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Inspection on 17/09/08 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 17th September 2008.

CSCI found this care home to be providing an Poor service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

Barrock Court provided good written information to people interested in using their service. Admission arrangements were good, and helped new people settle in quickly. The staff maintained good relationships with outside health and social care agencies, so people were able to receive specialist input and advice as needed. People living in the home felt well looked after and said the staff were very `kind and helpful`. A high number of care staff had gained, or were working towards a National Vocational Qualification in care. The home was clean and comfortable, and most people had made their bedrooms very personal.

What has improved since the last inspection?

The manager was unable to tell us in the AQAA what improvements had been made in the home over the last year, stating that she was new in post. A subsequent letter told us that some decoration had taken place in the last year. At the time of the inspection, workmen were on site fitting new water pipes and undertaking work on the boiler to improve the provision of hot water. We did not find any areas where the service had improved.

What the care home could do better:

The service fails to meet the National Minimum Standards and Care Home Regulations in a number of areas. Statutory requirements are made on the following: Care plans must be kept updated to accurately reflect people`s personal and health care needs, to ensure people receive the care and support they need. Medicines must be handled safely and records for administration must be accurate and clear to protect people from errors. Medicines must be administered in the prescribed dosage. Staff must be properly trained and competent in the handling of medication to keep people safe. People must be consulted on, and provided with appropriate activities and occupation to prevent boredom. People must be enabled to voice their concerns or complaints about the service if they wish, and to know they will be listened to. Staff must be trained in safeguarding procedures and understand their role in protecting people. New staff must not start working in the home until all recruitment checks have been competed. There must be a staff training plan that includes induction, foundation and ongoing training, relevant to the needs of the people receiving care. The service must have a manager who is registered with the commission. There must be effective quality monitoring processed in place to ensure the service is operating to the expected standards, and this should include the views of people receiving the service. Hot water temperatures must be controlled to within acceptable limits and exposed hot water pipes must be covered. Potentially dangerous items, such as work tools, must be safely stored away from access by unauthorised persons.The service has slipped in a number of key areas and the provider will be asked to provide us with an improvement plan. The plan should explain what they are going to do to meet our requirements and improve the service. Good practice recommendations are made on the following: People should be consulted about their care plan and about who can have access to their information. Care plans for "when required" medicines should contain clear instructions so that people receive safe, effective and appropriate treatment. Regular audits of medication should be done to monitor the management of medicines. People should be consulted on the menus and there should be a choice at each mealtime. Staff dealing with food, should be trained in food safety. Staff should be supervised on a regular basis to ensure they are working to the homes policies and procedures and to identify any training needs. Communal areas of the home should be kept clear of equipment and there should be better signage to help people find their way around. General maintenance and repairs should be dealt with more promptly to ensure all services are in good working order. Consideration should be given to making it easier for people in wheelchairs to navigate in and out of the home. Lighting should be improved so people can see properly.

