Inspection on 22/10/07 for Barrow Hall Care Home

This inspection was carried out on 22nd October 2007.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Barrow Hall Care Home 21/10/08

Barrow Hall Care Home 26/09/06

Barrow Hall Care Home 19/01/06

Barrow Hall Care Home 25/07/05

Barrow Hall Care Home 17/02/05

Barrow Hall Care Home 23/08/04

Barrow Hall Care Home 27/02/04

Similar services:

Whiteley House

Tyndale Avenue

2-10 Norfolk Road

Bennfield House Nursing Home

Eastfield Residential Home

Sign Health

Springwood

Fairburn Mews

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Barrow Hall Care Home Wold Road Barrow On Humber North Lincolnshire DN19 7DQ Lead Inspector Angela Sizer Unannounced Inspection 22 & 23 October 2007 09:30 nd rd DS0000032128.V352630.R01.S.doc Version 5.2 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 DS0000032128.V352630.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 Adults 18-65. 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. DS0000032128.V352630.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Barrow Hall Care Home Address Wold Road Barrow On Humber North Lincolnshire DN19 7DQ 01469 531281 01469 532544 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) Guardian Care Homes Mr Patrick Michael Griffiths Care Home 37 Category(ies) of Dementia (37), Dementia - over 65 years of age registration, with number (2), Mental disorder, excluding learning of places disability or dementia (37), Mental Disorder, excluding learning disability or dementia - over 65 years of age (37) DS0000032128.V352630.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care (including nursing) and accommodation to service users of both sexes whose primary care needs on admission to the home are within the following categories: Dementia - over 65 years (Code DE(E) 2, Mental Disorder, excluding learning disabiity or dementia (Code MD), Dementia (Code DE), Mental Disorder, excluding learning disability or dementia, over 65 years (Code MD(E)). The maximum number of service users who may be accommodated is 37. 26th September 2006 2. Date of last inspection Brief Description of the Service: Barrow Hall is a listed building and retains many of its period features. The home is set in pleasant grounds in the village of Barrow, providing easy access to local shops and facilities. Barrow Hall offers personal and nursing care for up to 37 people with a mental health problem. The home is owned by Guardian Care Homes, which is a large national company. A choice of single and shared accommodation is available. In addition people who live in the home have access to a range of communal facilities including a dining room, sitting room and recreational area. Twenty-five beds are provided in the main building, a further ten beds are provided in an adjacent building known as The Mews. The Mews consists of ten apartments. Two of the apartments have a separate bedroom, sitting room, kitchen and bathroom. The other eight apartments have an adjoining bedroom, sitting area and small kitchenette. All have separate bathrooms with showers, wash hand basins and toilets. Storage and telephone points are provided in all ten apartments. Two of the apartments have been adapted to accommodate service users with physical disabilities. The remaining two beds are provided in a self-contained house called The Lodge, which is situated at the top of the long driveway. The home has extensive grounds that people who live there have access to and there is ample car parking facilities. The weekly fees currently start from £500.00 - information supplied by the registered manager during the visit on 22.10.07. The registered manager stated that all residents are given a service user guide upon admission. The registered manager also stated that prospective residents are offered a copy of the home’s statement of purpose and service user guide. DS0000032128.V352630.R01.S.doc Version 5.2 Page 5 DS0000032128.V352630.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced key inspection and took place over two days and took a total of 14.5 hours. Prior to the visit surveys were posted out to people living in the home, their representatives and social and healthcare professionals; 6 residents surveys were returned, two of the relatives surveys were returned, 7 staff members, 2 of the health and social care professionals and 1 care manager surveys were returned. The Annual Quality Assurance Assessment was completed and returned to the CSCI (Commission for Social Care Inspection). The previous requirements were discussed with the manager and it was identified that a large proportion have been met. A discussion occurred regarding how the residents are supported to follow their religion of choice and practise their faith and how the home meets diverse needs of individuals. Several of the residents were spoken to throughout the two days regarding the care they receive and what it is like to live in the home, some of their comments have been included in this report. Four residents’ care records were tracked during the site visit and four staff personnel files were looked at. Three of the staff were spoken to find out what it was like working in the home and what training, management and support was offered to them. A tour of the premises was undertaken and a number of records were looked at to ensure that the correct maintenance has been undertaken. The manager was given feedback during and at the end of the visit. The inspector would like to thank the residents, manager and staff for welcoming them into the home and contributing to the content of this report. What the service does well: The home’s assessment process ensures that new residents are admitted only on the basis that a full assessment of need has been undertaken by people competent to do so, this ensures that the placement is appropriate. DS0000032128.V352630.R01.S.doc Version 5.2 Page 7 People living in the home receive a statement of purpose and service user guide and these clearly describe what services and support they can expect to receive. Prospective residents are enabled to visit and sample the home prior to moving in on a permanent basis and this ensures that they are making an informed choice whether to live there. From observation and from speaking to the people who live in the home it was apparent that overall choice and independence are promoted and the residents are enabled to make their own decisions about everyday life within the home. The majority of people living in the home are free to come and go and the majority lead a fairly independent lifestyle. One resident said, “I love it here, I go to the shops”, “I go out with the staff sometimes”, “I helped with interviewing the staff