Inspection on 11/02/08 for Barrowhill Hall

This inspection was carried out on 11th February 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Barrowhill Hall 23/08/06

Barrowhill Hall 15/11/05

Barrowhill Hall 21/04/05

Barrowhill Hall 30/09/04

Barrowhill Hall 27/05/04

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

CARE HOMES FOR OLDER PEOPLE Barrowhill Hall Barrowhill Rocester Near Uttoxeter Staffordshire ST14 5BX Lead Inspector Rachel Davis Unannounced Inspection 11th February 2008 09:10 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 Barrowhill Hall DS0000004913.V359033.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. Barrowhill Hall DS0000004913.V359033.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Barrowhill Hall Address Barrowhill Rocester Near Uttoxeter Staffordshire ST14 5BX 01889 591006 01889 591951 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) Staffordshire Property Investment Fund Ltd. Nada Ana Evans Care Home 45 Category(ies) of Dementia (45), Dementia - over 65 years of age registration, with number (45), Mental disorder, excluding learning of places disability or dementia (10), Mental Disorder, excluding learning disability or dementia - over 65 years of age (10), Physical disability (5), Physical disability over 65 years of age (5) Barrowhill Hall DS0000004913.V359033.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 10 MD - minimum age 45 years on admission 41 DE - minimum age 45 years on admission 5 PD - minimum age 45 years on admission Date of last inspection 23rd August 2006 Brief Description of the Service: Barrowhill Hall is registered to meet the needs of 45 adults with dementia or mental health related conditions, it may also support 5 people who have a physical disability. Barrowhill Hall can also offer day care to a small number of people. The home is a detached property situated in an elevated position on the outskirts of Rocester, near Uttoxeter. The accommodation is in two buildings, one known as the main house, which is two storeys and served by a lift and staircase, in this part of the home there is a spacious main lounge with a separate dining area. This part of the home is fit for purpose but in need of some refurbishment. Further accommodation known as The Stables is an extention to the main building on ground floor level only. This area has 13 single occupancy bedrooms, all with en-suite facilities. There is a separate lounge and dining room area attached to this part of the home. Staffordshire Property Investment Fund Ltd own this property and have a number of care establishments nationwide, Mrs Nada Evans is the registered manager for this service. Information about the fees for this service were not available as needed, fees must be recorded in the Service User Guide but presently people will need to enquire directly to the home to obtain this information. Barrowhill Hall DS0000004913.V359033.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 1 star. This means people who use this service experience adequate outcomes. This unannounced inspection took place over 9 hours, it was carried out by 2 inspectors who used the National Minimum Standards for Older People as the basis for the inspection. This was the first ‘Key’ inspection of this service for this inspector, during a ‘Key’ all the core Standards are assessed. We also requested the Commissions pharmacist inspector to look at the medication practices within the home, his findings are recorded within the inspection report under Health and Personal Care, in the body of this report. The last ‘Key’ inspection took place in August 2006. In August 2007 we undertook an annual service review, which is an inspection without a visit to the home. We analyse information given to us via questionnaires and the Annual Quality Assurance Assessment which is a legal document completed by the manager of the home. Since August, and following identified areas of concern we have visited the service twice completing random inspections, once in December 2007 and once in January 2008. These inspections confirmed the need for us to bring forward the next key inspection that would have been required around August 2008. During our visit we looked at how people were admitted to the service and the information they had to make a decision. We looked at the life people are able to lead and whether their health and personal care needs are being met. We also looked to see whether people who use the service are being protected and the arrangements the service had for listening to what people thought about Barrowhill Hall. During the visit we met and spoke to a number of people living in the home, some visitors and members of staff. Observations were made of staff and resident interaction around non-personal care tasks, at lunchtime and whilst activities were taking place. The pharmacist inspector also visited the home on the 11th February 2008 as part of the key inspection and carried out an inspection of the medicines management systems being practiced within the home. The inspection comprised of examining the medication storage areas, examining the records kept and having discussions with the care staff and the people who use the service. Barrowhill Hall DS0000004913.V359033.R01.S.doc Version 5.2 Page 6 We looked round the home to see the standard of the accommodation and some of the people living in the home showed us their bedrooms. Potential service users and their representatives are able to gain information about the service from the Statement of Purpose although it needs additions in some areas. Our inspection reports can be obtained directly from the provider or are available on our website at www.csci.org.uk