Inspection on 14/12/07 for Barton House

This inspection was carried out on 14th December 2007.

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

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

Other inspections for this house

Barton House 21/11/06

Barton House 15/02/06

Barton House 04/10/05

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Barton House 1 Barton Terrace Dawlish Devon EX7 9QH Lead Inspector Peter Wood Unannounced Inspection 14 and 15 December 2007 08:30 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 House DS0000064471.V356544.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 House DS0000064471.V356544.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Barton House Address 1 Barton Terrace Dawlish Devon EX7 9QH 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) 01626 864474 Mrs Sally Ann Child ****Post Vacant**** Claudette Harrower has yet to be registered Care Home 15 Category(ies) of Dementia (15), Mental Disorder, excluding registration, with number learning disability or dementia - over 65 years of of places age (15), Old age, not falling within any other category (15), Physical disability over 65 years of age (15) Barton House DS0000064471.V356544.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category Dementia - Code DE Mental Disorder, excluding learning disability or dementia - over 65 years of age Code - MD(E) Physical disability over 65 years of age - Code PD(E) 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is 15. Key: 21/1106 Random: 29/05/07, 26/06/07, 24/08/07 Date of last inspection Brief Description of the Service: Barton House is a care home now providing personal care and accommodation for 15 Older People with additional physical and mental problems associated with increasing age. Mr Glen Child and Mrs Sally Child took over the home in May 2005. The home is a grade II listed building situated in a prominent end position of Barton Terrace in Dawlish. It is close to shops, a library, churches, doctors surgery, a hospital, pharmacies, communal gardens, public houses, a post office and a railway station. There is easy access into the city of Exeter by a regular bus or train service. The house has three floors plus a large attic. The attic is currently used as two offices, for the owners and for the manager (who has yet to be registered). The second floor has recently been transformed from the owners office, together with accommodation for staff from overseas, into 4 new en-suite bedrooms plus a reading area in the room which houses the new lift. This lift was recently specially purchased to serve all three floor which now contain bedrooms for people who live at the home. However, owing to installation problems, which are subject to litigation, this lift cannot now be used. There are 6 single bedrooms on the first floor. The ground floor consists of 5 single bedrooms, a lounge, separate dining room and the kitchen. Bathrooms and toilets are located on both floors. All the homes bedrooms are for single occupancy. At the side and rear of the property the garden and patio Barton House DS0000064471.V356544.R01.S.doc Version 5.2 Page 5 has level access from the house. The rear patio benefits from shaded seating. The home provides many varied social activities in and out of the home. Fees range between £305 and £425 depending on care needs. The inspection report can be read at the home and copies can be obtained via the CSCI website. Barton House DS0000064471.V356544.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and undertaken over one weekday and a further half day on a Saturday in December 2006. The focus of this inspection was to inspect all key standards and to seek the views of people who live in the home, staff, relatives and professional visitors to the home, the latter using survey forms. At the time of writing eight people who live at the home completed and returned the “Have your say about Barton House” survey questionnaire, three staff returned the “Care Workers Survey” form. One “Health and Social Care Professional in Contact with the Care Home” returned a form with that title and six “Survey for Relatives, Carers and Advocates” forms were returned. Considerable time was spent with the Registered Providers and their Manager (who has yet to be registered) examining documentation, particularly that relating to client assessment and care planning, staffing and health and safety. A full tour of the building was undertaken. The inspection included a review of contact between the home and the Commission since the last key inspection. This included three random inspections undertaken in May, June and August 2007. The reason for those inspections was to investigate potential breaches of the Care Homes Regulations 2001 regarding the fire precaution arrangements to protect the vulnerable people who live in the home. The inspection process also includes a review of the Annual Quality Assurance Assessment (AQAA) questionnaire completed by the owners and manager, which is extensively quoted throughout this report. What the service does well: The owners and manager write in the Annual Quality Assurance Assessment (AQAA) that: “This home empowers its residents in all aspects of ADL. This home ensures that residents are treated with dignity and respect and are offered choice in all things. The home provides a safe, clean and loving environment for its residents. This home is investing in ongoing training and support of its staff to ensure excellence in care.” The needs of people who come to live at the home are properly assessed to ensure that only those people whose needs can be met are admitted. Their personal and social care needs are met, they are treated respectfully, and the home’s medication procedures are aimed to protect them from risk. They are able to enjoy a range of social activities, maintain contact with friends and Barton House DS0000064471.V356544.R01.S.doc Version 5.2 Page 7 families, exercise choice, and have nutritious meals. People who live at the