recently, I prepared the questions myself and helped pick the person who got the job”. People who live in the home are enabled to take part in appropriate activities and education. People who live in the home are encouraged to maintain outside links with their family and friends and the routines in the home are flexible, therefore they have their rights respected and independence promoted. The menu and food offered is of a good quality, therefore people receive a varied and healthy diet. People who use the service are informed about the complaints procedure and are able to express their concerns in an open culture. The quality assurance within the home ensures that the views of the people living in the home are sought on a regular basis. What has improved since the last inspection? People who use the service have a care plan that fully describes their needs and what support is required. The risk management system has been improved and there were various risk assessments on the individual files of people who live in the home. These covered all sorts of issues including verbal and physical aggression, medication, communication difficulties, mobility, weight loss, self-harming and sexualised behaviour. The risk management plan clearly describes what the risk is and how this is to be minimised, also what staff need to do and at what point would other agencies need to be contacted. DS0000032128.V352630.R01.S.doc Version 5.2 Page 8 Overall people who use the service are protected from possible harm or abuse, as the home only employs staff when the appropriate vetting has taken place prior to them starting work. The financial records held for people living in the home are accurate and up to date. However, not all staff have undertaken the safeguarding vulnerable adults training so therefore may not be aware of their responsibilities if a safeguarding incident occurred. People living in the main house and the Mews have a clean, nicely decorated and hygienic environment. People receive support from staff who have been properly vetted and therefore the protection of the residents is promoted. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. DS0000032128.V352630.R01.S.doc Version 5.2 Page 9 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. DS0000032128.V352630.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000032128.V352630.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 & 4 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home’s assessment process ensures that new residents are admitted only on the basis that a full assessment of need has been undertaken by people competent to do so, this ensures that the placement is appropriate. People living in the home receive a statement of purpose and service user guide and these clearly describe what services and support they can expect to receive. Prospective residents are enabled to visit and sample the home prior to moving in on a permanent basis and this ensures that they are making an informed choice whether to live there. EVIDENCE: During this inspection visit four files of people who live in the home were looked at, this was to make sure that the home finds out what residents’ needs are and to ensure that the home can meet their needs. The registered manager stated that the home usually receives a community care assessment DS0000032128.V352630.R01.S.doc Version 5.2 Page 12 of need from the placing Authority, in addition the home also undertakes their own assessment and evidence of this was seen on the files looked at. The assessment includes the personal history, employment, family, previous clinical history including any mental health issues, communication and mobility. The manager stated, “people can come and look around, stay overnight and it is free until they move in”. From speaking to several people who live in the home and from the surveys received before the inspection it was confirmed that they were able to visit and test drive the home before making a decision to move in. Some comments received included; “I came to look around and then stayed for tea”, “I really like it here and wanted to move in”. The home ensures that prospective residents or their representative are able to visit the home, have a meal, meet the other residents, see their room before making the decision as to whether they would like to move in. The statement of purpose and service user guide have been updated and reviewed in May 2007. From looking at both of these documents it is clear that the home explains what services, facilities and support are available to people who live in the home. From speaking to several of the residents they confirmed that they had received a service user guide that gave them information about the room they would have, the food and mealtimes and also how to complain if they needed to. During discussion with the manager about meeting diverse needs it was clear that he had a good awareness of the different needs individuals may have and how these could be met. He gave examples about religion, culture and special dietary needs of residents. It was confirmed from speaking to several residents that their religious, cultural and dietary needs were all being fully met. DS0000032128.V352630.R01.S.doc Version 5.2 Page 13 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8 & 9 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People who use the service have a care plan that fully describes their needs and what support is required. People living in the home are enabled to make choices about everyday life in the home. The risk management system ensures that the people who live in the home are safe and risks are either eliminated or reduced to a minimum. EVIDENCE: During the visit to the home four of the residents’ files were looked at and overall were found to be of a good standard. The recording was up to date, clear and gave instruction to staff about what they should do and when. On each file there was an activities of daily living or service user plan and it was DS0000032128.V352630.R01.S.doc Version 5.2 Page 14 evident that staff use these on a daily basis. From speaking to two staff members it was evident that the improvements to the system has made a positive change to the way the home records information. Some comments included; “I feel that the care plans and risk assessments have improved since the last inspection, there is consistency now rather than having several variations”. The activities of daily living or service user plan contain information in relation the person’s history including employment, likes and dislikes, family and support outside of the home, interests/hobbies, previous mental or physical health problems, mobility, sexuality, spiritual needs, sleep