What the service does well: Any person considering moving into Barrowhill Hall is given assurance that the home can meet their needs, they are assessed prior to moving in and are encouraged to visit the home before making any decision. If the Local Authority refers a prospective resident, the manager obtains an assessment from the social worker and in all cases a member of the homes management assesses the person themselves. Peoples’ descriptions of the home are as follows: “I am happy here” “I like coming here, they are nice people.” “ The food is good.” Relatives’ and other visitors comments included: “Staff have a good understanding of health care needs.” “Staff seek advice where necessary.” “My relative appears very happy Care plans and risk assessments are developed for the people who use the service the home has begun to produce new improved plans of care. These are person centred and give a picture of the individual, looking at their abilities as well as their needs. There is evidence to confirm people who use the service have involvement with their own plan of care. Health needs are closely monitored and access to other health professionals is arranged as required, emotional needs appear to be addressed with care and sensitivity. There is a good range of activities and stimulation offered to the people who use the service. The activities co-ordinator has forged strong links with the local community, this means the people who use the service are able to feel part of the community and are encouraged to participate in community life. Barrowhill Hall DS0000004913.V359033.R01.S.doc Version 5.2 Page 7 The management of residents’ monies is robust and safe. When we looked at the way the service recruited staff we found that their procedure was protecting people who use the service. The registered person meets their legal obligation of recording the Regulation 26 visits, completing these means the responsible individual is able to evidence an opinion of, or show how they monitor the standard of care provided at Barrowhill Hall, we will be analysing these to ensure progress in the appropriate areas is being made. What has improved since the last inspection? What they could do better: We are not sure if people who use the service know how to complain, we are not clear if everybody receives a Service User Guide as people we spoke to were unsure. The complaints procedure is outdated and does not offer all the information necessary. Barrowhill Hall DS0000004913.V359033.R01.S.doc Version 5.2 Page 8 Medication systems do not always follow good practice or safe practice guidelines and require action to ensure that the residents are fully safeguarded. There is a strong mal odour in the home, especially in the entrance hall and small lounge. This has been noted on all the visits we have made over the last 3 months, and was also verified by people that we spoke with during the ‘Key’ and random inspections. The manager confirmed new carpets have been purchased for all communal areas and these should be laid within the next 6 weeks, hopefully this will greatly improve the present situation. We have asked the manager to ensure the service is run in a person- centred way, which fully promotes the privacy and dignity of the people who use the service, examples of how we expect the manger to implement these are recorded within the body of this report. The Statement of Purpose and Service User Guide need to give individuals an accurate account of the fees payable. The home may also wish to offer a more “user friendly” version. 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. Barrowhill Hall DS0000004913.V359033.R01.S.doc Version 5.2 Page 9 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 Barrowhill Hall DS0000004913.V359033.R01.S.doc Version 5.2 Page 10 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 adequate. This judgement has been made using available evidence including a visit to this service. Prospective people who use services have a needs assessment carried out before they are admitted to the home. More written information is needed to ensure that people who use the service and prospective residents can make an informed choice about the home. EVIDENCE: The service has developed a Statement Of Purpose and Service User Guide, these set out the aims and objectives of the home, and includes information about the service. They need to be reviewed and include the fees payable and the staffs’ qualifications. There is no reference to smoking in the Statement of Purpose and four people who presently live in the home smoke, there should also be clarity around this situation for prospective residents. Barrowhill Hall DS0000004913.V359033.R01.S.doc Version 5.2 Page 11 Although confirmed by the manager that the people who use the service receive a Service User Guide there was no evidence to verify this. It is recommended that the Statement of Purpose and Service User Guide are made available in a format appropriate to the people who use the service, individual capacity and language. The home may wish to consider an audio or pictorial version. The care records were checked and contained the needs assessment as required, pre admission documentation is sound and offers appropriate opportunities for the manager to assess whether Barrowhill Hall can meet the needs of the prospective user. It was evident the manager has assessed the needs of the resident prior to admission and a subsequent care plan had been developed, this affords staff the information necessary to provide appropriate care. The home operates a key worker system and this should help individuals feel comfortable in their new surroundings and enable them to ask any questions about life in the home. It will also encourage and help staff to develop a person centred approach to care. One person who had recently arrived at Barrowhill Hall said they had settled in well and were happy. Standard 6 is not assessed, as the home does not provide intermediate care. Barrowhill Hall DS0000004913.V359033.