Inspection on 25/07/05 for Barton Grange

This inspection was carried out on 25th July 2005.

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

Barton Grange 09/10/07

Barton Grange 23/04/07

Barton Grange 08/06/06

Barton Grange 08/11/05

Barton Grange 07/03/05

Barton Grange 05/10/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Barton Grange Barton Road Barton Winscombe North Somerset Lead Inspector Alison Murray Unannounced 25 July, 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Barton Grange D53 - D02 S49161 Barton Grange V224906 250705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Barton Grange Address Barton Road, Barton, Winscombe, North Somerset, BS25 1DP Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01934 842827 Scosa Ltd Ms Sarah Jane Matthews Personal Care home only 20 Category(ies) of Old age (20) registration, with number of places Barton Grange D53 - D02 S49161 Barton Grange V224906 250705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7 March, 2005 Brief Description of the Service: Barton Grange provides personal care for up to 20 elderly residents. The home is situated on the outskirts of the village of Winscombe. Mr and Mrs Scott, trading as Scosa Ltd bought the home in June 2003. They own two similar care homes in the south of England. Ms Sarah Matthews is the registered home manager. Accommodation is a Victorian country house with a modern extension. Seven of the bedrooms are on the ground floor. There is level access to these rooms. The remaining bedrooms are on the first floor. A chair lift is provided on both staircases. Additional steps to some of the rooms mean that service users with impaired mobility may not be able to access these areas. The rooms affected are clearly identified in the service user guide. None of the bedrooms have en suite facilities. There is a large garden containing an aviary to the front of the building. To the rear is an open-air swimming pool, and patio area. The home can sometimes accommodate Service users’ pets, subject to prior agreement. Barton Grange D53 - D02 S49161 Barton Grange V224906 250705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a positive unannounced inspection. The inspector spent over 4 hours in the home, talking to residents and staff. All of the 13 residents and staff on duty were consulted. Some care records were reviewed, but the main focus of the inspection was the day-to-day experience of the residents. Ms Matthews, the registered manager was on holiday. Mrs Tarling, her deputy was able to provide all the information required during the inspection. What the service does well: What has improved since the last inspection? The ongoing programme of refurbishment and redecoration of the home continues to improve the accommodation provided at Barton Grange. Since the last inspection, a number of bedrooms have been upgraded. Work has been carried out to a high standard, and is in keeping with the character of the property. Barton Grange D53 - D02 S49161 Barton Grange V224906 250705 Stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Barton Grange D53 - D02 S49161 Barton Grange V224906 250705 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Barton Grange D53 - D02 S49161 Barton Grange V224906 250705 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4 and 5. Barton Grange does not provide intermediate care, so standard 6 does not apply. Prospective residents’ needs are comprehensively assessed before admission to the home. Staff and existing residents help to make new admissions feel welcome. EVIDENCE: Residents said that one lady had been recently admitted for a ‘holiday’ visit. They said that staff had introduced her to everybody. One person commented ‘it’s nice to see new faces’. She added that although the new resident ‘didn’t always remember things’; they tried to make her feel welcome, and include her in conversation. A review of the lady’s care records confirmed that Ms Matthews had visited her in hospital. During this visit, she had carried out and documented a thorough assessment of the lady’s needs. Ms Matthews had clearly spoken to other family members to build up a picture of her likes and dislikes. She had also consulted the placing social worker, and received an up to date care management plan. Barton Grange D53 - D02 S49161 Barton Grange V224906 250705 Stage 4.doc Version 1.30 Page 9 Barton Grange D53 - D02 S49161 Barton Grange V224906 250705 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 Residents’ health and personal care needs are well met. Appropriate referrals are made to other health professionals. Current medicine administration procedures offer the potential for error. Staff have already identified ways to improve these. EVIDENCE: All the residents were consulted during the course of the inspection. They all looked well, and were neatly dressed in appropriate clothing. Several of the ladies were very frail, and not all were able to initiate a conversation. Those residents who were able, all commended the standard of care provided at Barton Grange. One person commented ‘they always look after me very well’. Another resident had an operation on her leg earlier in the year. She