patterns, wishes upon death, behaviour and medication. This ensures that the staff have knowledge about the person’s holistic needs and the plan details how the needs will be met. From speaking to the two staff members it was clear that they had developed a very good understanding of the residents’ needs and could describe what the needs of individual residents were and were clear about what support they required. The home employs Registered Mental Nurses and there is a qualified member of staff on duty at all times. Some staff have undertaken training in relation to managing challenging behaviour and mental health awareness, this was confirmed by speaking to the manager and looking at written evidence. Due to the home being registered for mental health and a high proportion of the residents present with some difficult to manage behaviour, it is recommended that all staff undertake appropriate mental health awareness and difficult to manage behaviour training. This would ensure that all of the staff group were trained and aware of different approaches when dealing with difficult to manage behaviour. From observation and from speaking to the people who live in the home it was apparent that overall choice and independence are promoted and the residents are enabled to make their own decisions about everyday life within the home. The majority of people living in the home are free to come and go and the majority lead a fairly independent lifestyle. One resident said, “I love it here, I go to the shops”, “I go out with the staff sometimes”, “I helped with interviewing the staff recently, I prepared the questions myself and helped pick the person who got the job”. The risk management system has been improved and there were various risk assessments on the individual files of people who live in the home. These covered all sorts of issues including verbal and physical aggression, medication, communication difficulties, mobility, weight loss, self-harming and sexualised behaviour. The risk management plan clearly describes what the risk is and how this is to be minimised, also what staff need to do and at what point would other agencies need to be contacted. Two surveys were received from a healthcare professional and a care manager confirming that the home’s staff are co-operative and helpful and comments included; “they respond and inform me regarding all of my clients care needs and as requested I am involved in all of the decision making”, “personal and professional care”. DS0000032128.V352630.R01.S.doc Version 5.2 Page 15 Written evidence was seen confirming that the care plans and risk management plans are updated and reviewed on a regular basis. Although the risk assessments were signed by the person who had developed it, the resident or their representative had not signed the risk management plan. From speaking to the manager he stated that, “some of the residents refuse to sign them”. It is recommended that if the person refuses to sign the care plan or risk management plan, then this should be recorded. DS0000032128.V352630.R01.S.doc Version 5.2 Page 16 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 & 17 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People who live in the home are enabled to take part in appropriate activities and education. People who live in the home are encouraged to maintain outside links with their family and friends and the routines in the home are flexible, therefore they have their rights respected and independence promoted. The menu and food offered is of a good quality, therefore people receive a varied and healthy diet. EVIDENCE: DS0000032128.V352630.R01.S.doc Version 5.2 Page 17 During the inspection visit several of the people who live in the home were spoken to about the range of activities and outings, it was confirmed that during the last few months the activities have continued to occur, but some stated not as regular as they would like them to be. A discussion was held with the manager and he stated, “the new activities co-ordinator has been in post for 4 weeks now and the home is beginning to return to normal after the floods in June”. From discussion with the activities co-ordinator it was clear that the activities plan was currently being implemented and there is now a budget to purchase and maintain supplies of art, craft and equipment. The activities co-ordinator said, “most activities are advertised on the notice board and we now keep evidence of what has been offered, declined and undertaken”, “each resident has an activities sheet and this has personal likes/dislikes for example; films, gardening, TV or games, the activity would be recorded, dated and comments”. Evidence was seen confirming this when looking at the individual files of four people living in the home. The activities co-ordinator also stated that over the next few weeks the stock that was lost in the floods will be replaced and when the current dining room moves to a different location this will then become the activities room. She said, “this will have a computer installed with internet access, but this will be supervised at all times and there will be activities tables with a library and quiet area at one end”, “there is a residents’ meeting this Friday to discuss what activities people want to do”. Some of the residents have been on holiday this year and this was confirmed by speaking to them, “we went on holiday to Wales and I enjoyed it”. The activities co-ordinator was in the process of planning next year’s holiday and confirmed, “I am looking at where we can go next year, possible Devon or the Lake District”. From looking at written evidence, speaking to people who live in the home and staff it was confirmed that other activities take place on a regular basis and these included; birthday parties, disco, entertainment, trips out for lunch, bowling, to Hull market and swimming. The activities co-ordinator was very enthusiastic and it was clear that the people who live in the home are consulted about what activities they would like to undertake. Some of the residents attend a day centre in Barton and two residents attend a local college. During the inspection visit several of the residents and a visiting social worker were spoken to about the level of activities and some comments included; “I like to do my knitting and I go out as well”, “we go out for meals sometimes”, “the staff take me to the pub for a pint”, “they have done a good job with my client and overall has improved”. It was also observed that some of the more able residents go out independently on a regular basis. Other residents who either have physical problems or their mental health prevents them from going out alone, tend to remain in the home during