CARE HOMES FOR OLDER PEOPLE Barrock Court Nursing Home Barrock Park Low Hesket Carlisle Cumbria CA4 0JS Lead Inspector Jenny Donnelly Unannounced Inspection 17th and 25th September 2008 09:15 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 Barrock Court Nursing Home DS0000038773.V371712.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. Barrock Court Nursing Home DS0000038773.V371712.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Barrock Court Nursing Home Address Barrock Park Low Hesket Carlisle Cumbria CA4 0JS 016974 73765 016974 73865 manager.barrockcourt@aermid.com 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) Aermid Health Care Group Plc vacant Care Home 28 Category(ies) of Dementia (1), Mental disorder, excluding registration, with number learning disability or dementia (2), Old age, not of places falling within any other category (28), Physical disability (5) Barrock Court Nursing Home DS0000038773.V371712.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The home is registered for a maximum of 28 service users to include: up to 28 service users in the category of OP (Old age, not falling within any other category) up to 5 service users in the category of PD (Physical disability under 65 years of age) 1 named service user in the category of DE (Dementia under 65 years of age) may be accommodated within the overall number of registered places. 2 named service users in the category of MD (Mental disorder) may be accommodated within the overall number of registered places. Date of last inspection 15th August 2007 Brief Description of the Service: Barrock Court nursing home is purpose built and is situated near Low Heskett at the end of a long driveway with fields and trees surrounding it. The home has its own internal courtyard that people are able to enjoy in warmer weather. The building is on one level, divided into three units. These units accommodate people of varying levels of dependency and each unit has its own lounge and bathing facilities. Aermid Health Care (UK) Ltd, operates the home. The registered manager left in April 2008 to take up another post within the company. The new manager is Mrs Amanda Bechelli. At the time of this key inspection, the weekly fees were advertised as from £511.00 to £651.00 according to the peoples needs. Written information was available in the form of a ‘service users guide pack’. The homes’ latest inspection report was also available in the home. Barrock Court Nursing Home DS0000038773.V371712.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. Barrock Court was last inspected in August 2007 and received a ‘good’ quality rating. We undertook an Annual Service Review in July 2008. This review included gathering written information from the service in a document called an Annual Quality Assurance Assessment (AQAA). The AQAA is a selfassessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. The AQAA we received from Barrock Court was not fully complete and did not give us all the information we required to satisfactorily undertake the review. We had also sent surveys out to some of the people who live in the home and to staff. We received some negative and worrying responses to the surveys. The result of our review was to undertake a full inspection sooner than planned, to see how well the service was meeting people’s needs. Jenny Donnelly inspector, made an unannounced visit to the service on 17th September 2008. During the visit we (the Commission) toured the building, spoke with residents, visitors, staff and the manager. We looked at care, medication, staffing and management records. We saw how people were spending their day, and observed the day’s activities. We were so concerned about how medicines were being managed that we asked the pharmacist inspector to visit. Angela Branch pharmacist inspector visited the home on 25th September 2008, and assessed the handling of medicines. This was done through inspection of relevant documents, storage and meeting with the manager and staff. The pharmacy inspection took five and a quarter hours, and the findings are included in this report. What the service does well: Barrock Court provided good written information to people interested in using their service. Admission arrangements were good, and helped new people settle in quickly. The staff maintained good relationships with outside health and social care agencies, so people were able to receive specialist input and advice as needed. People living in the home felt well looked after and said the staff were very ‘kind and helpful’. A high number of care staff had gained, or were working towards a National Vocational Qualification in care. The home was clean and comfortable, and most people had made their bedrooms very personal. Barrock Court Nursing Home DS0000038773.V371712.