home are protected from abuse, have a homely home to live in, are cared for by properly recruited, motivated staff who are managed properly. What has improved since the last inspection? What they could do better: The owners and manager write in the Annual Quality Assurance Assessment (AQAA) that: “We think we could continue to learn something new about each resident. To do this we will listen, record and react, leading by example.” Prior to purchasing the home the new owners identified many areas of the operation of a care home which they wish to improve upon. These include the fabric of the building, which would benefit from redecoration and some refurbishment throughout to enhance the quality of life of people who live in the home. It is also recommended that the owners consider installing a suitable shower for those who live at the home who do not like baths. Water from the hot taps in both bathroom wash hand basins must be reduced to prevent scalding. The owners now need to implement their “Schedule of Process” listing the priorities to be undertaken each month, together with those that need reviewing every month. Barton House DS0000064471.V356544.R01.S.doc Version 5.2 Page 8 The new owners and their newly-recruited manager are currently evaluating the new client documentation which the manager has introduced. This will hopefully result in a true system of assessment – care planning implementation documentation. The revised documentation should be more meaningful and helpful for the staff, and ultimately people who live at the home should receive care better targeted to their individually assessed needs. The new owners already run a successful care staff training business and have plans to improve NVQ and in-house training and staff supervision. This should better equip staff to undertake their caring task in a more professional manner to the benefit of the people who live at the home. Medication administration practice must improve to comply with the home’s policies to ensure that people who live at the home are actually protected from drug errors. The home must ensure that there are sufficient staff to administer medication correctly and care for people who live at the home at the same time. The home must take on board and respond sympathetically to the findings that a significant number of people who live at the home and their relatives are not confident that their complaints will be listened to, taken seriously and acted upon. It is recommended that the owners and manager clarify and write down their respective roles and responsibilities to ensure effective and efficient management of the home. 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 House DS0000064471.V356544.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 Barton House DS0000064471.V356544.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): 3, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of people who come to live at the home are properly assessed to ensure that only those people whose needs can be met are admitted. EVIDENCE: The owners and manager write in the Annual Quality Assurance Assessment (AQAA) that: “Prior to admission the prospective resident is visited in their home or in hospital, an initial assessment is carried out which forms the basis of our care plan. This home invites the family and where possible the resident at least twice prior to admission to spend time with the other residents and staff. They are invited to a meal or an activity, the service user guide is offered, for information. We recommend Care Aware helpline for questions which we are unable to answer. We mentally try to match up new residents with a ’buddy’ (with the same interest) prior to admission and ask that person Barton House DS0000064471.V356544.R01.S.doc Version 5.2 Page 11 to greet the new resident on arrival. We have a good keyworker system in place and staff are trained in the role of keyworking.” As part of the inspection process we (The Commission for Social Care Inspection, hereafter referred to as ‘we’) examined assessment documentation of four people who live in the home. Examination of this documentation, consultations with and questionnaire returns from the providers, manager, staff, relatives, visiting professionals and people who live in the home substantially evidence the statements as above. The registered owner or the manager undertakes a pre-assessment prior to the admission of a person who may come to live at the home. This is then followed by quite detailed assessments that generate reasonably comprehensive care plans. A relative commented: “Visitors are welcome at the home.” The home does not offer intermediate care. Barton House DS0000064471.V356544.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, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health, personal and social care needs of people who live at the home are met and they are treated respectfully. The home’s policies and procedures relating to medication administration are aimed to protect them from risk. However, practice must improve to comply with those policies and procedures to ensure that people who live at the home are actually protected. EVIDENCE: The owners and manager write in the Annual Quality Assurance Assessment (AQAA) that: “This home has implemented medication reviews with GPs for many of its residents. We have implemented asking new residents GPs to visit shortly after admission to go over medication and health issues with us for better understanding for their health needs. This home involves and works in conjunction with, a pharmacist, physio, continence nurse, elderly nurse specialist, SALT, optician, audiologist, podiatrist, where needed. Staff are all Barton House DS0000064471.V356544.R01.S.doc Version 5.2 Page 13 being trained in administration of medication, dementia care and infection control as well as other health care topics.” As part of the inspection process we examined care planning documentation of four people who live in the home. Examination of