not attend. Relatives meetings are also held on a regular basis where general information is passed on and general topics can be discussed. 85 of relatives turned up for the last meeting held in October. The Manager explained that she prefers not to discuss specific problems at this meeting but that relatives/residents can always discuss these with her afterwards. One relative confirmed that she does not find this easy to do. The home complies with BUPA’s quality assurance system, which includes sending out satisfaction surveys to residents or their relatives and an ongoing audit system. The latter is a working document with action plans and dates by which an area of practice or service must be improved. An example seen referred to falls. The Manager noted that not enough information was always being completed on the accident form and had asked for this to be done. An audit has also been carried out on the activities provided and an outcome of this is that a care plan will be devised for each resident, recording what they can manage to do, what they enjoy and how much support they need to achieve this. Residents’ pocket monies are not physically held, but ‘in house’ accounts are held on computer. Any expenditure is entered and an appropriate amount of interest is added. The home administrator is aware of those that hold Power of Attorney. One resident said that she felt it would be a good idea for the home to run a mobile shop, she had done this as a volunteer in a care home before needing care herself ‘it would be very useful for little things you always forget to ask your family for’. Records show that care staff are receiving supervision sessions on care practices. Supervision sessions for kitchen and housekeeping were behind, but these have been carried out regularly in the past and the Inspector has no reason not to think these will catch up. Barrington Lodge Nursing Home DS0000016382.V321171.R01.S.doc Version 5.2 Page 25 Many health and safety checks are carried out of which records were seen. Recent reviews have been carried out on infection control practices and the policy to ensure ‘best practice’ is being applied. The supplying company recently delivered an update training to care staff in the Control of Substances Hazardous to Health (COSHH); housekeeping staff are also due an update. Fire training for all staff is ongoing. Accidents and incidents are reported appropriately within the home and to external agencies. Currently 10 staff have a First Aid Certificate. Barrington Lodge Nursing Home DS0000016382.V321171.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 3 2 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 X X X 3 3 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 4 X 3 3 X 3 Barrington Lodge Nursing Home DS0000016382.V321171.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 OP2 Regulation 5B(b&c) Requirement The Registered Manager must, irrespective of how a residents fees are being met inform each existing resident as to whether a nursing contribution is paid in respect of nursing being provided to him/her at the home. The Registered Manager shall ensure that the care home is conducted so as to make proper provision for the health and welfare of the residents (this is with particular reference to staff being able to understand and interpret the residents’ needs, where English may not be their first language). The Registered Persons shall in relation to the conduct of the home maintain good personal and professional relationships with each other and with residents (this is in relation to how staff are interacting with residents at specific times. These have been highlighted in this report). The Registered Manager shall DS0000016382.V321171.R01.S.doc Timescale for action 31/01/07 2. OP4 18(1)(a) 31/01/07 3. OP10 12(5)(a) 31/01/07 4. OP27 12(1)(b) 18/12/06 Page 28 Barrington Lodge Nursing Home Version 5.2 ensure that the care home is conducted so as to make proper provision for the care and, where appropriate, treatment, education and supervision of residents (this is with reference to the supervision of resident in the main lounge during the last afternoon/early evening). RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP1 OP15 OP18 Good Practice Recommendations The information within the reception area needs to be made more obvious to those entering the home. The menus displayed in the lounge area should be lowered in height on the wall. Someone from the home should attend the ‘enhanced alerters’ training and cascade information back to other staff in the home. Barrington Lodge Nursing Home DS0000016382.V321171.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. 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