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Each person has a plan of care and the practice of involving people who use the service in the development and review of the plan has commenced. Medication systems do not always follow good practice or safe practice guidelines and require action to ensure that the residents are fully safeguarded. EVIDENCE: The care records of two people who used the service were checked during this inspection. A plan of care for both had been developed and reviewed. There was evidence to confirm one individual had been involved with the development of their care plan and the review. It has been confirmed by the Regional Director that a full review of care plans is to be carried out and staff have been instructed that in each case where Barrowhill Hall DS0000004913.V359033.R01.S.doc Version 5.2 Page 13 possible the people who use the service or their relative or representative is to be invited to take part in the review. The manager confirmed that staff are also receiving training in care planning. Care plans will now contain more succinct information around areas of need such as personal care, recreation, nutrition, spiritual needs, sexuality, life skills, hobbies etc. The plans of care did include an assessment of risk for moving and handling and the information on how to manage this risk is then recorded on the plan of care and subsequent reviews. It is recommended that in some instances risk assessments are expanded upon or post risk assessments implemented. Examples of these included medication management, smoking and incidents or accidents especially falls, in all instances the information recorded could be improved upon. From observation, it was evident, that staff have ensured that individuals are able to receive support to address personal care issues and personal hygiene. There was evidence to confirm that professional visits are offered and provided as is necessary, one visiting professional spoke to the Commission and stated, “ The staff have a good awareness and refer to us when needed.” The pharmacist inspector visited the home on the 11th February 2008 as part of the key inspection and carried out an inspection of the medicines management systems being practiced within the home. The inspection comprised of examining the medication storage areas, examining the records kept and having discussions with the care staff and residents. The findings of the inspection were then fed back to the manager at the end of the visit. We found that on the whole the recording the receipt of medicines into the home was occurring. We found that medication held over from the previous month was in the main being taken into account to give a grand total for the start of the new monthly medication cycle. However, the audit sampling process showed that some people were not receiving their medication as prescribed by their doctor. The audit process showed that the Medicine Administration Record (MAR) charts had been signed when the medication had not been administered. We also found other poor practice issues with the MAR charts and these included undefined generic abbreviations, handwritten entries being poorly written out and not checked for accuracy by other suitably trained members of staff and the attaching of additional dispensing labels to the MAR charts. Where variable doses had been prescribed the records did not show what quantity had been given. The care plans were also lacking information about medicines that had been prescribed on a when required basis for the treatment of anxiety and Barrowhill Hall DS0000004913.V359033.R01.S.doc Version 5.2 Page 14 aggression. Risk assessments had been carried out, for the residents case tracked, but there was no mention of what medication was to be used, what behavioural triggers would result in the administration of the medication, what the maximum daily dose was and what intervals were required between doses. We also found that one of the residents was self administering their insulin. The home kept possession of the insulin and the injections were done under supervision of the staff. Again there was no information in the care plan about the procedure and what the staff could and could not do. Although the staff were supervising the resident to ensure that the injecting procedure was carried out correctly none of the staff had received any training to know what the correct technique was. The Controlled Drugs cabinet found within the home was breaching the Misuse of Drugs (Safe Custody) Regulations because it had not been attached to the wall. We found failings in the recording of Controlled Drugs in the Controlled Drugs register. These were highlighted to the Manager, who was asked to rectify the issues and ensure that the Controlled Drugs register was an accurate recording of the receipt, administration and disposal of Controlled Drugs. We found that the residents’ current medication was stored in two mobile drugs trolleys. One of these trolleys was stored in the bottom lounge and the other in the top lounge. We found that the temperature of these lounges was exceeding the maximum temperature required to store medication. The home was asked to store the trolleys, when not in use, in the treatment room as the temperature of this room remained within the acceptable temperature range. The maximum and minimum temperatures of the fridge