the day and the activities coordinator stated, “I am aware that some people who have more complex needs will require a lot of input and will need to be included in the activities programme as much as possible”. DS0000032128.V352630.R01.S.doc Version 5.2 Page 18 During the visit staff were observed interacting with residents and this was carried out in a caring and sensitive way. From speaking to several people who live in the home it was clear that on the whole staff treated them with respect and called them by the name they prefer. One person living in the home did comment, “some staff do not knock before they come in”. During the inspection visit the staff that were spoken to could describe clearly the principles of good care and how they should treat the residents. Surveys received from residents, relatives and other professionals confirmed that the home supports and maintains family links and friendships both inside and outside of the home. Several of the residents were spoken to during the visit also stating that the staff group support them fully in maintaining relationships/friendships. Visitors are welcomed into the home and there are several quiet areas that residents can meet with their visitors in private. Some comments from residents and other professionals included; “the staff are always friendly and polite”, “I get on well with the staff”, “they are good”, “the staff are lovely”, “the staff are welcoming and always offer me a drink and they ensure I have privacy with my client”. It was confirmed by speaking to the residents that they have a key to their own room and that staff refer to them by the name they prefer. The home continues to offer a varied menu and from speaking to several of the people who live in the home it was evident that the cook or staff consult them on a daily basis in order to discuss the options for lunch and tea. Some comments made by people included; “the food is scrumptious and I am always full”, “the food is good and we get a good choice”, “we have plenty of fruit and veg”, “it’s a balanced menu, always meat and vegetables”, “the cooks ask us what we like”, “you can have a sandwich or something else if you want to”. There were no negative comments on the visit to the home. Lunch was observed and consisted of steak or sausage with onion rings, grilled tomatoes, chips and peas and there was a vegetarian option of jacket potato, the sweet was sponge and custard, fruit or yoghurt. The main meal of the day is served at lunchtime with a lighter option for tea. From speaking to the residents it was confirmed that if there is something that they do not like on the menu then they can have an alternative, “the cooks talk to us everyday about what we are having”, evidence of this was recorded in the residents meetings. Breakfast and supper are also offered, there are set times for drinks (hot), staff explained that cold drinks are available throughout the day. Residents confirmed that they find it acceptable to have drinks at set times. Since the last inspection risk assessments have been developed in relation to the transporting of hot meals and drinks and from discussion with the manager DS0000032128.V352630.R01.S.doc Version 5.2 Page 19 it was apparent that in the near future the dining room will be relocated to another part of the building. He said, “once the new dining room is complete, none of the staff or residents will have to walk up and down stairs to get to it and there is a ‘dumb waiter’ installed to transport the food from the ground floor to the mezzanine floor”. DS0000032128.V352630.R01.S.doc Version 5.2 Page 20 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People who use the service receive a good level of personal and healthcare support that ensures their needs are met. The medication procedure is adhered to and staff have been appropriately trained, however the stock held in the home did not always match what was recorded. A system should be in place to record all medication received in to the home and medication carried over from the previous month. This helps to confirm that medication is being given as prescribed and when checking stock levels. EVIDENCE: Prior to the visit-taking place an Annual Quality Assurance Assessment was received and had been completed by the registered manager. This stated that DS0000032128.V352630.R01.S.doc Version 5.2 Page 21 all of the health care needs of residents had been maintained since the last inspection visit. During this visit four of the files for people who live in the home were looked at, written evidence was in place confirming what health care checks have been undertaken with the residents and these included optical, dental, chiropody, psychiatrist and other health care and social care professional involvement. From speaking to the residents it was apparent that they have access to all of the healthcare services they need, one person stated; “I am seeing my social worker tomorrow”, and another person said they were going to the hospital later in the week for a regular check up with their Psychiatrist. A general discussion occurred with some of the residents regarding bathing, bedtimes etc, the residents stated that there are no restrictions upon bathing and bedtimes. All of the residents spoken to could confirm who their key worker was and that they spent time with them on a regular basis. Some comments included, “the staff are friendly and approachable”, “I have a very good relationship with my key worker”, “they are good”, “the staff are lovely”. Staff spoken to could describe the needs of the residents who they were key worker to and what support was required from them, it was obvious that the staff had developed a good understanding of what the residents needs were and on the whole residents were treated with respect and their dignity maintained at all times. Two comments were received stating that staff do not always knock before entering the bedrooms of people living in the home, “some come in without knocking”. During the visit the medication procedure was looked at and the records were in good order, there were no gaps in recording. Only the trained nursing staff administers the medication. The member of staff who has responsibility for ordering and booking in the medication was spoken to confirming that the order for prescriptions is sent straight to the pharmacist and then dispensed direct from the GP’s surgery to the home. However, the prescriptions are not sent to the home before the supply is made. The person in charge of ordering medication should have sight of the prescriptions before a supply is made. The prescription is the authority for the staff to administer medication. This also provides an opportunity to check if any new