Inspection on 22/11/07 for Barton Court

This inspection was carried out on 22nd November 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Barton Court 03/05/06

Barton Court 29/11/05

Barton Court 17/05/05

Barton Court 07/12/04

Barton Court 09/08/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Barton Court New Road Minster On Sea Sheppey Kent ME12 3PX Lead Inspector Christine Lawrence Key Unannounced Inspection 22 November 2007 09:30 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 Barton Court DS0000023901.V353151.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. Barton Court DS0000023901.V353151.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Barton Court Address New Road Minster On Sea Sheppey Kent ME12 3PX 01795 878003 01795 871296 emma.hodges@kcht.org.uk www.kcht.org Kent Community Housing Trust 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) Post vacant Care Home 41 Category(ies) of Dementia - over 65 years of age (25), Old age, registration, with number not falling within any other category (16) of places Barton Court DS0000023901.V353151.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3 May 2006 Brief Description of the Service: Barton Court is owned by Kent Community Housing Trust and is one of 10 homes in the Kent area. The company also has other homes in Bexley and in Greenwich. The home occupies premises that were originally custom built for the local authority but were taken over by KCHT some years ago. It provides accommodation for 41 older people, some of who have a diagnosis of dementia. There is a designated unit which accommodates some of the people with more advanced dementia. The home is within walking distance of the village of Minster and close to local shops and other amenities. It is near a bus route. The fees charged by this service are £358.92 for residential clients and £469.61 for people needing extra support due to their dementia. These amounts are per week. Information about the home, including a copy of the last inspection report will be made available on request to the home. Barton Court DS0000023901.V353151.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit to Barton Court was unannounced and I was there from 09.30 till 15.00. I spoke to the manager and other staff, including team leaders and also briefly to the general manager of KCHT’s Kent and Medway homes. I made observations of staff supporting and interacting with residents. I spoke to several residents and made a tour of the building with the manager. Residents completed five surveys and relatives completed two surveys and information from them is used in this report. There were also two surveys completed by care managers and four completed by staff at the home. The previous registered manager retired in the summer and the current manager (not yet registered) provided further information by completing the Annual Quality Assurance Assessment (AQAA) form. Information from the previous inspection is also used for this report. What the service does well: What has improved since the last inspection? Since the last inspection the following things have been done, as required from the previous report:- recruitment procedures now include the appropriate records; several of the toilets have been raised; staff have received training regarding adult protection; a new hoist has been purchased and the work surface has been replaced in the dementia unit’s kitchenette. The odour noted in the dementia unit lounge has been resolved by the replacement of the carpet. Barton Court DS0000023901.V353151.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Barton Court DS0000023901.V353151.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Barton Court DS0000023901.V353151.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be confident that the home judges that it can meet their needs. EVIDENCE: Seven individual records were looked at for this inspection. The manager also provided written information through the completion of the Annual Quality Assurance Assessment (AQAA). At the site visit she confirmed that assessments are undertaken prior to a person being admitted to Barton Court. She or her deputy undertakes the assessments. Examples were noted of residents and their relatives (where appropriate) being involved and asked to contribute. I noted that information is then used to compile care plans (see standard 6). Barton Court DS0000023901.V353151.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. 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. Residents would benefit from having a person centred plan of care which involves them more in identifying how their health and care needs are to be met. They are protected by the home’s procedures for dealing with medication but this needs to be underpinned by up to date written policies. They can be confident that they will be treated with respect. EVIDENCE: Seven care plans were looked at for this inspection. They included a service user profile which provides basic information; a social history which provides background information of the individual; identification of care needs (personal; medical details; nutrition, appetite and eating problems; activities, social and cultural needs; behaviour; and daily routines); and a format for noting that the plan is reviewed on a monthly basis. A record is maintained indicating individuals’ involvement with healthcare professionals such as GPs, community nurses, opticians etc. At the previous inspection in May 2006 the commission was informed that new care plans were being developed by the Barton Court DS0000023901.V353151.R01.S.doc Version 5.2 Page 10 organisation and these would be gradually introduced. At this visit I was informed that this is still awaited. It is clear that the care plans need some improvements to more fully reflect a person centred approach, especially for residents with dementia. The home involves individuals to a certain extent, for example in establishing preferences for times to get up and go to bed; maintaining appearance; choices about food and activities but more could be done to enable staff to support residents to be more involved in the plans which will affect their lifestyle and quality of life. There were also examples of families being involved especially by providing information about a person to be included in the ‘social history’ part of the care plan but some of this is limited. For one person there was no social history, so important information about his background and experiences might only be known by some staff. Of the four staff surveys completed three answered ‘always’ to the question “Are you given up to date information about the needs of the people you support or care for?” and one answered usually. Of the two care managers who completed surveys both answered ‘usually’ to the question asking if the right service is