were not being recorded on a daily basis, although the home had the correct thermometer. The reading on the maximum and minimum thermometer showed that the fridge was not being maintained at between 2 and 8°C and as a consequence the home was asked to remove and destroy the insulin and eye drops contained within the fridge and seek new supplies. We also found that a tube of Daktacort cream, which must be kept in the fridge, was being stored in the excess stock cabinet. We also found that a tube of Betnovate RD ointment was being kept in a downstairs bathroom, which meant that the ointment was available to unauthorised people. We found that the majority of staff who administered medication to the residents had received training on the safe handling of medicines. Those staff that have not received any training must do so as a priority. We also found that the staff had not been assessed and were not receiving ongoing assessments for their competency to handle and administer medication safely. Barrowhill Hall DS0000004913.V359033.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is flexible and provides a service with opportunities for interaction and events within the current staff and resources. Activities and stimulation are in place and people are able to maintain good relationships with family and friends and receive visitors at any time. EVIDENCE: The home has a structured activity programme but also offers a variety of activities according to preferences each day. Activities tend to occur from Monday to Friday, which is when the activity coordinator is contracted to work. A lengthy discussion was held with the co-ordinator who confirmed activities take place on a one to one basis and in small groups, examples of these included dominoes, reminiscence, crafts, knitting, skittles, ballroom dancing quizzes and word searches. The home has access to a community mini bus, and people who use the service go to a local friendship club, tea dances and bingo nights. Some people who use the service are taken for walks and where an individual has a Barrowhill Hall DS0000004913.V359033.R01.S.doc Version 5.2 Page 16 particular hobby the staff and activities coordinator will try to ensure appropriate information etc is made available. From discussion with people who use the service, and from observation of practices, individuals are able to retain control of their lives and were given opportunities to make informed decisions. Discussion with people who use the service confirmed there were no restrictions on visiting from family and friends. The home has two separate dining areas and everyone was given the choice of where to take their meal. Some people who use the service ate in their bedrooms and other people ate in the lounge area with a cantilever table, it is recommended that more of these tables are purchased to assist people who choose not to sit at the dinner table. The cook has a 4-week menu cycle, it is recommended that this could be expanded upon to 6 weeks if possible, all of the meals are ‘home-cooked’ and home-baked cakes and puddings are available. The kitchen is well maintained, it was inspected and found to be clean and tidy. All the required records were in place including fridge and freezer temperatures, meat probing and cleaning duties. Food supplies are plentiful and fresh fruit and vegetables are available. We noticed that people who use the service are offered an alternative meal but there was little evidence of written or visual prompts to enable people who use the service to know what was for dinner. The 4 weekly menu was on the notice board in the main lounge but in did not marry with the meal of the day. It is particularly difficult to offer choices to people with dementia and related conditions, who either forget what they asked for or in many cases cannot communicate their wishes. The home could look at offering more visual choices such as developing menus in photo format. Some people who use the service may be able to choose their own vegetables from a separate dish or decide whether they fancy gravy or a sauce that day by having them in sauceboats or jugs. Presently no liquidized meals are being provided, but should they be required the cook has moulds available in the shapes of vegetables etc and liquidizes all parts of the meal separately. This is considered very good practice because it enables people to experience a variety of taste, texture, colour and visual stimulation. All areas of the kitchen were clean and well presented, crockery and cutlery were of a satisfactory standard, and the home should consider if plastic Barrowhill Hall DS0000004913.V359033.R01.S.doc Version 5.2 Page 17 disposable cups are appropriate for the dinner table, hot drinks are served in suitable cups or mugs. Barrowhill Hall DS0000004913.V359033.R01.S.doc Version 5.2 Page 18 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. The home has a complaints procedure which needs to be amended and there needs to be evidence to confirm that people who use the service are encouraged to express their concerns. Training in the protection of vulnerable adults must be provided to all staff. EVIDENCE: The recruitment of staff to Barrowhill Hall follows the requirements and therefore people who use the service are protected from abuse in this area. A safeguarding alert received by the Commission has been investigated and poor practice issues evidenced during the initial random inspection have been addressed by the home. We found the people who use the service were not always being consulted on the time they got up, on our first random inspection to the home in December 2007, 15 people were up and dressed at 05:35. On our second unannounced