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Inspection on 16/06/05 for Barrock Court Nursing Home

Also see our care home review for Barrock Court Nursing Home for more information

This inspection was carried out on 16th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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.

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

What the care home does well

The residents said that they liked living in the home and that they felt well cared for. The meals continue to be very good and the kitchen staff were very knowledgeable about the dietary needs of specific residents. An alternative meal to the main choice on the menu was available. There was clear evidence within their care plans and social profiles that residents were asked about their preferences and specific likes and dislikes. Positive comments were received about the staff and the way that they cared for the residents.

What has improved since the last inspection?

A new en suite has been fitted in the room that used to be the respite room. This means that all the bedrooms now have an en suite facility. Two new bedroom carpets have been fitted and eight new beds provided. Training has been accessed and staff have shown an interest in attending the courses. This included the NVQ Level 2 in care award and an in depth Infection Control Course. The Registered Manager has nearly completed the Registered Managers Award.

What the care home could do better:

Staffing levels continue to cause concern, as although there had been a successful recruitment exercise, this did not provide any extra bank staff that could be called upon at short notice. Staff worked extra shifts during sickness and holidays. However, the normal staffing levels are deemed to be insufficient. One resident said that there was "not enough staff to do what you want them to do." Similar comments were heard throughout the day. The standard of cleanliness, hygiene, and tidiness is very poor and although the home did not smell it was very untidy, dirty in places and did not provide a comfortable and homely feel to the place. Trip hazards were seen as well as inappropriate storage of chemicals, equipment, and medical and nutritional products.

