Inspection on 08/11/05 for Barton Grange

This inspection was carried out on 8th November 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report 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 25/07/05

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 BS25 1DP Lead Inspector Alison Murray Announced Inspection 8th November 2005 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 Grange DS0000049161.V250185.R01.S.doc Version 5.0 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 Grange DS0000049161.V250185.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Barton Grange Address Barton Road Barton Winscombe North Somerset BS25 1DP 01934 842827 NONE 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) Scosa Ltd Ms Sarah Jane Matthews Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Barton Grange DS0000049161.V250185.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25/07/05 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 residents 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 residents’ pets, subject to prior agreement. Barton Grange DS0000049161.V250185.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over 7 hours. Thirteen of the 16 residents were consulted, and time was spent in discussion with Ms Matthews, the registered manager. The inspector spoke with 2 visitors, and all of the staff on duty. Comment cards were received from 5 residents, 10 relatives, and both of the local GP surgeries. What the service does well: What has improved since the last inspection? Over the summer months, occupancy levels in the home were low. Since then, they have steadily increased. Mrs Scott and Ms Matthews have kept this under review, and have provided information to confirm the financial viability of the business. Barton Grange DS0000049161.V250185.R01.S.doc Version 5.0 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 DS0000049161.V250185.R01.S.doc Version 5.0 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 Grange DS0000049161.V250185.R01.S.doc Version 5.0 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 the following standard(s): 1, 2, 3, 4 & 5. 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: The written information given to prospective residents and their families has been amended since the last inspection. A resident admitted recently said that it gave her the information she required. This person said that she and her family were invited to visit Barton Grange, and meet the staff and residents. At this visit, Ms Matthews had discussed her care and social needs. On admission, she felt that the staff had a good knowledge of her needs, likes and dislikes. She commented that everyone had made her feel very welcome. Another person sent in a comment card, following a respite stay. This person wrote that they had a ‘very happy time’ at Barton Grange, and would have no hesitation returning for a further respite stay. Barton Grange DS0000049161.V250185.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 &11. 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. EVIDENCE: Thirteen of the 16 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 ‘it is exceptional’, another said that the care was ‘perfect’. 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. Entries in the care records indicated that on occasions when this person’s skin had broken, they contacted the district nurses very promptly. It was clear that they worked well together, and the pressure sore had healed very quickly. Comment cards received from Barton Grange DS0000049161.V250185.R01.S.doc Version 5.0 Page 10 local surgeries indicated a high level of satisfaction with the care provided at Barton Grange. 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. One of the current residents is terminally ill. A visiting relative said that staff provided a very good level of care. This person felt that they received ‘excellent support from the staff’, and that their relative was treated with ‘the greatest respect’. 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. The current medicine cupboard is too small to hold the Nomad boxes. They are stored in another secure cupboard, and transported around the home in a cardboard box. 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. This problem was identified at the last inspection. Ms Matthews said that she is in discussion with the community pharmacist, and hopes to address both these issues in the near future. Barton Grange DS0000049161.V250185.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 The programme of activities meets the expectations and preferences of the residents. Their family and friends are actively encouraged to visit. Residents appreciate the meals provided. EVIDENCE: Ms Matthews and the care staff co-ordinate the programme of activities in the home. This includes a good range of events, from walks in the garden, to performances by local musicians. Residents said that they were consulted about planned events, and the programme was regularly reviewed to ensure that it met their needs. One resident said that she prefers to remain in her room. She said that staff always respected her wishes and ‘don’t make me feel guilty about it’. Several residents commented that they particularly enjoyed a recent Halloween party. 