visit only 3 people who use the service were up and dressed. The regional director and manager of the home have also done a spot check at this time in the morning and have advised the Commission that they will continue to do so. The complaints procedure is displayed on the notice board as you enter the home and is in the Service User Guide. Barrowhill Hall DS0000004913.V359033.R01.S.doc Version 5.2 Page 19 The procedure records that individuals can make a complaint at any time, and if not resolved can approach the Commission for Social Care Inspection. The service must review the procedure to inform people that they are able to contact the Commission at any time, and the correct contact details and phone number are to be recorded. The home should consider making the complaints procedure available in other formats and consider how people with complex conditions are able to voice any of their concerns. The home should also consider offering people other alternatives such as a suggestions box and /or a comment, compliments, grumbles book. The manager confirmed she is happy to promote the recording of complaints in a transparent manner and these had been documented following the last random inspection but the home still needs to develop this approach. We are aware some complaints and/or concerns are not recorded in the complaints log and this was discussed with the manager during the inspection. Recording all matters will enable the home to see if there are any patterns and trends and also evidences that the manager is open and transparent and happy to record issues and outcomes. Not recording concerns etc does not allow the home to evidence that it has learnt from the process, and the same issues do not reoccur. Staff working at Barrowhill Hall have some understanding around restraint issues but practice around the use of equipment such as bed rails, locking bedroom doors and keypads is too focused on keeping people safe. Individuals and their families need to be involved in the assessment. It was clear that visitors were not able to access their relatives’ bedrooms and therefore had no choice but to meet with their family in the lounge area. This does not offer choice or privacy and must be addressed. Any restrictions (i.e. locking bedroom doors during the day) must be assessed and considered in a multi disciplinary way, the home cannot make these judgements alone. Following the safeguarding referral and subsequent visits to Barrowhill Hall we made a requirement that all staff must be trained in the Protection of Vulnerable Adults and in raising an alert. This has still to be completed, a training date was scheduled for 25.01.08 but this was cancelled, this training needs to be provided as a matter of priority. To ensure that people are protected from harm and abuse, staff must be aware of how to recognise signs of abuse and how to safeguard people and the manager must be clear on how to respond to an alert. The manager needs to confirm that the guidance has been reviewed in the context of the Government guidance ‘No Secrets’, and in line with the Safeguarding Adults protocol and Guidance agreed by the Commission for Social Care Inspection (CSCI), the Association of Directors of Social Services (ADSS) and the Association of Chief Police Officers (ACPO). Barrowhill Hall DS0000004913.V359033.R01.S.doc Version 5.2 Page 20 It is strongly recommended that the home is in receipt a copy of the Safeguarding of Adults policy to ensure they are aware of new procedures. Barrowhill Hall DS0000004913.V359033.R01.S.doc Version 5.2 Page 21 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 and 26. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home is clean and comfortable, but there is a strong mal odour in communal rooms. EVIDENCE: Barrowhill Hall stands well, it has an elevated position with fantastic views of Uttoxeter and the surrounding countryside. A tour of the environment was taken and confirmed Barrowhill Hall is clean and comfortable. Redecoration and upgrading of all the bathrooms and toilets is presently occurring. New carpets are also being provided in all communal areas, which should address the strong mal odours noted, especially in the reception area and lounges. Barrowhill Hall DS0000004913.V359033.R01.S.doc Version 5.2 Page 22 In the bathrooms and shower rooms large amounts of toiletries were stored in unlocked cupboards, this is a danger, especially as the home is registered to provide care for people with mental health and dementia related conditions, it also gives an impression of communal usage. The manager should complete a risk assessment to ensure that people who use the service are safe. We discovered that the temperature of the water is not tested prior to bathing, this should be undertaken with the use of a thermometer. During our inspection we saw that some fire doors were propped open with door wedges, this is not acceptable and does not conform to fire Regulations. If a fire door is to remain open they must be fitted with a suitable devise to enable this, the fire officer must approve these devises. Bedrooms were seen and personalised, the people were happy with their private space, issues around the locking of bedroom doors has been addressed under Complaints and Protection. The laundry area was not inspected on this visit. Infection control measures are in place, examples of this include: paper towels, liquid soap, hand sanitizer and personal protective clothing. Barrowhill Hall DS0000004913.V359033.R01.S.doc Version 5.2 Page 23 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 adequate This judgement has been made using available evidence including a visit to this service. In most instances