medicines or dose changes are included. Any problems with prescriptions can be addressed at this point rather than after the supply has been made. The checking of prescriptions is an important part of the management of medication. The home has a returns procedure, which detailed the name of the person the medication was for, the drugs returned, prescribed drug and amount. The medication is stored in a locked medication room or ‘clinic’ and within that room there are several locked cabinets and these are secured to the walls, there are also two medication trolleys. There is a fridge that is used to store medication only, records were seen confirming that the temperature was taken DS0000032128.V352630.R01.S.doc Version 5.2 Page 22 on a daily basis. It was observed that medication in bottles or packaging that once opened have a use by date had the date of opening recorded. The current (MAR) charts were looked at. A number of people do not have a current photograph attached to their MAR chart. This means there is a risk that a person may be wrongly identified and given incorrect medication. The quantity of medication from one monthly cycle to another is not recorded on the new MAR. Therefore the quantity on the MAR chart did not include all the stock being stored. This means it is difficult to have a complete record of medication within the home and to check if medication is being administered correctly. DS0000032128.V352630.R01.S.doc Version 5.2 Page 23 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People who use the service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People who use the service are informed about the complaints procedure and are able to express their concerns in an open culture. Overall people who use the service are protected from possible harm or abuse, as the home only employs staff when the appropriate vetting has taken place prior to them starting work. The financial records held for people living in the home are accurate and up to date. However, not all staff have undertaken the safeguarding vulnerable adults training so therefore may not be aware of their responsibilities if a safeguarding incident occurred. EVIDENCE: The home has a complaints procedure and it was clear from speaking to several of the residents that they were aware of the procedure and knew how to make a complaint if necessary. One person said, “I have no problems, but I know who to talk to if I did”. Four out of the six questionnaires received back stated that they knew whom to approach to raise concerns and complaints. The protection of vulnerable adults policy has been updated since the last inspection. Examination of a selection of staff training records identified that some staff have still not received adult abuse training. DS0000032128.V352630.R01.S.doc Version 5.2 Page 24 From speaking to two staff members during the visit it was clear that they had a good understanding of the procedure and where aware of what their responsibilities were. Since the last inspection there has been two safeguarding referrals made to the local care management team, the outcome of these resulted in no further action being taken. The manager responded in accordance to the procedure and sought advice about what action he would need to take. A discussion was held with the manager with regard to the current policy and procedure in relation to the use of physical restraint. The manager stated, “there have been no incidents since the last inspection where physical restraint has been used”, “we now have a no restraint policy and I am currently looking into training for non physical intervention or therapeutic intervention”. Some of the staff have undertaken training for dealing with challenging behaviour. The manager is aware that if physical restraint is to be used then all staff would need to undertake the appropriate training that is registered with the British Institute for Learning Disabilities (BILD) and ensure that the decision to use restraint has been made in a multi-disciplinary setting with written agreement in place. All records of restraint must be recorded fully and forwarded to the CSCI. The home has a policy and procedure for dealing with residents’ monies and financial affairs. Records for maintaining the personal finances of residents are kept. The home has one account with the bank and residents have their own individual bank statements, several of the residents’ families take care of their finances. The manager said, “we always have two appointees, it is myself and the admin person. The financial records for two people who live in the home were looked at and found to be up to date and accurate. DS0000032128.V352630.R01.S.doc Version 5.2 Page 25 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26,28 & 30 People who use the service good outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People living in the main house and the Mews have a clean, nicely decorated and hygienic environment, but the Lodge requires some redecoration and renewal to ensure that people live in a well-maintained home that meets all of their needs. There are appropriate aids and adaptations within the home that aid independence and this ensures that people with physical needs have them met. The lack of infection control training for staff may place people who live in the home at risk of infection or cross contamination. EVIDENCE: DS0000032128.V352630.R01.S.doc Version 5.2 Page 26 Since the last inspection visit the home was flooded in June this year, resulting in all of the people living in the home being moved to another care home owned by Guardian Care. This was carried out in partnership with those people and their representatives, including the appropriate Social Services Departments. The residents were able to return to Barrow Hall in July. A tour of the building was undertaken confirming that the previous acceptable standards of cleanliness have been maintained. Overall the standard of the environment is good, but there is one area that will require attention in the near future and that is the Lodge, which is situated away from the main building. Some of the flooring was worn and stained and in general could do with a clean up and redecoration/renewal. On the whole the home smelled fresh and was clean, in one room there was a smell of urine, but from speaking to the staff and manager this was currently being dealt with. The person in that room was moving to newly refurbished bedroom that had a nonslip floor and disabled facilities, this had been agreed with the care manager as the best way to deal with the continence problem. Overall the bedrooms and communal areas were homely, personalised and comfortable and from speaking to the people living in the