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The service fails to meet the National Minimum Standards and Care Home Regulations in a number of areas. Statutory requirements are made on the following: Care plans must be kept updated to accurately reflect people’s personal and health care needs, to ensure people receive the care and support they need. Medicines must be handled safely and records for administration must be accurate and clear to protect people from errors. Medicines must be administered in the prescribed dosage. Staff must be properly trained and competent in the handling of medication to keep people safe. People must be consulted on, and provided with appropriate activities and occupation to prevent boredom. People must be enabled to voice their concerns or complaints about the service if they wish, and to know they will be listened to. Staff must be trained in safeguarding procedures and understand their role in protecting people. New staff must not start working in the home until all recruitment checks have been competed. There must be a staff training plan that includes induction, foundation and ongoing training, relevant to the needs of the people receiving care. The service must have a manager who is registered with the commission. There must be effective quality monitoring processed in place to ensure the service is operating to the expected standards, and this should include the views of people receiving the service. Hot water temperatures must be controlled to within acceptable limits and exposed hot water pipes must be covered. Potentially dangerous items, such as work tools, must be safely stored away from access by unauthorised persons. Barrock Court Nursing Home DS0000038773.V371712.R01.S.doc Version 5.2 Page 7 The service has slipped in a number of key areas and the provider will be asked to provide us with an improvement plan. The plan should explain what they are going to do to meet our requirements and improve the service. Good practice recommendations are made on the following: People should be consulted about their care plan and about who can have access to their information. Care plans for “when required” medicines should contain clear instructions so that people receive safe, effective and appropriate treatment. Regular audits of medication should be done to monitor the management of medicines. People should be consulted on the menus and there should be a choice at each mealtime. Staff dealing with food, should be trained in food safety. Staff should be supervised on a regular basis to ensure they are working to the homes policies and procedures and to identify any training needs. Communal areas of the home should be kept clear of equipment and there should be better signage to help people find their way around. General maintenance and repairs should be dealt with more promptly to ensure all services are in good working order. Consideration should be given to making it easier for people in wheelchairs to navigate in and out of the home. Lighting should be improved so people can see properly. 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. Barrock Court Nursing Home DS0000038773.V371712.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 Barrock Court Nursing Home DS0000038773.V371712.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): 1 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Barrock Court provides good information for people interested in their service, and carries out detailed assessments of peoples needs before they are offered a place. EVIDENCE: Barrock Court had a statement of purpose and service user guide, which had been updated recently to include the change of manager. These documents contained all the details required under regulation and gave good general information to people interested in using this service. There was a summary of the information on display and the full documents were available in a pack on request. We looked at the pre-admission assessment of a person fairly new to the care home. This had been completed in detail and provided a good picture of their personal, health and social care needs. The assessment had also taken account of information from the social worker and healthcare specialists involved with the persons care. Barrock Court Nursing Home DS0000038773.V371712.R01.S.doc Version 5.2 Page 10 We asked some people if they had been provided with all the information they needed when choosing the care home, and they told us; • “My family got information, I didn’t.” • “I came as an emergency admission, loved Barrack Court and wanted to stay.” Barrock Court Nursing Home DS0000038773.V371712.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People felt well looked after in Barrock Court, but medicines were poorly managed and this places peoples health at risk. EVIDENCE: Each person had a plan of care in place that had been generated from his or her initial assessment, and we looked at three of these, including one younger person and two older people. In some sections of the plan it was evident that people had been consulted on what was written. For example one person had signed their ‘choices’ page that listed likes and dislikes in relation to food, entertainment and timings for the day. But for the same person there was a record of what information relatives wished to be informed of, that had been signed by a relative, with no evidence that this had been discussed with the person receiving care. This raises concerns about choices and confidentiality, especially with people who have capacity to make their own decisions. Barrock Court Nursing Home DS0000038773.V371712.R01.S.doc Version 5.2 Page 12 The care plans and risk assessments seen had been signed to show they had been reviewed and updated monthly. However we found that records were not accurate or up to date in respect of peoples wound care and medication needs. People did have good access to the doctor, dentist, optician and other healthcare specialists such as the wound care specialist and dietician from the local health trust. Risk assessments had been completed for people’s nutritional status, mobility needs and skin care. We found that standard of record