the manager ensures that the home is staffed at all times by a sufficient number of trained personnel. EVIDENCE: It has been confirmed that there should be 6 staff on days 6 staff on afternoons and 4 staff during the night. There are presently 5 vacancies at Barrowhill Hall, which is putting a strain on the remaining staff. It was confirmed staff morale was low and a consistent approach when using agency staff is difficult to achieve. On the day of inspection one member of staff had called in sick and so there were 5 staff on duty that morning. The manager is super numery but does occasionally work ‘on shift’, there are adequate domestic, administrative, maintenance and kitchen hours to meet the needs of the people who use the service. During the random inspection in December 2007 we looked at 5 staff files, new staff were recruited appropriately and files contained the necessary information. We asked for the manager to provide us with evidence of work permits where identified, and the Commission has recently received these. Barrowhill Hall DS0000004913.V359033.R01.S.doc Version 5.2 Page 24 The manager has audited the staff files and confirmed all evidence is in place to substantiate robust recruitment practice. In December 2007 we looked at some training records and noted some staff have not received training in the recognition of abuse, this requirement has not yet been met. Support and training must be provided for all staff in relation to Safeguarding adults to ensure staff are aware of types of abuse and neglect and can respond to an alert. The manager confirmed all other mandatory training was up to date. We are aware the service has provided some specialist training for staff and the manager is presently ensuring all staff receive training in the completion of care plans. The home should consider offering staff training in equality and diversity. The registered manager has obtained the Registered Managers Award, this is a legal requirement for managers of a care service. During the time we spent at the service we spoke to a number of staff and observed them supporting people. We found there were positive and engaging interactions between those people living at Barrowhill Hall and the staff members. Barrowhill Hall DS0000004913.V359033.R01.S.doc Version 5.2 Page 25 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): 31, 33, 35 and 38. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The registered person needs to promote safeguarding and continue to improve upon the health and safety requirements and legislation, this will ensure the wellbeing of people who use the service. EVIDENCE: The manager is qualified or has the necessary experience to run the home. The manager understands person centred planning and thinking but there is minimal evidence presently to show the translating of this theory into practice. When we completed the annual service review in October 2007 we sent surveys to a number of people using the service and the staff . Ten were returned to us by people using the service and five by staff providing the care. Barrowhill Hall DS0000004913.V359033.R01.S.doc Version 5.2 Page 26 These gave us information about how the service is managed, whether people using the service are satisfied and whether the staff have the training and support required to meet their needs. This information is recorded within the annual service review report. On this visit we did not check all maintenance records but we have been informed by the manager on the Annual Quality Assurance Assessment the dates of all required tests. The Annual Quality Assurance Assessment was completed by the manager prior to the annual service review. All sections of the Annual Quality Assurance Assessment (AQAA) were completed (this is a legal document and must be provided by the agency prior to an inspection.) The information gave a reasonable picture of the current situation within the service. The evidence to support the comments made was satisfactory, although there were areas where more supporting evidence would have been useful to illustrate what the service has done, or how it is planning to improve. The home should continue to consider ways in evidencing equality and diversity within their service. Records of supervision were evident and discussions with staff confirmed these took place, staff felt they were able to speak with the manager and that she was supportive. There is evidence of regular staff meetings, which are minuted. We checked the accident book and noted that of the two incidents we were looking at only one had been appropriately recorded, the home was still using an incident book, which does not comply with DATA Protection. This has been raised with the home during the first random inspection; information on a number of people who use the service cannot be stored in one book. It was removed during this inspection. Where the home is responsible for resident’s money it works to a safe system and maintains clear records. A sample of individuals’ money was scrutinized on this visit and all records tallied. A very small number of people manage their own money, the service may be able to become more proactive in developing skills in this area, certainly assessments should be available to confirm why people who use the service do not manage their own money. Barrowhill Hall DS0000004913.V359033.R01.S.doc Version 5.2 Page 27 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 2 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Barrowhill Hall DS0000004913.V359033.