home it was confirmed that they were happy with their room and the general environment. Some comments included; “I like it here, it is quiet and peaceful”. On the whole people living in the home are supported to undertake daily living tasks, for example making tea in their own room, doing their washing and making their bed and keeping their room tidy. This was identified as part of their care package and was recorded appropriately. The manager said, “we promote daily living skills and enable people to live an independent lifestyle as far is possible”. Surveys returned from relatives indicated that the home was clean and hygienic. During the inspection a visiting social care professional was spoken to confirming that the home is usually clean and tidy. Some comments included; “the environment is good and the home is set in lovely grounds, my client really likes the peace and quiet and also the animals that are in the grounds” Evidence was seen confirming that the home has adequate moving and handling equipment and staff have received training on the use of the equipment. Specialist equipment for one service user has been provided. The home has a maintenance plan in place and written evidence was seen confirming this. In addition the person responsible for the maintenance was spoken and records were seen confirming that regular health and safety checks are undertaken including water temperatures, fire drills and tests and other routine checks on the equipment and grounds. DS0000032128.V352630.R01.S.doc Version 5.2 Page 27 Since the last inspection new chairs have been purchased for the residents smoking lounge and the blue lounge. The manager explained that since the flooding in June building work has been undertaken and is nearing completion. There will be a new dining room with medication room situated next to it and a bedroom has recently been refurbished, this has a walk in shower room with appropriate aids in place to assist independence. The old dining room will become an activities room, which will house a computer, library and quiet area and activities tables. The home has a separate laundry room and there are infection control procedures in place. From looking at written records it was identified that not all staff have undertaken training in this area. During a walk around the building several residents were spoken to confirming that they had everything they needed in their individual rooms, some comments included, “Our bedroom is tidy”, “the cleaners do a good job”, “I have my own bedroom and we share the kitchen and bathroom”, “I like it here, it is quiet”. A laundry assistant was spoken to and some records in relation to health and safety, Control of substances hazardous to health (COSHH) were looked at confirming that the laundry is run in a way that ensures the health and safety of the residents. All cleaning products were kept in a locked facility and the data sheets were present for each product. The laundry assistant said, “some residents can do their own washing, mainly those in the Mews flats, but there is always a staff member present to help out”. DS0000032128.V352630.R01.S.doc Version 5.2 Page 28 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 & 36 People who use the service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The staffing levels are sufficient in order to ensure that the health and safety of people using the service is maintained. People receive support from staff who have been properly vetted and therefore the protection of the residents is promoted. People are supported by staff who have either not received or updated the mandatory training, therefore the health and safety of residents could be compromised. Staff receive supervision, however this is not always on a regular basis. This would ensure that people using the service receive care from staff who are properly supervised and monitored. EVIDENCE: DS0000032128.V352630.R01.S.doc Version 5.2 Page 29 The home has a staff team of 27 consisting of 9 trained nurses (RMN) and 18 care workers; in addition there are laundry assistants, kitchen assistants and domestic staff. From discussion with the manager it was confirmed that since the last inspection the care hours have been remained the same for care hours totalling 835 per week, but currently the domestic hours are decreased by 35 hours per week due to a vacancy and the total is 48 hours. From speaking to staff and residents it was apparent that the staffing numbers were sufficient to meet the basic needs of the residents. Some comments included; “the staffing levels are currently ok”. The home has five care staff and two trained nurses (RMN) on duty at all times, the manager is in addition to this. During the night there are 3 care staff and 1 trained nurse (RMN). From speaking to the manager and the activities co-ordinator it was clear that the activities plan once fully implemented will offer a variety of activities, hobbies and interests to the people living in the home. Several people living in the home said that they feel that currently activities are offered, but would like to do more either within or outside of the home. Staff confirmed, “it would be nice to have more time to spend doing activities”. As the activities co-ordinator has been in post for only 4 weeks this will be fully assessed at the next inspection. Staff meetings occur and written evidence was seen confirming this. There was written evidence confirming that 67 of staff have now achieved NVQ level 2, which exceeds the minimum required amount of 50 , it also ensures that people who live in the home receive support from a well-trained and qualified staff group. During the inspection visit four staff personnel flies were looked at and this confirmed that the home undertakes appropriate checks including Criminal Records Bureau disclosure and two references prior to staff commencing work. One person spoken to during the visit confirmed that residents are involved in the interviewing process, “I helped with the last interviews for staff and I enjoyed this and was happy with the people employed”. The home demonstrates a commitment to involving the people who live in the home within everyday decisions and procedures, therefore promotes inclusion and equality. Internal induction records were available and the manager assured the inspector that induction training to Skills for Care Standards had been carried out with new employees, the records for these are now kept in the home and evidence of this was seen. One new staff member was spoken to the during the inspection visit and it was evident that an in-house induction commences on the first day of employment that is basically a checklist and this covers; roles and responsibilities, general