keeping on wound care was variable. In one of the two wound care records we looked at, the plan had been altered many times and listed a number of different treatments. There was also another set of instructions recorded elsewhere, so the current state of the wound and the actual treatment being given were not clear. People we spoke with said they felt well looked after and thought that the staff gave them what help they needed. The surveys we received said; • “Care is very good” • “Most staff seem to be really good with [my relative], but occasionally I feel one or two of the staff members are not really sure how to deal with mental health issues” • “The Barrock Court care team looked after [my relative] to the best of their ability”. We saw records for administration of medicines that were very poor and must be reviewed. These records were inaccurate and confusing and leave people at risk from errors that could seriously affect their health. For example medication for the emergency treatment of fits or low blood sugar levels in diabetes were not listed. In these cases staff may be unaware that people are prescribed these and they may go without the necessary medication at times of emergency. The records for a blood thinning medication were also poor and misleading placing people at risk from errors that could cause clots or bleeding. Medicines were not always given as prescribed so that people may not receive safe and effective treatment. For example we saw a strong pain-killer patch that should be replaced every three days that was not replaced until the fourth day. This would leave the person at risk of pain on the fourth day when the patch would be ineffective. We also saw that on occasions lunchtime medication was not given because the morning medications were given too late. The reasons for giving medication late were not documented. For example this happened for medicines for Parkinson’s Disease where administration at the wrong time or missed medication could affect well-being by reducing mobility. We counted a number of medicines and compared them with the records. This frequently showed that some medicines were missing and could not be accounted for, and on occasions too much remained suggesting that they had not been administered. We checked care plans for people receiving “when required” medication and these did not provide staff with clear instructions on their proper use. This Barrock Court Nursing Home DS0000038773.V371712.R01.S.doc Version 5.2 Page 13 may result in people receiving inappropriate or inconsistent treatment. We did not see any care plans for the use of “when required” medication to treat fits and there were no instructions for staff to follow. For example, one person who was prescribed a rectal medication for fits had no care plan for this even though the home’s policies requires a written protocol to be in place. The medication was not listed on their records and despite a number of recent fits there was no record that this medication had been administered. There was also no record that the person’s doctor had been contacted for advice despite a recent increase in the frequency of fits. Another person had a medication for emergency treatment of low blood sugar levels in diabetes. Again there was no care plan in place for this. The medication was not listed in their records and the medication itself was stored at room temperature when it should be refrigerated and this could seriously affect its effectiveness. Some medication had been removed from their original containers and put into other packs. This increases the risk to people from mix-up of medication. Some loose injections were stored next to others with the risk that they too could be mixed up and cause harm. The service should consider doing medicines checks more regularly and thoroughly to identify problems and errors so that action can be taken promptly. This should include regular assessments of staff to show that they are, and continue to be, competent and follow good practice at all times when handling medicines. Staff require further training including the administration of rectal medication with assessment of competence in order to protect the health and well-being of the people who live at the service. Barrock Court Nursing Home DS0000038773.V371712.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The provision of activities and entertainment was so minimal that people were bored. The quality of the food served was good, but the menus lacked choice and variety. EVIDENCE: The home employs an activity organiser for 15 hours each week, plus an occupational therapist for 10 hours each week. Despite this, there was very little evidence of much activity taking place. Many people we spoke with said they were bored and only watched TV. • “It’s just TV and something at Christmas” • “Nothing to do but watch TV” • “There are no outside activities or trips organised by the care home”. There was an advert for a forthcoming cake sale with no date set, and a poster about a recent ‘pyjama day’ that raised money for the ‘residents fund’. Money from this fund was going to be used to buy a gazebo to provide shelter in the courtyard for people who smoke. The manager had told us that outings were Barrock Court Nursing Home DS0000038773.V371712.R01.S.doc Version 5.2 Page 15 difficult due to a lack of transport, although there was accessible transport for hire locally. The manager also said she could not provide staff to accompany people on outings. The