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes 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 OP1 Timescale for action 5(2) Barrowhill Hall must confirm they 01/04/08 have provided a Service User Guide to each person who uses the service or their representative. This then enables people to understand what is available, how to complain, the terms and conditions, the address for the Commission for Social Care Inspection and will assist people to make informed choices. 4(1)(c) The Statement of Purpose needs 01/04/08 to include information on the staffs qualifications to offer awareness to people who use the service and prospective users on the training offered by the service. (5)(1)(bb) The fees must be included within 01/04/08 (bc)(c) the Service User Guide so people who use the service know the appropriate cost and what is included. 13(2) The records of the receipt, 01/04/08 administration and disposal of medicines for the people who use the service must be robust and accurate to demonstrate DS0000004913.V359033.R01.S.doc Version 5.2 Page 29 Regulation Requirement 2 OP1 3 OP1 4 OP9 Barrowhill Hall 5 OP9 13(2) 6 OP9 13(2) 7 OP9 13(2) 8 OP9 13(2) 9 OP16 22(2) 10 OP18 17(1)(a) Schedule 3 (q) 11 OP19 13(4)(a) that all medication is administered as prescribed. Appropriate information relating to medication must be kept, for example, in risk assessments and care plans to ensure that staff know how to use and monitor all medication including “when required” and self administered medication to ensure that all medication is administered safely, correctly and as intended by the prescriber to meet individual health needs. Staff who administer medication must be trained and competent and their practice must follow written policy and procedures to ensure that residents receive their medication safely and correctly. The Controlled Drugs cabinet is fixed to the wall in order to comply with the Misuse of Drugs (Safe Custody) Regulations. Medication must be stored within the temperature range recommended by the manufacturer to ensure that medication does not loose potency or become contaminated. The complaints procedure must be appropriate to the needs of the people who use the service, and offer up to date information. A record of any limitations as to the service users freedom of choice or liberty of movement must be available, it must be discussed and considered in a multi disciplinary way. The manager needs to complete a risk assessment to ensure that the people who use the service are safe when toiletries are stored in unlocked cupboards. DS0000004913.V359033.R01.S.doc 01/04/08 01/04/08 11/05/08 11/03/08 01/04/08 01/04/08 01/04/08 Barrowhill Hall Version 5.2 Page 30 12 OP19 16(2)(k) 13 OP30 13(6) 14 OP38 17(1)(a) The care home needs to be kept free of offensive odours Previous requirement 31/01/07 not met Support and training is to be provided for all staff in relation to Safeguarding adults to ensure staff are aware of types of abuse and neglect and can respond to an alert. Previous requirement 01/02/08 not met A record of all accidents should be recorded in the appropriate place, in this instance the accident report book. Previous requirement 21/01/08 not met 01/03/08 01/04/08 01/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP1 OP1 Good Practice Recommendations The home should develop a more user friendly Statement of Purpose and Service User Guide to assist people who use the service with diverse and/or complex needs. The Statement of Purpose should advise people that Barrowhill Hall is a home where people who use the service can smoke. This then ensures that people are able to make an informed decision about whether to use this service. It is recommended that some of the information in the care plans be expanded upon to ensure the staff know exactly what support is required for each individual and any associated risks. Care plans to reflect what choices people who live in the home are given about how their medicines are administered and their consent to the way in which nurses administer their medicines. Where consent is not possible because of lacking capacity records should be made of the agreement that the way in which medicines are DS0000004913.V359033.R01.S.doc Version 5.2 Page 31 3 OP7 4 OP9 Barrowhill Hall 5 6 7 8 9 10 11 12 OP9 OP9 OP9 OP15 OP15 OP15 OP15 OP16 13 14 15 OP18 OP30 OP33 administered is in the best interests of that particular person. All staff administering medication should undergo periodic assessments to ensure their ongoing competency to follow the home’s procedures correctly. The fridge temperatures are monitored on a daily basis using a maximum and minimum thermometer. The medication storage areas are kept clean and well organised thus reducing the risks of picking the wrong medication. The home should ensure people who use the service know what is on offer at mealtime. The home should increase the variety offered over a 6week period if possible. The home should consider if all people who use the service should drink from plastic disposable cups. The home should provide more cantilever tables for people who use the service who choose not to sit at the dinner table The home could improve upon the recording of complaints, however minor they may appear, including the outcome, this will further evidence the homes openness and transparency. The home should ensure they have a copy of the Safeguarding of Adults policy. The home should consider offering staff training in equality and diversity. The home should continue to consider ways in evidencing equality and diversity within their service. Barrowhill Hall DS0000004913.V359033.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Barrowhill Hall DS0000004913.V359033.R01.S.doc Version 5.2 Page 33 - 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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