said that it was thanks to the efforts of the staff in the home, that she had made such a good recovery. A third resident is at high risk of developing pressure sores. Staff had liaised with the district nurse, to provide appropriate pressure relief equipment. They had also initiated sensible skin care practices. Care records indicated that despite their efforts, the lady had developed a pressure sore. Comments in the district nurses’ notes demonstrated that referrals had been made to them Barton Grange D53 - D02 S49161 Barton Grange V224906 250705 Stage 4.doc Version 1.30 Page 11 when necessary. It was clear that they worked well together, and the pressure sore had healed very quickly. Care records reviewed during the inspection were well completed. Care plans were clearly written and had been regularly reviewed. Individual assessments provided staff with good guidance to minimise identified risks. Either the resident, or their representative had signed these. All the medicine administration records were reviewed. These were clearly printed, and there was a good audit trail of medicines received into the home and administered to each resident. The medicine administration procedures were discussed with staff. The majority of medicines are dispensed in ‘Nomad’ containers. A small number of tablets (eg. Aspirin) are supplied in the original container. Senior staff said that they ‘put up’ any medicines not contained in the Nomad box into small pots. These pots have a lid with the resident’s name on. They are stored on a tray, labelled ‘morning’ etc. in the drug cupboard until they are needed. The staff member administering this medicine to the resident is not usually the same person who ‘put up’. This is not good practice, and potentially increases the risk of medication error. In discussion, Mrs Tarling identified a way of amending the medicine administration procedures to prevent this happening. She plans to discuss this with staff, before implementing the change. There was a relaxed and informal atmosphere in the home. It was apparent that residents and staff like and respect each other. All staff were observed to seek a resident’s permission before entering their room. Barton Grange D53 - D02 S49161 Barton Grange V224906 250705 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15 The programme of activities meets the expectations and preferences of the residents. Their family and friends are actively encouraged to visit. EVIDENCE: One of the care staff co-ordinates the programme of activities in the home. A diary of planned and informal activities is displayed on the residents’ notice board. This included a good range of events, from walks in the garden, to performances by local musicians. Residents said that they particularly enjoyed watching ‘old films’ whilst drinking a glass of sherry. They said that several times a week, staff offer to take people into the village to do some shopping and ‘catch up with what is going on’. One of the residents is a keen gardener. Staff have provided him with his own garden shed. During the inspection, he was critically reviewing the work of a contractor employed to trim the hedges. All the residents said that family and friends were actively encouraged to visit. Several people commented that clergy and lay members of the local church were very supportive. The regular cook was on holiday when the inspection took place. Mrs Tarling, the deputy manager was doing the cooking. Many of the residents teased her about the standard of her meals, but all appeared to enjoy the lunch served. Barton Grange D53 - D02 S49161 Barton Grange V224906 250705 Stage 4.doc Version 1.30 Page 13 Barton Grange D53 - D02 S49161 Barton Grange V224906 250705 Stage 4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Residents feel able to raise concerns or complaints with staff in the home. EVIDENCE: Residents said that they would have no hesitation raising any concerns with Ms Matthews or her staff. All were at pains to point out that they had no need to do so. Care staff consulted demonstrated a good awareness of adult protection procedures. Barton Grange D53 - D02 S49161 Barton Grange V224906 250705 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25 and 26 The ongoing programme of refurbishment has significantly improved the accommodation at Barton Grange. Work to upgrade the bathrooms is due to start later in the year. The standard of housekeeping is commendable EVIDENCE: Mr and Mrs Scott have produced an extensive programme of maintenance and refurbishment. Work is progressing well, and considerable improvements have been made to the fabric of the home. All areas of the home were inspected. Residents said that they appreciate the investment in the property. All the residents expressed satisfaction with their room. One person said that he loved sitting watching the birds nesting outside his window. Bedrooms were attractively decorated in a style in keeping with the character of the property. All the residents had chosen to bring small items of furniture and pictures into the home. Bedroom doors were fitted with locks. Several residents said that they chose to use these. Barton Grange D53 - D02 S49161 