activity organiser kept a daily diary of what activities she had supported people to take part in. The entries in this showed people had been smoking, eating chocolate, having a cup of tea, watching TV, were asleep, were in a comfortable chair and so on. With the exception of one game of dominoes there was no evidence of any meaningful activity or stimulation during the last week. We did not see anything taking place during the day other than one person being escorted on a walk, some people were “hanging around” in the corridors / courtyard with nothing to do. At the inspection last year, people had commented very positively on the level of activities provided, so it’s disappointing for people that this has slipped. We received varied comments on the meals provided, some people said they were “very good” whilst others said they were “alright”, “OK”, and “boring”. One person told us “we sometimes get the same meal more than twice a week”. The manager provided us with the homes’ four week printed menu and copy of four weeks records of actual food served. The record of food served did not always match the printed menus supplied. On the day of our inspection the lunch menu stated steak and kidney pie, but beef casserole was served. The evening menu stated bacon and leek pie, but it was jacket potatoes. We were told this was because of problems with supplies. It was also evident from the record of food served that vegetable quiche was served twice for lunch during one week, and sausages in different forms were often served three or four times a week. We observed lunch and the food did look and smell appetising and people were seen to eat well and be given appropriate support. There was no advertised choice of main meal; the cook said she knew people’s likes and dislikes and prepared an alternative when she thought it would be needed. She also said she made the occasional curry for one person who liked that. Cakes were home baked daily and there was always homemade soup available. The food looked to be good quality and had been well prepared, but the meals served were repetitive and rather boring to some of the younger residents. Barrock Court Nursing Home DS0000038773.V371712.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People did not feel encouraged to raise concerns and seemed resigned to this. Although the manager had recognised some safeguarding issues, these had not been appropriately reported and staff lack knowledge in this area, which may put people at risk. EVIDENCE: The home had a complaints procedure that was on display and some people told us they knew how to complain if necessary, saying; • “Tell the carers or the nurse in charge” • “I am not aware of any communication problems” • “We have never had a reason to complain”. One person told us their complaint had not been taken seriously and they felt “fobbed off”. Other people complained to us about the lack of activities and the meals, and these are issues that people should feel comfortable raising within the service, but if they had, no action had been taken. People felt there was little point is making complaints as things “wouldn’t change”. One staff member told us, “everything is swept under the carpet and forgotten”. The manager reported there had been no complaints but it became evident that there had been a serious complaint that had gone on to become a safeguarding matter, and was being dealt with by the local adult social care Barrock Court Nursing Home DS0000038773.V371712.R01.S.doc Version 5.2 Page 17 safeguarding team. The manager had not reported this to us as required under regulation. The manager had also made an earlier safeguarding referral that had not been reported to us. Whilst the manager understood the need to report safeguarding concerns to the adult social care team, she was not aware of the need to inform the homes inspector. When asked about safeguarding training the manager said this was out of date. Of the seven staff files seen, only one contained evidence of safeguarding training, in April 2007. There was no evidence of more recent update training or any training for new staff. Barrock Court Nursing Home DS0000038773.V371712.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19. 20, 21, 24, 15 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Barrock Court is a comfortable, pleasantly decorated care home, but poor signage and heavy doors make it hard for some people to navigate the home independently. More attention needs to be paid to completing minor repairs promptly and keeping communal areas free from clutter and equipment. EVIDENCE: Barrock Court is a purpose built care home, all on one level. The building is divided into three units, with each having its’ own lounge and bathrooms. There are two dining rooms. There is ground to the front of the home that overlooks the surrounding countryside and an enclosed courtyard. All bedrooms are single with en-suite facilities. There are details in the service user guide on bedroom sizes. The manager reported that over the last year re-decoration had taken place in bedrooms, communal areas and bathrooms. However, the majority of this work had already been done at the time of the Barrock Court Nursing Home DS0000038773.V371712.R01.S.doc Version 5.2 Page 19 last inspection in August 2007. At that time there were plans to create another shower room, and the manager reported that this was still the case. There were also plans to replace soft furnishings and some furniture. There had been