philosophy, statement of purpose and service user guide are issued, a tour of the building and the fire procedure are discussed. It was confirmed by speaking to the training co-ordinator and from observation of written records that all new employees are placed upon the Skills for Care induction and foundation training. DS0000032128.V352630.R01.S.doc Version 5.2 Page 30 Since the last inspection there has been some improvement with regard to the training offered to staff, but records showed that not all staff was up to date with mandatory training, for example, food hygiene, infection control, first aid, health and safety and safeguarding adults. This remains an outstanding requirement from the previous inspection and must be addressed without delay. During the last inspection the training records showed that some support workers had undertaken training in relation to mental health and challenging behaviour. However, the manager must ensure that all staff receive training on mental health and challenging behaviour. This is required to ensure that staff have the skills needed to meet the changing needs of the people in their care. This requirement will remain outstanding until all of the staff have undertaken the training. The home has a separate training budget and there is a programme of inhouse training, as well as external courses available to staff. Supervision records were looked at and staff were spoken to, it was confirmed that supervision is offered to all staff, but it is not occurring as regular as it should be. Some comments from staff included, “everyone is supportive, the manager is approachable and he listens to what I say”, I make sure I get supervision about once a month”. Staff did confirm that they could go to the manager for advice on an informal basis. Staff were observed interacting with the residents throughout the visit, this was done in a sensitive and respectful way. From speaking to the people who live in the home it was clear that they had developed good relationships with the staff and manager and some comments included; “the staff look after me really well”, “I like it here”, “the staff are good”, “most of them are ok”. One person said, “some staff are rough with me”, when asked what was meant by rough the person explained that it was in relation to staff assisting with shaving and commented that the “male staff tend to be not as gentle”. The senior member of staff who was present agreed to discuss this with the manager and look at how this can be addressed to ensure that all staff are ‘gentle’ when assisting anyone. Both staff members who were spoken to could clearly describe the needs of the people living in the home and how they are to be assisted. Surveys from a health care professional and a care manager were received and these contained positive comments about the staff and the manager. Some of these included; “they respond and inform me re all of the care needs as requested and I am involved in all decision making”, “personalised and professional care”. A visiting social care professional was spoken during the visit and commented, “staff are welcoming and offer you a drink”, “privacy is respected”, “they have done a very good job with my client, she presents much happier”, “the staff and manager are approachable”, “my client is well-cared for and I have nothing negative to say about the home”. DS0000032128.V352630.R01.S.doc Version 5.2 Page 31 DS0000032128.V352630.R01.S.doc Version 5.2 Page 32 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,41 & 42 People who use the service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People live in a well run home, there is clear leadership and an open door policy ensures that residents are able to speak to the manager on a regular basis. The quality assurance system seeks the views of the people who live in the home, their relatives, staff and other professionals recorded and evaluated, therefore currently the system does reflect the views of the service users or their representatives. People using the service receive support from staff who have either not undertaken or updated essential health and safety training including; health and safety, first aid, safeguarding adults, infection control and food hygiene and therefore their health and safety may be compromised. DS0000032128.V352630.R01.S.doc Version 5.2 Page 33 EVIDENCE: The manager originally trained in the nursing field and is a qualified RMN, he has also completed a recognised management course. During discussion he said that he had recently undertaken some refresher training in relation to fire awareness, health and safety, safeguarding adults and infection control. Following discussions with several people who live in the home and with some members of staff it was confirmed that overall the manager was approachable and deals with any issues quickly and efficiently. Some comments included; “Mike is great, he’s like a father to me”, “I would go to the manager if I had any problems”, “the manager is approachable and he listens to what I have to say”, “at Barrow Hall it works well because of team leadership from the manager”. Several of the surveys received from staff members stated that they did not feel supported and some said, “sometimes the manager is not as supportive as I would like”, “usually he criticises work rather than give any positive feedback”. These comments were discussed with the manager and he acknowledged that there had been some staffing difficulties recently due to changing ways of working. Some of the comments also related to the company rather than the manager; “the company does not support the home and doesn’t understand the mental health issues”, “the company is less supportive, they took over 4 years ago and since then there have been cut backs”. On examination of records some of the systems required for the effective overall management of the service were not fully developed for example, mandatory training, staff supervision and development. This means that people living in the home may receive support from staff who have not been trained in essential areas that would maintain their health, welfare and safety. Since the last inspection the quality assurance system has been further developed. The manager explained that the home no longer uses an independent company to carry out a yearly audit. The audit is undertaken internally and the manager said, “a quality assurance and training manager has just undertaken a 2 day audit of the quality assurance system and an action plan and report will produced within the next few weeks”. The manager confirmed that a copy will be forwarded to the CSCI. It was confirmed by looking at the quality assurance records that surveys are