Inspection on 29/06/05 for Barrington Lodge Nursing Home

This inspection was carried out on 29th June 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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 19/01/06

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 Janice Patrick Unannounced 29 June 2005 16:50hrs The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Barrington Lodge Nursing Home D51_D03_s16382_Barrington Lodge_V218632_290605_Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Barrington Lodge Nursing Home Address Cirencester Road Cheltenham Glos GL53 8DS 01242 263434 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) BUPA Care Homes Limited Mrs Tracy Gardner Care Home with Nursing 46 Category(ies) of Old Age not falling within any other category registration, with number (46) of places Barrington Lodge Nursing Home D51_D03_s16382_Barrington Lodge_V218632_290605_Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 20 December 2004 Brief Description of the Service: This Home is situated in a residential area outside of Cheltenham main town. It is on a main bus route and close to local shops. It is a large house that has been extended many times and which sits in its own extensive garden. There is ample parking to the front of the Home making easy access for wheelchair users and level walk ways within the garden itself. The Home predominantly offers general nursing care and is staffed by qualified nurses, 24hours of the day. The Home liases with many external health care professionals including several GP Surgeries. Barrington Lodge Nursing Home D51_D03_s16382_Barrington Lodge_V218632_290605_Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One Inspector carried out this inspection between the hours of 4.50pm and 9.30pm. The Registered Manager was present for the first half of the inspection and gave a comprehensive update on events since the last inspection in December 2004. Several bedrooms and all communal areas were visited. Four residents were spoken to including several members of staff, which included a representative from the night staff. Requirements from the previous report were discussed. A requirement to improve the general fabric of the building and its layout is still outstanding due to ongoing problems obtaining planning permission. Documentation pertaining to Advocacy, Power of Attorney and care were read. The duty rotas were also seen. What the service does well: What has improved since the last inspection? The standard of soft furnishings in the large lounge have vastly improved, with new linings to the curtains, new armchairs, cushions and new televisions. A lack of storage within the Home for wheelchairs, hoists and walking aids has, in the past, resulted in the lounge area being cluttered. Thought has been given to this problem resulting in the lounge looking tidy and spacious on this visit. Various floorings have been replaced and include the kitchen. Barrington Lodge Nursing Home D51_D03_s16382_Barrington Lodge_V218632_290605_Stage 4.doc Version 1.40 Page 6 Panes of glass have been replaced in several bedrooms thus eliminating an opaque mist that had formed within the glass. Ten bedrooms have been fitted with new sets of furniture. Staff retention has improved and the Home enjoys continuity of its staffing at present. 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 D51_D03_s16382_Barrington Lodge_V218632_290605_Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Barrington Lodge Nursing Home D51_D03_s16382_Barrington Lodge_V218632_290605_Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 There is adequate information provided to help prospective service users make an informed decision about the Home, both prior to admission and during the initial trial period. EVIDENCE: The Statement of Purpose document remains in the reception area. This is available at all times and can be read by service users, relatives and visitors. It contains a vast amount of information about Barrington Lodge and includes an explanation of some of BUPA’s key policies and procedures. More information aimed specifically at the service user once admitted, is within each bedroom in the form of the ‘Welcome Pack’. This is effectively the Home’s Service User Guide. Also within the reception area is a mixture of other information all aimed to help and guide those living in the Home and their family. There is advice and information on advocacy, power of attorney, burial arrangements and finances. Barrington Lodge Nursing Home D51_D03_s16382_Barrington Lodge_V218632_290605_Stage 4.doc Version 1.40 Page 9 A recent addition to the Statement of Purpose is an updated version of the Advocacy Policy. This includes a more in-depth look at the power of attorney process, agents and appointees, the court of protection and guardianship. The administrator was observed talking to a relative on some of these subjects and another relative has agreed to give a talk during one of the relatives meetings in the near future, on the power of attorney process. Barrington Lodge Nursing Home D51_D03_s16382_Barrington Lodge_V218632_290605_Stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 & 10 Care plans give staff clear direction in the care that is to be delivered and reflect the needs of the service user, but also recognise the need to uphold the service user’s privacy and dignity. EVIDENCE: Each care plan is audited for the quality of its written content, its relevance and frequency of review. The auditing is successfully highlighting areas such as dates missing, out of date reviews, out of date care plans as well as any poorly written care plans. The system is also helping staff to ensure that the care records are complete and