problems with the hot water supply and workmen were in the building laying new water pipes to alleviate this. Many people had made their bedroom a homely personal pace, but some had fairly dark up lighter shades fitted to the ceiling lights which made the rooms gloomy. Lounges were comfortable and the dining rooms smart and clean. The main corridor carpet was marked. Each unit had a bathroom but only one also had a shower. In one bathroom where the bath had been re-positioned last year, there was exposed piping that needed covering. This was brought to the previous managers attention last year, and was at that time said to be in hand as the bath had only just been moved. We also commented last year on one toilet being crowded with laundry bins, and this was still the case. There was no hot water in one toilet. One person said the call bell in their bedroom was not working and when we checked, it was not. The person stated it had not worked for months. Signage around the home was poor, with no signs (written or pictorial) to help people find key areas such as lounges, dining rooms or the office. We spoke with three people in the corridors who were not sure which way to go. As all units and corridors were decorated the same, there was nothing to distinguish one area of the building from another. Most of the doors that had a ‘bathroom’ sign on them, were in fact storerooms, which is confusing for people looking for a bathroom. One storeroom contained equipment and tools, this door was not locked and later in the day was seen propped open. This should be kept locked for safety reasons. The laundry was seen to be functioning satisfactorily, and the kitchen was clean and tidy, although the flooring was ripped. The manager said the flooring was due to be replaced, and the company had got quotes for this. We received the following comments about the environment in our surveys; • “The home does the best with what is available, although I feel the design of the home is not wholly conducive to the needs of a wheelchair user” • “A door bell is needed for when the entrance door is locked” • “Easier access through entrance door for wheelchair, i.e. automatic opening via switch” • “More and stronger external lights in the car park for winter loading and unloading of wheelchair” • “The rooms could do with brightening up” • “I am currently most concerned at the way the smoking room has been taken over as a staff room, without first having made provision for a smoking shelter”. Whilst the building was purpose built as a care home, there are many areas where the décor and signage could be improved to assist people find their way round. Also the external doors were heavy and stiff to open so were not user friendly for frail elderly people or people in wheelchairs. Barrock Court Nursing Home DS0000038773.V371712.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although people said staff were kind and helpful, recruitment processes were not robust enough to protect people, and staff training was not up to date and did not address the specific needs of people using the service. EVIDENCE: Staffing levels were stable with the rotas showing four or five staff on duty most days, reducing to three or four in the evening. One person complained that there were only three staff on duty during the day at weekends but the current rota did not reflect this. The manger reported a high use of temporary/agency staff in the last three months, which can be disruptive for people. These shifts were later said to have been provided by the same two staff members who worked for Barrock Court in an ‘as required’ capacity. Of the care staff, 42 had a National Vocational Qualification in care and 47 were working towards this, which is good. There were sufficient numbers of administrative, domestic and catering staff. To check the homes recruitment practices we looked at the files of three staff new to the home since the last inspection. These showed that although the home went through all the proper checks, these staff had commenced work before their criminal records bureau (CRB) check was completed. Neither had any of these staff been checked against the protection of vulnerable adults list (using PoVA 1st) before they started work. This is to check if potential staff Barrock Court Nursing Home DS0000038773.V371712.R01.S.doc Version 5.2 Page 21 had ever been deemed unsuitable to work with vulnerable people. These basic precautionary checks must be in place before new people commence work in a care home, and the manager could not explain this. Training records did not evidence that all staff had received the basic regular mandatory training required, or sufficient other training to be able to meet peoples needs competently. There had been a session the previous day on safe use of chemicals (COSHH) and a moving and handling training session took place during the inspection. We looked at seven staff files, and all had a blank 2008 training plan. Some files contained evidence of moving and handling and challenging behaviour training in 2006 and infection control training in 2007, some files showed no training records at all. The manager confirmed a lot of staff training was out of date, and said she herself lacked some. There was a staff training matrix on the wall, which the manager said was up to date, but this only showed that fire training was due in November. One staff member told us they received a lot of training, but others said; • “No form of any training in the last 