sent out on a six monthly basis to all stakeholders including the people who live in the home, their relatives/representative, staff and other professionals. The person who collates the information said, “I am currently preparing the shortfalls and any DS0000032128.V352630.R01.S.doc Version 5.2 Page 34 corrective action. Following the inspection visit an annual report was produced and a copy of which forwarded to the CSCI this information has also been made available to the people living in the home. There is a comprehensive health and safety statement and policies in place. Inspection of water temperature records indicated that water temperatures were now being done on a monthly basis. Inspection of other records for example, fire alarm system check, emergency lighting were found to be up to date. The electrical wiring certificate was available for the inspector to see as was the portable appliance testing which was completed in May 2007. The provision of mandatory training for example, moving and handling, fire safety, basic food hygiene, first aid and COSHH ensure safe working practices for staff, however gaps in this training were found and the registered person must address these without delay Risk assessments for equipment in the home are completed and these ensure safe working practices to protect the health, welfare and safety of service users and staff. Since the last inspection the individual risk assessments have been further developed. They clearly describe what the risk is, any triggers or symptoms and how the risk can be managed or minimised. Inspection of accident records found that all accidents were recorded in an accident book and a complete report maintained in the individual service users files. A weekly accident report was sent to the company. Completed Regulation 37 notices were sent to the CSCI. The records for service users finances were inspected. All benefits were paid into individual service user accounts. Some residents had appointees for example, court of protection, solicitors, family members and social services. There is a bank account made out in the name of Barrow hall for some service users which the inspector was informed was the only way the account could be set up with the appointees being the registered person and another member of staff as the second signature on the account. The manager has produced a procedure with appropriate guidance of what to do and how it is to be done and it states that residents should always be given the opportunity to manage their own money if they are able to do so. Equality and diversity is promoted to some extent within the home. The residents have a range of diverse needs including mental health issues, depression, schizophrenia, anxiety disorders, alcohol and drug related issues. The home employs both male and female staff. The staff group have not DS0000032128.V352630.R01.S.doc Version 5.2 Page 35 received any training in relation to equality and diversity and this would promote empowerment for the residents. The registered manager stated that all new staff will undertake induction and foundation training that meets Skills for Care specification. DS0000032128.V352630.R01.S.doc Version 5.2 Page 36 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 X 28 3 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 3 3 3 2 X DS0000032128.V352630.R01.S.doc Version 5.2 Page 37 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 YA9 Regulation 13 & 15 Requirement The registered person must ensure that people living in the home are involved when a detailed behaviour management plan(s) is developed. These must be subject to regular review and monitoring and the person or their representative signs the plan. This would ensure that the individual and their representative are involved in the decision making process and participation promoted. The registered person must ensure that risk assessments and intervention plans are in place to support the use of physical interventions. The plans must ensure that a specific description of the interventions to be used. Risk assessments and care plans must be agreed with a multi-disciplinary care team and the service user, this would promote inclusion and the use of physical intervention would be a joint decision. (Previous timescale – 25/02/07 not met) DS0000032128.V352630.R01.S.doc Timescale for action 22/03/08 2 YA23 13 & 15 22/03/08 Version 5.2 Page 38 3 YA23 13 & 18 4 YA32 18(1) c, 12(4) b Staff must undertake training in 22/02/08 relation to safeguarding vulnerable adults, this would ensure that staff are aware of their responsibilities and the protection of the people living in the home would be maintained. (Previous timescale – 25/02/07 not met) Staff training and development 22/02/08 programme includes specialist subjects around mental health problems, challenging behaviour or difficult to help residents and all other mandatory training including infection control, health and safety, food hygiene and first aid must be undertaken to ensure that people using the service are supported by a welltrained staff group who can ensure their health and safety. (Previous timescale – 30/12/06 not met) Staff must be appropriately supported and receive regular supervision as this would ensure that people using the service receive care from staff who are properly supervised and monitored. (Previous timescale – 30/12/06 not met) 22/02/08 5 YA36 18 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 YA16 Good Practice Recommendations Staff should only enter the bedrooms’ of people living in the home when they have sought permission to enter, this DS0000032128.V352630.R01.S.doc Version 5.2 Page 39 2 YA20 3 YA20 4 YA20 5 YA24 is to ensure that privacy is maintained. Medication in use and in date should be carried forward and recorded onto the Medication Administration Record as this would ensure there was an accurate record of current medication stock. The person who has ordered the medication should have sight of the prescriptions before they are dispensed, this provides an opportunity to check if any new medicines or dose changes are included. Each person should have a photograph on the Medication Administration Record; this would ensure that the risk of wrongly identifying the person or incorrect medication being given is reduced. The Lodge would benefit from some redecoration and renewal, to ensure that all residents live in a comfortable environment that would meet all of their needs. DS0000032128.V352630.R01.S.doc Version 5.2 Page 40 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 DS0000032128.V352630.R01.S.doc Version 5.2 Page 41 - 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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