comprehensive. In one particular case the auditing had highlighted that the care documentation had omitted to take into account a recognised history of falls. This had still not been assessed and care planned at this inspection. There is not a lot of evidence within the care plans to suggest that service users and/or relatives have been involved in the care planning process. The Inspector is aware that the Manager has held care review meetings with some relatives. This has allowed for a more in-depth discussion about the care being given and has usually taken place when relatives have had concerns or there has been a deterioration in the condition of a loved one. Barrington Lodge Nursing Home D51_D03_s16382_Barrington Lodge_V218632_290605_Stage 4.doc Version 1.40 Page 11 Service users’ right to privacy and dignity is strongly supported in this Home and is reiterated within the Home’s policies and procedures and is part of staff training. Two service users confirmed that their privacy is always maintained and were able to confirm that they observe other service users being cared for appropriately. Several service users, during this inspection voiced a dislike of the way they are spoken to. This seemed to be very specific and has been discussed separately with the Manager and the Operations Manager for the Home. The Inspector was not of the opinion that this was a widespread problem and subsequent discussions with the Operations Manager has shown that this is no longer an ongoing problem. Barrington Lodge Nursing Home D51_D03_s16382_Barrington Lodge_V218632_290605_Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 & 13 Within the limitations that are enforced by their health and through recognising that it is communal living, service users are able to make choices and see their friends and family as they wish. EVIDENCE: All service users confirmed that they are able to spend their day as they choose. Service users’ preferences varied in areas such as being part of an activity or not, remaining in ones own room or not, having a set routine daily or not and where they chose to eat their meals. Two service users spoke about the activities within the Home and how they had been encouraged to voice their preferences. The activities co-ordinator is obviously popular and liked. One service user was looking forward to the garden party coming up soon and over the years had the same set job on the day. Another service user particularly enjoyed music and although physically frail, was seen listening to this through a set of headphones in the lounge. One service user talked about how important it had been to come to this particular care home as it enabled her to remain part of a circle of friends she had had for forty years. This weekly get together now takes place within the nursing home so she can participate. Barrington Lodge Nursing Home D51_D03_s16382_Barrington Lodge_V218632_290605_Stage 4.doc Version 1.40 Page 13 Several had enjoyed a recent trip to Prinknash Abbey. Barrington Lodge Nursing Home D51_D03_s16382_Barrington Lodge_V218632_290605_Stage 4.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 There is enough information on how to make a complaint and enough choices in whom to talk to, which should enable service users and their families to feel confident about making a complaint. EVIDENCE: There is information about complaints and concerns both in the Statement of Purpose and the Welcome Pack. The complaints procedure is on display and offers a choice in who can be contacted. The address of the Commission for Social Care Inspection (CSCI) is also present. The Manager has had one complaint since the last inspection that has been recorded appropriately. BUPA have a robust Complaints Policy and it is an area that is regularly audited by the company. Barrington Lodge Nursing Home D51_D03_s16382_Barrington Lodge_V218632_290605_Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20, 22, 23 & 24 Although the layout of the environment has been recognised as not being ideal, service users are happy with the private and communal accommodation. Individual needs are assessed and adequate and appropriate equipment and space is provided. EVIDENCE: There was a definite improvement in the presentation of the communal lounge. New armchairs and televisions had been bought and the storage of wheelchairs and hoists had been located elsewhere. This allowed for a clear thoroughfare and a more domestic feel in the room. This room remains the one and only large communal lounge, which staff have arranged in such a way, maximising the space available and offering segregated areas for different uses. Ten bedrooms had complete new sets of furniture. Bedrooms varied from looking very ‘homely’ because service users had a lot of their own belongings in them, to those not so personalised. All rooms are furnished however, to the minimum standard. Because of the inherited layout of the building bedrooms vary in size and some are bigger Barrington Lodge Nursing Home D51_D03_s16382_Barrington Lodge_V218632_290605_Stage 4.doc Version 1.40 Page 16 than others. The management team do however, keep aware of the space required to nurse some individuals. This was demonstrated in the case of one service user who required all care. The room was large enough to accommodate the required equipment and a four way profiling bed with a pressure-relieving mattress, was in use. Another example demonstrated that thought had gone into the layout of the room. Furniture was placed according to how the occupant moved around their room. Through careful planning the service user was able to access every part of their bedroom despite their limitations. One part of the Home is only practical for service users who are confidently mobile and this is taken into consideration when these rooms are let. BUPA are fully aware that sluice facilities and improved bathing facilities are required long-term. Although these have been required in previous reports their requirement has not been repeated in this report, as it is not considered that this is detrimental to service users’ health. Barrington Lodge Nursing Home D51_D03_s16382_Barrington Lodge_V218632_290605_Stage 4.