CARE HOMES FOR OLDER PEOPLE Barrock Court Nursing Home Barrock Park Low Hesket Carlisle Cumbria CA4 0JS Lead Inspector Lorraine Frost Unannounced 16 June 2005 09:15 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. Barrock Court Nursing Home F58-F10 s38773 barrock court v224757 160605 ui stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Barrock Court Nursing Home Address Barrock Park Low Hesket Carlisle Cumbria CA4 0JS 016974 73765 016974 73865 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) Ancyra Health Limited Roseanne Fearon Care Home 28 Category(ies) of Old age, not falling within any other category, registration, with number Physical disability of places Barrock Court Nursing Home F58-F10 s38773 barrock court v224757 160605 ui stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 2. Ten people in the category OP (10 (OP)) 3. Eighteen people in the category PD (18 (PD)) Date of last inspection 25.02.2005 Brief Description of the Service: Barrock Court was purpose built and is near Low Heskett at the end of a long driveway with fields and trees surrounding it. The home has its own internal courtyard that service users are able to enjoy in warmer weather. The building is on one level, divided into three units. These units accommodate service users of varying levels of dependency and each unit has its own lounge and dining room. The registration certificate states that up to 10 service users over the age of 65 years may be accommodated and 18 service users with a physical disability may be accommodated. This does not accurately reflect the situation at Barrock Court and is being dealt with between CSCI and Ancyra Health Limited. Barrock Court Nursing Home F58-F10 s38773 barrock court v224757 160605 ui stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and started at 09.15. Mr Ian Rundle (Regulation Manager) accompanied the Lead inspector. The inspection process included a tour of the building, talking with staff, residents, and visitors. The files of newly appointed staff were checked, as were the files of a number of randomly selected residents. Other relevant documents were also read. The inspection concluded at 14.55 hours. The Registered Manager assisted throughout and the inspector took the opportunity to meet the new Operations Manager. What the service does well: What has improved since the last inspection? A new en suite has been fitted in the room that used to be the respite room. This means that all the bedrooms now have an en suite facility. Two new bedroom carpets have been fitted and eight new beds provided. Training has been accessed and staff have shown an interest in attending the courses. This included the NVQ Level 2 in care award and an in depth Infection Control Course. The Registered Manager has nearly completed the Registered Managers Award. Barrock Court Nursing Home F58-F10 s38773 barrock court v224757 160605 ui stage 4.doc Version 1.30 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. Barrock Court Nursing Home F58-F10 s38773 barrock court v224757 160605 ui stage 4.doc Version 1.30 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 Barrock Court Nursing Home F58-F10 s38773 barrock court v224757 160605 ui stage 4.doc Version 1.30 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) 3 and 5 Residents’ benefit from having a pre admission assessment carried out which identifies potential and actual needs of the person prior to a decision being made to move to Barrock Court. Visits to the home prior to admission are encouraged to enable the resident and their family to make an informed decision about the suitability of the home. EVIDENCE: Residents and visitors confirmed that the manager had visited them prior to a decision being made to move to Barrock Court and they said that this had included being asked questions about their needs. The manager confirmed that she had re-visited someone whose discharge had been delayed to reintroduce herself, and to briefly reassess the person. The manager confirmed that residents could visit prior to admission and that a trial period would be offered. Barrock Court Nursing Home F58-F10 s38773 barrock court v224757 160605 ui stage 4.doc Version 1.30 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 standard(s) 7, 8, 9, and 10. Although documentation has continued to improve, inadequate care plans and risk assessments cannot guarantee that all residents needs can be met. Residents’ health care needs were being identified and action taken to ensure that their needs were met. The medication administration practices were very poor putting residents at risk of not receiving their medication as prescribed. Staff attended to residents in a way that respected their privacy and dignity. EVIDENCE: Four resident files were checked. The files of established residents were in much better order than the one checked for a new resident. This file contained very little information to assist staff to care for the resident or any specific risks that they ought to be aware of. Consent for the use of bedrails was not in place and the brief moving and handling assessment did not explain when staff would choose one way of working over another. The other files were up to date, had been reviewed, and were individualised. There was evidence of resident involvement in the occupational therapy assessment. Medication was not being administered as prescribed. Staff gave medication at times other than that stated on the medication chart and the first medication Barrock Court Nursing Home F58-F10 s38773 barrock court v224757 160605 ui stage 4.doc Version 1.30 Page 10 round took two hours to complete. It was said that there was a constant “catch up” happening with medication. A medication audit trail could not be completed for one resident because there was no record of the amount of medication bought into the home. There were no incidents witnessed whereby the privacy and dignity of residents was not respected. Residents were spoken to appropriately and care was carried out discreetly. Barrock Court Nursing Home F58-F10 s38773 barrock court v224757 160605 ui stage 4.doc Version 1.30 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 standard(s) 12, 13, 14, and 15. The social aspect of life at Barrock Court is poor, leaving residents feeling that there was nothing to do. However, the open visiting policy enables residents to maintain friendships and relationships that they previously enjoyed. Meals are varied, nutritious, and appetising with special diets catered for ensuring that residents enjoy a well balanced diet. EVIDENCE: Residents said that they didn’t see much of the staff because they were always too busy to be able to spend time with them. Residents were left unattended and without social stimulation for long periods of time. The Activities organiser and the Occupational Therapist provided social stimulation and recently it had included taking residents shopping to help buy plants for the courtyard area. Other residents had been very involved in cleaning and tidying the area. When asked, residents said that there wasn’t much to do but that they were very happy at Barrock Court. Visitors confirmed that they could visit at anytime that suited the resident and themselves and that the staff were welcoming. Barrock Court Nursing Home F58-F10 s38773 barrock court v224757 