3 years” • “Sometimes we don’t get told about the important things for maybe a week/10 days” • “I did 7hrs then was left on a unit on my own, not knowing anyone or their needs/ names/ wishes, and felt very uncomfortable”. Other surveys told us; • “On the whole the staff are very kind and friendly to my mum” • “More staff to respond to service user needs more quickly e.g. Toilet” • “I think the manager and staff do the best with what they are given” • “Staff are not really sure how to deal with mental health issues”. Whilst the majority of people we spoke to said the staff were kind and helpful, there was a lack of training on topics such as person centred care, and the people were supported in a rather task orientated way. There was no overall training plan and the training that did take place, was not targeted towards particular staff needs nor did it take into account specific needs of the people using the service. The manager said it was difficult to get some staff to attend training, and there did not seem to be a management plan in place to deal with this. Barrock Court Nursing Home DS0000038773.V371712.R01.S.doc Version 5.2 Page 22 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 poor. This judgement has been made using available evidence including a visit to this service. The service is poorly managed, both within the home and externally. There is a lack of leadership and forward planning, which is detrimental to the future of the service and the people who use it. EVIDENCE: The previous registered manager for this service, Mrs Roseanne Fearon was promoted to ‘area manager’ for Aermid Health Care, the homes operator, in April 2008. A new home manager Mrs Amanda Bechelli was appointed, having formerly been employed at Barrock Court as a registered nurse. Mrs Bechelli told us her induction consisted of a two-week handover with the outgoing manager and that she was due to commence some management training shortly. She applied for registration with the commission in July 2008, but her Barrock Court Nursing Home DS0000038773.V371712.R01.S.doc Version 5.2 Page 23 application was incomplete and was returned to her. A new application had not been received at the time of this inspection. The home manager must apply to be registered with commission without delay. Prior to this inspection we asked the manager to complete an Annual Quality Assessment Audit (AQAA) for us. This provides us with numerical data about the service, and tells us about any improvements made over the last year and about future plans. The AQQA was poorly completed, was blank in some sections and did not give us sufficient information about the service. The manager had recorded that she was unable to complete this fully as she was new in post, and the area manager had not been available to assist her. The home had a number of quality assurance processes in place, but these were very sporadic and were not seen to be working well. A few care plans had been audited by the manager in June and again in September this year. The audit showed that all of the plans audited required some remedial action, although there was no record this had been attended to. The previous care plan audit took place a year previously in June 2007. Medicine records had also been audited in June and September of this year, and again showed a lot of remedial action was required. The previous audit of medicine records was in April 2007, a gap of fourteen months. This was not a robust audit system, and showed that quality monitoring was not being implemented as a core management tool. Surveys had been sent to residents and relatives in August 2008, and the results of these were on display and were mostly very positive, as people felt they were well looked after. A staff survey had been done in July 2008 and 20 staff had responded to this. Even though the surveys were named, and therefore not anonymous, the results were poor. The majority of staff did not agree that they had received up to date training in the areas listed on the form. There were also a number of negative comments made about the organisation and management of the service. There was no clear management plan in place to address these issues. The service holds money for safe keeping on behalf of some people. We inspected the records and monies of four people and found the records to be in order and the amount of money correct. Individual records sheets were kept for each person, along with any receipts for expenditure and the money was held securely in separate wallets for each person. Records showed that staff supervision last took place in July 2007, fourteen months ago. Care staff should received formal recorded supervision six times a year, i.e. every eight weeks, which includes philosophy of care, working practices and carer development. The manager was aware of the lack of supervision and said she had not received any supervision herself. We looked at some health and safety records. Moving and handling training was taking place that day, and training on safe use of chemicals had happened the day before. The fire safety logbook was up to date; showing the fire warden had maintained checks on equipment and provided regular fire drills and training updates for staff. Only 35 of care staff were reported to have food hygiene training, even though care staff prepared and served the evening meals. We did not see evidence of this training and when asked, the manager Barrock Court Nursing Home DS0000038773.V371712.R01.S.doc Version 