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 30 Residents are benefiting from being cared for by a familiar group of staff who are either fully competent to do their job or who are being trained and supervised well. However, the ratio of staff compared to the service users’ needs do not appear to be balanced. EVIDENCE: The high turn over of staff that the Home has been suffering from since Christmas has slowed down and no agency staff have been required since March. Nurses from overseas are receiving support such as English classes, and are settling in well. There have also been new recruits in other departments such as the kitchen and housekeeping. A member of staff who was relatively new at the last inspection and who has required a high level of support, said they were very happy and was seen to be carrying out their tasks well. Two other nurses were spoken to; one was in charge of the Home during the last half of the inspection. She handed over the day’s events to the night nurse in a way that demonstrated that she had a good knowledge of the condition of each service user on that day. The Manager felt that the Home was staffed adequately. Other members of staff said it can be very extremely busy and that extra staff, at particular times of the day would be of benefit. Barrington Lodge Nursing Home D51_D03_s16382_Barrington Lodge_V218632_290605_Stage 4.doc Version 1.40 Page 18 All the service users spoken to volunteered comments about the length of time it took for their call bells to be answered and in two cases, said that sometimes they give up and get to the toilet or off their bed independently despite being advised to wait for staff. In one case a member of staff who came into a resident’s bedroom for a different reason, did not acknowledge the call bell. This was reported to the Manager. Barrington Lodge Nursing Home D51_D03_s16382_Barrington Lodge_V218632_290605_Stage 4.doc Version 1.40 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32 & 36 The Registered Manager manages the Home according to BUPA’s Policies and Procedures and communicates well with her Deputy who has very clear views on the high standard of care she expects within the Home. EVIDENCE: There are clear lines of accountability and responsibility in this Home. The Deputy Manager under the guidance of the Registered Manager is very much in charge of care delivery and expects high standards from her staff. All staff, residents and relatives are aware of this very high expectation and staff are made aware when this is not met. The Deputy Manager is extremely keen that staff train well and that they are supervised well. Staff confirmed that she is ‘very hands on’ and communicates with them throughout the shift. One member of staff said ‘she likes it done in a certain way and that’s how it is’. This style of management appears to be difficult for some staff. Barrington Lodge Nursing Home D51_D03_s16382_Barrington Lodge_V218632_290605_Stage 4.doc Version 1.40 Page 20 Heads of Departments meet weekly with the Registered Manager and communicate within their own teams. Resident and relative meetings are held regularly, of which the minutes of the last one were on display in reception. The views of those that do not wish to or prefer not to attend a large meeting are sought on an informal basis over coffee or on a one to one basis. On the day of this inspection the Registered Manager was preparing for her Management review meeting the next day, with her Line Manager. A staff member who had been very keen to commence care for sometime, but had to wait until she was 18years was spoken to. She explained that she was still within her first week of induction training and was under the supervision of another more senior carer. She was thoroughly enjoying the work. Supervision for this new carer was also seen as planned on the duty rota ensuring consistent mentorship. Barrington Lodge Nursing Home D51_D03_s16382_Barrington Lodge_V218632_290605_Stage 4.doc Version 1.40 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x COMPLAINTS AND PROTECTION x 2 x 3 3 3 x x STAFFING Standard No Score 27 2 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x 3 x x x 3 x x Barrington Lodge Nursing Home D51_D03_s16382_Barrington Lodge_V218632_290605_Stage 4.doc Version 1.40 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15(1) Requirement The service user or their representative must be consulted in the planning of their care. The staffing levels must reflect the needs of the service users at all times. Timescale for action 1st December 2005 1st December 2005 2. 3. 27 18 (1)(a) 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 15 Good Practice Recommendations There should be able to demonstrate whether the service user or their representative were involved in the care planning process. Refusal to participate, should also be recorded if appropriate. Barrington Lodge Nursing Home D51_D03_s16382_Barrington Lodge_V218632_290605_Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection 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 D51_D03_s16382_Barrington Lodge_V218632_290605_Stage 4.doc Version 1.40 Page 24 - 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. 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