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. He said that he likes to ‘potter around’ in the garden, and ‘keep an eye’ on the regular gardener. Barton Grange DS0000049161.V250185.R01.S.doc Version 5.0 Page 12 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. All the residents consulted said that the standard of food provided was good. They said that the cook knew what they liked and disliked. Lunch on the day of inspection looked and smelt very appetising. The majority of residents chose to take their meal in the dining room. Staff served the meal in two sittings, to ensure that more dependent residents were given the assistance they required, whilst those who were less dependent could linger and chat over their meal. Residents said this worked well. Barton Grange DS0000049161.V250185.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Residents and their relatives feel able to raise concerns or complaints with staff in the home. EVIDENCE: Residents and visitors 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 DS0000049161.V250185.R01.S.doc Version 5.0 Page 14 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 the following standard(s): 19, 21, 25 & 26 The refurbishment programme needs to be re-started to ensure that Barton Grange provides a safe environment, which meets the needs of residents. EVIDENCE: At the time of registration, Mr and Mrs Scott produced an extensive programme of maintenance and refurbishment, which they agreed with CSCI. Considerable improvements have already been made to the fabric of the home. Residents and their families commented on the ‘comfortable and homely’ environment. The refurbishment programme appears to have ‘stalled’ over the summer months, when occupancy in the home was low. All the bathing facilities look dated. They have been reviewed and the annual plan for the home indicated that work to refurbish them would be complete by the beginning of October. This work has yet to be started. Barton Grange DS0000049161.V250185.R01.S.doc Version 5.0 Page 15 The inspection took place on a cold day. The home felt pleasantly warm, but a significant number of radiators were extremely hot to touch. Ms Matthews had carried out risk assessments to alert staff to the risk these posed to residents. She said that quotations had been obtained to fit guards to the radiators, but that they had not yet been ordered. None of the first floor windows were fitted with opening restrictors. The openings were comparatively small, and did not pose a significant risk to residents. Ms Matthews agreed to keep this under review, and to fit opening restrictors on a risk assessment basis. Barton Grange DS0000049161.V250185.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 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. Staff recruitment procedures are unsafe, and do not protect the residents. EVIDENCE: There were 16 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. Residents and relatives confirmed that this was always the case. 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. The recruitment records of 3 staff members were reviewed. None of these confirmed a robust recruitment procedure. Two people had started work in the home with only one written reference, and no CRB or PoVA first declaration; another had only one written reference, whilst a third had no references at all. An immediate requirement notice was issued at the inspection. Barton Grange DS0000049161.V250185.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36, 37 & 38 Management systems enable staff and residents to comment on the way the home is run. EVIDENCE: Since the last inspection, Ms Matthews has completed level 4 NVQ in management. 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. At the last inspection, concerns were raised about low occupancy levels in the home, and their impact on its financial viability. Over the past few months, occupancy levels have been consistently higher. Financial statements sent to CSCI confirmed the ongoing viability of the business. Mrs Scott’s monthly Barton Grange DS0000049161.V250185.R01.S.doc Version 5.0 Page 18 reports of her visits to Barton Grange demonstrate that she is keeping this under review. A review of the health and safety information in the home confirmed that the appropriate tests checks and drills have been carried out. Barton Grange DS0000049161.V250185.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 3 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 3 2 X 2 X X X 1 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 Barton Grange DS0000049161.V250185.R01.S.doc Version 5.0 Page 20 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 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. Not met within previously agreed timescale of 25/08/05 Refurbishment must continue in accordance with the action plan agreed with CSCI at the time of registration. The bathing facilities require refurbishment in order that they meet the needs of the current service users. Not met withn the previously agreed timescale of 05/10/05 Guards must be fitted to radiators whose surface temperature pose a risk to residents. Two written references and a CRB disclosure or PoVA First check must be in place before staff start work in the home. An immediate requirement was made. DS0000049161.V250185.R01.S.doc Timescale for action 08/12/05 2 OP19 23.-(2) 08/11/05 3 OP21 23.-(2)(n) 08/05/06 4 OP25 13.-(4) 08/01/06 5 OP29 19.-(1) Sched. 2 08/11/05 Barton Grange Version 5.0 Page 21 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 OP9 OP25 Good Practice Recommendations Medicine storage facilities should be reviewed. Opening restrictors should be fitted to first floor windows. Barton Grange DS0000049161.V250185.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street 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. Extracts may not be used or reproduced without the express permission of CSCI Barton Grange DS0000049161.V250185.R01.S.doc Version 5.0 Page 23 - 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!