160605 ui stage 4.doc Version 1.30 Page 12 The residents said that the meals were very nice and the cook demonstrated a sound knowledge of individual preferences and specific diets. Alternative meals were provided where appropriate. Residents in bed confirmed that staff did not rush them at mealtimes and that they had help with drinks throughout the day. A supper was provided for those who liked a supper, but not all residents were aware of this. Barrock Court Nursing Home F58-F10 s38773 barrock court v224757 160605 ui stage 4.doc Version 1.30 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 standard(s) 16 The complaints process was not robust enough to promote or encourage people to make their views known and therefore formally facilitate change to benefit residents. EVIDENCE: The complaints process was not complete. Informal complaints were not recorded and so there was no monitoring tool to ensure that complaints had been acted upon or that a satisfactory outcome had been achieved. It was confirmed though that if the manager was approached with a verbal complaint that she would listen and try to address the issue. A complaint was investigated as part of the inspection. This had been a complaint regarding the practices of three named staff in the home. There was no evidence to uphold the complaint, but the manager was made aware of the issues at the end of the inspection. Barrock Court Nursing Home F58-F10 s38773 barrock court v224757 160605 ui stage 4.doc Version 1.30 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 standard(s) 19, 22, 23, 24, 25, and 26. Residents are at risk in an environment that is not clean, tidy, or safe. New specialist equipment was assisting staff to promote good health care and encourage a degree of independence. EVIDENCE: A tour of the home revealed dirty and untidy bedrooms and bathrooms. Beds had been made but some still had dirty linen left on. The en suites and toilets were cluttered and medical and nutritional items were kept in the en suites. There were dead flowers in bedrooms and communal areas, rusted commode seats and rusted raised seats. Some equipment was dirty, fire exits were blocked, and there was a broken bath panel and a trip hazard. The carpet causing the trip hazard was due to be replaced the week following this inspection. The home did not smell unpleasant and new domestic and laundry staff had been appointed which was an improvement. Residents liked their rooms and they had been able to personalise them. Eight new beds had been provided which was benefiting those who needed Barrock Court Nursing Home F58-F10 s38773 barrock court v224757 160605 ui stage 4.doc Version 1.30 Page 15 assistance during the night as well as making it easier for staff to care for those residents who were unwell in bed. Two new carpets had been fitted since the last inspection, but more need to be replaced. Barrock Court Nursing Home F58-F10 s38773 barrock court v224757 160605 ui stage 4.doc Version 1.30 Page 16 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 and 29 Staffing levels do not enable staff to meet all the assessed physical, mental and social care need of all the residents. The procedure for the recruitment and selection of staff was being followed enabling appropriate staff to be appointed who would be suitable for the post offered. EVIDENCE: Throughout the day residents and visitors told the inspectors that there were not enough staff on duty and that they were too busy. The usual staffing levels showed that the Registered Nurse had to be included in a substantial amount of care hours which had caused some of the problems around medication as shown elsewhere. Newly appointed staff had undergone the appropriate checks before starting work and this had increased the number of staff employed to cover domestic duties. Staff covered sickness at short notice and this was proven during this inspection when a member of staff arrived to cover sickness of a colleague. Staff had enrolled on the NVQ level two course and others had commenced an Infection Control course. There had been difficulties in the past accessing training and so it was pleasing to see that staff were keen to attend these courses. Barrock Court Nursing Home F58-F10 s38773 barrock court v224757 160605 ui stage 4.doc Version 1.30 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 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) 38 The safety of staff, residents and visitors to the home was not being protected. EVIDENCE: Unlabelled bottles of cleaning fluid were kept on cleaning trolleys and these were often left unattended. Training has been arranged on the topic of Control of Substances Hazardous to Health. Two fire exits were blocked until the manager cleared them later in the day. There were a number of trip hazards and there was no signage to warn people that the bathroom floor was very wet due to a leak. Storage of some equipment was unsafe and inappropriate. There was easy unauthorised access to prescribed creams and dressings and personal information about residents. Barrock Court Nursing Home F58-F10 s38773 barrock court v224757 160605 ui stage 4.doc Version 1.30 Page 18 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 x x 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 4 COMPLAINTS AND PROTECTION 2 x x 3 3 2 1 1 STAFFING Standard No Score 27 2 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x x x x x x x x 1 Barrock Court Nursing Home F58-F10 s38773 barrock court v224757 160605 ui stage 4.doc Version 1.30 Page 19 NO 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 OP7 Regulation 15.2 Requirement Service user documents must be accurate and up to date at all times. (This requirement had a previous compliance date of 20.03.05). Medication must be given as prescribed. An accurate record must be kept of all medication received and returned. Residents social needs must be met. The complaints procedure must include a formal method of recording, and monitoring all complaints received. The Registered person must ensure that the home is kept clean and ensure that products and equipment are stored appropiately. Rusted commodes and raised toilet seats must be replaced and equipment such as hoists and wheelchairs must be kept clean. The home must be staffed in order to, at all times, meet the needs of the service users. The health, safety and welfare of service users, staff and visitors Timescale for action 20.03.05 2. 3. 4. 5. OP9 OP9 OP12 OP16 13 13 16.2m 22 16.06.05 30.06.05 30.06.05 30.06.05 6. OP19 16 16.06.05 7. OP 25 and OP26 OP27 OP38 16 30.06.05 8. 9. 18 13.4 30.06.05 16.06.05 Page 20 Barrock Court Nursing Home F58-F10 s38773 barrock court v224757 160605 ui stage 4.doc Version 1.30 must be safeguarded at all times. 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 OP31 Good Practice Recommendations The Registered Manager should complete the Registered Managers Award by 2005. Barrock Court Nursing Home F58-F10 s38773 barrock court v224757 160605 ui stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way, Penrith Cumbria, CA11 9BP 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 Barrock Court Nursing Home F58-F10 s38773 barrock court v224757 160605 ui stage 4.doc Version 1.30 Page 22 - 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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