this documentation, consultations with and questionnaire returns from the providers, manager, staff, relatives, visiting professionals and people who live in the home substantially evidence the statements as above. We saw that people who live at the home have quite good care plans, which the new manager authored and brought with her from the care home she previously managed. These are generated from the assessments of care management staff, supplemented by the further assessments of the owner or manager who visit each client prior to admission. The assessment and care planning documentation examined at the last inspection had been revised. This was to undergo further revision by the relatively new owners to become more efficient and accurate tools which would help enhance the care given to people who live at the home. It was recommended that the owners continue their review of client assessment - care planning - implementation documentation so that it becomes a comprehensive system to enhance resident care. The new manager’s new documentation may assist in reaching that aim. We observed that people who live at the home were treated with respect by staff. This is reinforced by relatives, whose comments include: “I have found all staff to be most caring and supportive.” “They support [my relative] in her everyday tasks”. “A small caring home. Staff are always polite and helpful”. “The staff are very friendly to people who live at the home and relatives or friends”. “They appear to treat the people who live at the home with respect and address them as adults should be addressed”. We saw that appropriate arrangements are in place for meeting the personal and health care needs of the people who live at the home. The home has good policies, procedures and practices for the proper administration of medication. People who live at the home are able to selfmedicate on the basis of risk assessment and their own wishes. Risk assessments are also undertaken with respect to moving and handling with a separate “assistance with daily living” risk assessment. The owners have bought a proper “hospital-like” medication trolley which is kept downstairs and a smaller storage cabinet bolted to the wall of the small first floor office. These enhance the security of medication. The proper practice of medication administration involves transporting the heavy trolley through all three floors of accommodation using the brand new “state of the art” lift. Unfortunately, this lift has not worked for much of its short life. An expert in lift installation claims the good lift has been badly installed, is dangerous and should be put out of action, which it now is until rectification work is undertaken, which is subject to litigation. The unavailability of this lift has considerable adverse consequences for the home. One such consequence is that the staff member Barton House DS0000064471.V356544.R01.S.doc Version 5.2 Page 14 administering medication can no longer take the trolley to each floor, but instead has to carry medications to each individual in a safe and secure manner. On the first visit to the home we saw that the staff member administering medication was pre-potting a whole tray of medication from blister packs and bottles into pots without lids to take to a number of residents. This practice was condemned by the manager as “poor and dangerous”. The manager and owners claimed such practice was not that which they taught staff to follow, insisting that staff are taught a safe practice. In order to verify those claims we undertook a second unannounced visit to the home the following day to observe a different staff member administer the medication for the same session. That was undertaken properly, though took a considerable amount of time. This was partly owing to the unavailability of the lift, partly owing to the staffing arrangements whereby a member of staff remains on each floor to care for people who live on that particular floor. As the staff member administering medication was also responsible for the people who lived on an upper floor, she had to stop administering medication, and lock away all medication in the trolley downstairs, in order to return upstairs to care for people who called for assistance. The home must ensure there are sufficient staff to administer medication and care for people who live at the home at the same time. Barton House DS0000064471.V356544.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, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at the home are able to enjoy a range of social activities. They are able to maintain contact with friends and families and are encouraged to exercise choice. Meals are nutritious and varied, now taken in the newly designated dining room. EVIDENCE: The owners and manager write in the Annual Quality Assurance Assessment (AQAA) that: “This home has empowered its residents to make choices in all ADL. We escort residents who have no family available, to personal appointments, (i.e. banks, GPs ) in order to support their independence. We have sought the input of each resident or their family to ensure that each persons favourite food is offered on the menu. We have introduced more word games, quizzes and board games. By request, we have started a drawing group and have introduced talking books, also the library service. As a result of a request we have arranged a bus trip out to see the Christmas lights in the local community.” Barton House DS0000064471.V356544.R01.S.doc Version 5.2 Page 16 As part of the inspection process we consulted most people who live in the home. We also consulted the providers, manager and staff. We examined documentation in the home and questionnaire returns from staff, relatives, visiting professionals and people who live in the home. Examination of this documentation and consultations confirm and contrast with the statements as above. Prior to their admission, many people who live at the home lived locally and had some knowledge of each other prior to coming into the