Barton Grange V224906 250705 Stage 4.doc Version 1.30 Page 16 Communal space is provided in two lounges and the dining room. These are attractive, well-proportioned rooms. At the last inspection, a requirement was made regarding the heating in the communal lounge. As the inspection took place on a warm day, it was not possible to judge if this requirement had been met. At present there are 5 bathrooms. Two of these are fitted with hoists. There is one shower room. This is rarely used, as it is not adapted for service users with impaired mobility. All the bathing facilities look dated. They have been reviewed and refurbishment is planned in the next year. This is included in the annual development plan for the home. The standard of housekeeping is commendable. All areas of the home were spotlessly clean and tidy. Residents said that this was always the case. Barton Grange is surrounded by about 2 acres of grounds. These are well tended, and offer a range of quiet areas to sit. There is a large aviary, and a fishpond. The swimming pool has been drained, and is fenced off from the rest of the garden. Residents commented that the gardens were ‘lovely to sit in’. Barton Grange D53 - D02 S49161 Barton Grange V224906 250705 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30 Staffing levels are sufficient to meet the needs of the current residents. The training programme equips staff with the skills and knowledge to meet these needs. EVIDENCE: There were 13 residents in the home on the day of inspection. All said that the staffing levels were sufficient to meet their needs. Staff were observed to answer call bells promptly. One resident told the inspector ‘it is always like that…not just because you are here!’ Staff records were not reviewed at this inspection, but a sample of the training records confirmed that staff have attended a good range of training sessions. The staff on duty said that they were encouraged to take part in these. It was clear that they appreciated these opportunities. Mrs Tarling said that she is doing her NVQ assessor course. Other staff were due to start NVQ courses in the new year. Barton Grange D53 - D02 S49161 Barton Grange V224906 250705 Stage 4.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 34, 37 and 38 Management systems enable staff and residents to comment on the way the home is run. There is no evidence to suggest that low occupancy is compromising the viability of the home. This will require careful monitoring over the coming months. EVIDENCE: Staff and residents said that they had regular meetings with Ms Matthews. They said that she was always open to new ideas, and suggestions to improve the running of the home. Minutes of these meetings were available for inspection. Financial records were not inspected at this unannounced inspection. Occupancy in the home has been low for several months. Staff said that a Barton Grange D53 - D02 S49161 Barton Grange V224906 250705 Stage 4.doc Version 1.30 Page 19 number of admissions were planned for the coming weeks. Although there was no evidence to suggest problems with the financial viability of the service, this will require careful monitoring over the coming months. Staff said that Mrs Scott, the registered provider visits Barton Grange regularly. CSCI has not received a regulation 26 report of these visits since January 2005. A review of the health and safety information in the home confirmed that the appropriate tests checks and drills have been carried out. During the inspection, several residents were transported around the home in wheelchairs without footplates. Barton Grange D53 - D02 S49161 Barton Grange V224906 250705 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 2 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 2 3 3 3 3 4 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x 3 x 2 x x 2 2 Barton Grange D53 - D02 S49161 Barton Grange V224906 250705 Stage 4.doc Version 1.30 Page 21 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 OP9 Regulation 13.-(2) Requirement Drug administration procedures in the home must be reviewed. Tablets must not be removed from the Nomad boxes or original containers until they are to be administered to the service user. The bathing facilities require refurbishment in order that they meet the needs of the current service users. This requirement was made at the last inspection. It is still within the previously agreed timescale for action. Mr and Mrs Scott must provide CSCI with a business plan, to demonstrate the financial viability of the home. A report of Mrs Scotts visits to the home must be sent to CSCI every month. All wheelchairs must be fitted with footplates, unless individual risk assessment dictates otherwise. Timescale for action 25/08/05 2. OP21 23.-(2)(n) 05/10/05 3. OP34 25.-(2) 25/09/05 4. 5. OP37 OP38 26.1 13.4 25/08/05 25/07/05 Barton Grange D53 - D02 S49161 Barton Grange V224906 250705 Stage 4.doc Version 1.30 Page 22 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 Good Practice Recommendations Barton Grange D53 - D02 S49161 Barton Grange V224906 250705 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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