planned and given to individuals and both answered ‘usually’ to the question about health care needs being properly monitored and attended to. One care manager gave a particular example of good practice relating to involving a healthcare professional. One care manager commented that the care plan documentation could be improved especially when identifying and sharing knowledge and techniques relating to dealing with any behavioural issues. The service user surveys reflected mostly ‘always’ and ‘usually’ with regard to the questions about receiving the care and medical support needed, with only one person indicating ‘sometimes’. There is a policy in place regarding medication but this has not been reviewed since September 2005. The manager informed me that all policies and procedures are due to be reviewed and updated in the New Year. She has a copy of the new Royal Pharmaceutical Society of Great Britain’s guidance (The Handling of Medicines in Social Care), which she will use to ensure that all procedures within the home are compliant. The storage is satisfactory but there are plans to refurbish the treatment/medication room. Staff who dispense medication have received training. One care manager gave an example of good practice with regard to staff approaching a problem with a resident and their medication. There is screening in shared rooms and staff were observed to knock on residents’ bedroom doors. An individual’s preference for how they wish to be addressed is noted in their individual records and staff were observed to be respectful and polite to residents. Barton Court DS0000023901.V353151.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. 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. Residents can be confident that their preferences will be responded to as far as possible and that they will be enabled to maintain contact with friends and family. Residents are given opportunities to make choices, therefore allowing for some level of control over their lives. The meals in this home offer both choice and variety and catering for special needs. EVIDENCE: Residents’ past interests are noted in their individual records and this includes religious practice if the resident wishes. I discussed with the manager that it would be helpful for some written information about an individual’s religion within their record to ensure that all staff have an understanding of what might be important to that person. There were examples of how the home supports people to practice their religion. Choices are available at mealtimes and the care plans reflect residents’ choices about their routines. Residents’ surveys had two ‘always’ responses to the question about activities that can be enjoyed and one person answered ‘usually’. Two people said ‘sometimes’ but one of these clearly identified that they preferred not to join in activities. One person said they liked to join in the in-house entertainments and also enjoyed the Barton Court DS0000023901.V353151.R01.S.doc Version 5.2 Page 12 minibus outings. There were examples of relatives being made welcome and one person confirmed that staff always were helpful and friendly. One comment included within a survey was “…our family are very close and the staff always allow us to stay that way…”. With regard to liking the meals at the home three residents’ surveys reflected ‘always’, one said ‘usually’ and one person said ‘ sometimes’ commenting that they especially enjoy the beans on toast. The home can provide special diets when required. Barton Court DS0000023901.V353151.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. 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. Residents/their representatives can be confident that any concerns will be taken seriously and responded to. Staff spoken to were very clear about their responsibilities relating to protecting residents. Residents would benefit from policies, procedures and guidance for staff which are up to date. EVIDENCE: Four of the five residents who returned surveys said they always know who to speak to if they were not happy. Four of them said yes that knew how to make a complaint and one said that their relative would do that for them if necessary. Both the relatives who returned surveys said they knew how to make a complaint. One person added the comment “…the manager is very approachable and issues I have had in the past have been dealt with immediately…”. Two complaints have been received by the home in the last twelve months; one was resolved within 28 days and was not upheld and the other is currently being investigated. A safeguarding vulnerable adult’s alert was raised by the local social services department out of this complaint and an investigation is being undertaken at this time. The manager confirmed that she is providing information as requested by this investigation. All four of the staff who completed surveys confirmed that they knew what to do if a resident or a relative expressed any concerns. Barton Court DS0000023901.V353151.R01.S.doc Version 5.2 Page 14 Staff spoken to during the visit were aware of their responsibilities regarding protecting people from abuse. Many of the policies and procedures relating to concerns and adult protection need to be reviewed to reflect current practice as most of them were last reviewed in September 2005. The organization needs to ensure that staff have the most up to date guidance reflecting current good practice. This includes aggression towards staff, concerns and complaints, dealing with violence and aggression, disclosure of abuse and bad practice, gifts to staff, management of service users’ finances, physical intervention and safeguarding vulnerable adults. The policies and procedures in place may still be relevant but this needs to be confirmed through review. The manager confirmed that this was taking place in the New Year. Staff have received training in respect of adult protection. Barton Court DS0000023901.V353151.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. 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. Residents benefit from living in a safe, well maintained home. They will further benefit from planned refurbishment. Residents would benefit from all care staff receiving safe food handling training. EVIDENCE: A handyman is employed at the home and decorating and maintenance are ongoing. There are plans in place for further refurbishment and replacement of furniture as it has been identified that improvements are necessary. There is no date in place for this work to start but it will be in the near future. The rear garden is accessible to residents and some also choose to sit out the front of the building. The manager informed me that there are also plans to improve the garden. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in private. Barton Court DS0000023901.V353151.R01.S.doc Version 5.2 Page 16 There have been some problems with odours in the past and the home has responded appropriately. At the time of my visit there were some slight odours as you enter the dementia care unit and in one of the dementia care bedrooms. The manager described the actions that have been and are being taken. One visitor to the home informed me that they had noted an improvement over recent visits. The five residents who completed surveys, who did not live in the dementia care unit, answered ‘always’ to the question “Is the home fresh and clean?” and made the following comments:- “…I find the home always very clean in fact spot on…” “…very much so…”. There are various slings available for residents to use the hoist in one of the bathrooms. There is not one for each person. I discussed this with the manager and advised her to contact the local Health Protection Unit for further advice about this. Although all of the catering staff have received training in safe food handling, only a few of the care staff have. Twenty staff have so far received training regarding infection control. The relevant policies and procedures (communicable diseases and infection control, disposal of clinical waste, food hygiene) are to be updated in the New Year. The policy and procedure relating to the control of substances hazardous to health was updated in October 2007. The laundry facilities are satisfactory and staff are employed for this role seven days a week. Barton Court DS0000023901.V353151.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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 good. This judgement has been made using available evidence including a visit to this service. Residents’ needs are met by sufficient staff who are competent and trained. Residents are supported and protected by the home’s recruitment procedures. EVIDENCE: Of the four members of staff who completed surveys the following answers were given in response to the question “Are there enough staff to meet the individual needs of all the people who use the service?” three ‘sometimes’ and one ‘usually’. Comments in these surveys included – Barton Court could do with more staff on each shift, especially in the dementia care unit, and – there can never be enough staff 100 of the time. Three residents answered ‘always’ to the question “Are staff available when you need them?”, one answered ‘usually’ and one answered ‘sometimes’. One relative noted that the home could be improved by being fully staffed. No examples of residents’ needs not being met was observed during this visit but the organization could reassess the current levels of care staff. There are staff employed to clean, launder and provide food. The manager said that more staff are being recruited. The manager provided information that 60 of staff currently have a national vocational qualification at level 2 or above and 36 are working towards this award. Two staff files were viewed for this inspection and they showed that Barton Court DS0000023901.V353151.R01.S.doc Version 5.2 Page 18 the procedures for recruitment are robust and include application forms, references and criminal record bureau checks. Staff spoken to and who completed surveys confirmed that they felt they were given training which was relevant to their role, helped them to understand the needs of the residents and kept them up to date with new ways of working. All four returned surveys answered ‘very well’ to the question asking if their induction covered everything they needed to start the job. The manager said there was a training programme in place and the organization was committed to providing on going training. A matrix is maintained giving details of which staff have completed which training, and when. Barton Court DS0000023901.V353151.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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 good. This judgement has been made using available evidence including a visit to this service. Residents benefit from the home being managed by someone who is competent, experienced and knowledgeable. Residents’ financial interests are safeguarded and their views are sought. Staff and residents mostly have their health and safety promoted and protected but this needs to be enhanced by up to date policies and procedures and food safety training. EVIDENCE: The manager has been deputy at the home for some time. She has been acting manager since the retirement of the previous manager and has recently been appointed as manager. She is in the process of applying for registration. She has started her qualification course at Canterbury College and has recently completed a distance learning course regarding dementia with Bradford Barton Court DS0000023901.V353151.R01.S.doc Version 5.2 Page 20 University. There are clear lines of accountability at the home, with a deputy manager role and senior carers/team leaders. The organization is represented by an area manager who is responsible for all the homes in Kent and Medway. The organization has Investors In People accreditation and the manager said that there are regular meetings to involve people who live at the home, feedback cards to relatives and staff said that someone from the management team talks individually to residents each day. Systems are in place to ensure that any involvement with residents’ finances is undertaken carefully and with checks in place. A spot check on some of the maintenance and service contracts showed them to be up to date and appropriate and this was confirmed in the written information provided by the manager. Fire safety checks are also appropriately carried out. Some health and safety training needs to be undertaken with regard to food safety (covered under standard 26) and some policies and procedures need reviewing. Barton Court DS0000023901.V353151.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable Barton Court DS0000023901.V353151.R01.S.doc Version 5.2 Page 22 CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Barton Court DS0000023901.V353151.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 12(3) Requirement Care plans to be improved to reflect a person centred approach and involvement of residents The arrangements in place relating to medication to include clear, up to date written guidance for staff. The arrangements in place relating to the prevention of harm or abuse to include clear, up to date guidance for staff Infection control measures to include sufficient training for care staff in the safe handling of food Timescale for action 31/03/08 2. OP9 13(2) 31/01/08 3. OP18 13(6) 31/01/08 4. OP26 13(3) 31/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Barton Court DS0000023901.V353151.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Barton Court DS0000023901.V353151.R01.S.doc Version 5.2 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!