5.2 Page 24 said she thought it would be out of date. Any staff handling food should complete some food safety awareness training. Water temperature records showed that in one area of the home, there was no hot water and in other areas the water was too hot to be safe. This was hopefully being addressed by the current work on the boiler and water pipes. Accident records were kept, and although the manager said she completed weekly and monthly returns of these for head office, there was no evidence in the home that accident records were audited to monitor for patterns or trends. The service lacks management oversight both within the home and externally. A number of core management areas including training, supervision and quality monitoring had been outstanding since summer 2007. This needs to be urgently addressed by Aermid Health Care who operates this service. There was a lack of strategic forward planning and no evidence of consultation with people who use the service on how the service should be run. Barrock Court Nursing Home DS0000038773.V371712.R01.S.doc Version 5.2 Page 25 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 3 2 X X 3 2 3 STAFFING Standard No Score 27 3 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X 3 1 X 2 Barrock Court Nursing Home DS0000038773.V371712.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? N/A 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 12(1) Requirement Care plans must be kept up to date and accurately record the level of personal support, and any nursing care or treatment people require from staff. Records for receipt, administration and disposal of medicines must be complete and accurate to protect people from errors that could affect health. Staff must be suitably trained and competent in the handling of medication so that medicines are administered safely. All medication must be handled safely and administered as prescribed so that people receive safe and effective treatment. People must be consulted with, and enabled to participate in activities and occupation of their choice. The service must enable people to complain if they want to and ensure people feel confident their concerns will be acted on. Staff must be trained in safeguarding procedures to DS0000038773.V371712.R01.S.doc Timescale for action 01/01/09 2 OP9 13(2) 01/11/08 3 OP9 18(1) 01/01/09 4 OP9 13(2) 01/11/08 5 OP12 16(2) 01/11/08 6 OP16 22 01/11/08 7 OP18 13(6) 01/01/09 Barrock Court Nursing Home Version 5.2 Page 27 8 9 OP25 OP29 13(4) 19(1) 10 OP30 18(1) 11 OP31 8 12 OP33 24(1) 13 OP38 13(4) 14 OP38 13(4) understand their role in protecting people, and to know how to report concerns or allegations. Exposed hot water pipes must be guarded / covered. New staff must not start work in the home without having proper recruitment checks in place, which include PoVA and CRB. There must be a training plan that ensures all staff receive induction, foundation and ongoing training relevant to the needs of the people they are caring for. The service must have a manager in day-to-day charge, who is registered with the commission. The service must have effective quality monitoring systems in place to measure its own performance against its stated aims and objectives. This must include the views of people who use the service and other stakeholders. Water temperatures must be controlled to ensure hot water temperature is within an acceptable range at the point of delivery. Work tools must be kept locked away when not in use; so unauthorised people cannot access them. 01/11/08 01/11/08 01/01/09 01/03/09 01/01/09 01/01/09 01/11/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000038773.V371712.R01.S.doc Version 5.2 Page 28 Barrock Court Nursing Home 1 Standard OP7 2 3 OP9 OP9 4 5 6 7 8 9 10 11 OP15 OP19 OP19 OP19 OP22 OP22 OP25 OP36 12 OP38 People who have capacity should be consulted on the content of their care plans, and be consulted on what information they agree can be shared with their friends/family. Regular audits of medication should be done to monitor the management of medicines and to keep people safe. Care plans relating to medicines such as “when required” medicines should contain clear detail of how they are managed to ensure people receive safe and consistent treatment. People should be offered a varied menu that includes choices at each meal and takes into account people views and wishes. Communal areas, especially toilets should be kept free from stores and equipment, to allow people safe access. Call bells should be checked and serviced regularly to make sure they are working. The torn kitchen flooring should be repaired or replaced. The service should consider improving signage around the home so people can find their way more easily, and so toilets and bathrooms are clearly marked. Consideration should be given to making the home easier for people in wheelchairs to navigate independently. Lighting around the home, especially in bedrooms, should be bright enough so that people can see properly to read. Care staff should be supervised to help them perform their role. This must include recorded supervisions that cover care practice, the homes’ philosophy and staff development needs. All staff who handle food, should be trained in food safety. Barrock Court Nursing Home DS0000038773.V371712.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Barrock Court Nursing Home DS0000038773.V371712.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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