home. Such prior knowledge is sometimes re-lived during conversations and interactions with people who live at the home. Several people who live at the home retain contact with friends and family in the locality and / or visit local shops, churches, places of entertainment and the like independently. The owners and manager write in the AQAA that: “We have re-organised the lounge / diner. We now have a separate dining room, ‘The Barton Bistro’ (a residents choice of name)”. However, the separate dining room is only big enough to fit two tables of four and one table of two people. Only ten of the fifteen people who live at the home are therefore able to eat together in the new dining room. The owners and manager write: “Residents who need close supervision and a great deal of time to eat are served together in the lounge at tables with a dedicated carer to supervise and assist. These residents who wander can be distracting to other residents. This has resulted in happy interactive mealtimes.” We have been inspecting this home for several years, during which we usually joined for lunch those who live at the home (and others if on a luncheon club day). It was our experience that lunchtimes then could be described as “happy interactive mealtimes”, in comparative contrast to our experience on the day of inspection. As only ten of the fifteen people who live at the home are able to eat in the new dining room it is serendipitous that: “some residents prefer to eat in their rooms, and this is catered for too.” This convenience may now be rather a necessity for those with poor mobility owing to the unavailability of the lift. The lounge has been set so that there is a quiet area and a TV area. There are, however, various activities organised within and outside of the home. Some musicians visit the home on a regular basis during which the people who live at the home enjoy a sing-song. “There are various activities taking place at the home.” There is also “a new library, quiet room on the top floor”, though this is now accessible only by the very fittest residents who can climb the many stairs now that the lift is out of action. People who live at the home used to be quite vocal regarding the food and other services provided in the home. While most people who live at the home were complimentary about the food, several begged me not to attribute to them any criticisms they had. Some people who live at the home told us they Barton House DS0000064471.V356544.R01.S.doc Version 5.2 Page 17 did not like the cramped dining room and bemoaned the loss of the small lounge where they could bring their friends and family to talk in private. Barton House DS0000064471.V356544.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, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst people who live at the home are protected from abuse, they and their relatives are not confident that their complaints will be listened to, taken seriously and acted upon. EVIDENCE: The owners and manager write in the Annual Quality Assurance Assessment (AQAA) that: “This home takes any complaint or concern seriously. We provide solutions and feedback. Our policy regarding complaints is in the service users guide. Staff are trained in how to pass on a complaint and to feedback. This is evidenced in our complaints and concerns file and in the clients file. Our staff are undertaking substantial POVA training both in house and externally. All staff undergo a CRB check. We have a facility to lock away clients personal valuables and the facility to record any money in the house for particular clients use should the client or the relative wish.” As part of the inspection process we consulted most people who live in the home. We also consulted the providers, manager and staff. We examined documentation in the home and questionnaire returns from staff, relatives, visiting professionals and people who live in the home. Examination of this documentation and consultations confirm and contrast with the statements as above. Barton House DS0000064471.V356544.R01.S.doc Version 5.2 Page 19 The home has a complaints policy, process and notice, which includes the contact details of the Regulation Inspector should a resident or visitor to the home have a wish to contact the Commission. There is also a Complaints Book, in which two complaints have been recorded. However, the home aspires to follow the good practice promoted in the National Minimum Standards that issues are resolved before they escalate to become complaints. Some people who live at the home whom we consulted reported that they were listened to and expressed confidence that appropriate action would be taken if they were to make a complaint. However, we were concerned that on this occasion, several people who live in the home were very wary about expressing any criticism to us. People who live at the home used to be quite vocal regarding services provided in the home, such as the food. While most people who live at the home were complimentary about the food, several begged us not to attribute to them any criticisms they had. Some people who live at the home told us they did not like the cramped dining room and bemoaned the loss of the small lounge where they could bring their friends and family to talk in private. We were further concerned to receive comments from people who live at the home and / or their relatives which include: ”I don’t know who to speak to. The owners are rarely there”. “I know who to make complaints to but they are either unavailable or too busy to do anything about it”. “ I have not been informed how to make a complaint”. “There may be issues on which I have no say - e.g. moving to sunny living area to the dark corner of the communal room”. “I have in the past raised issued with the person in charge. If I complain, the owners complain to [my relative] that I complain, therefore I do so as little as possible”. We were particularly concerned to discover that people who live in the home were so worried that they may be asked to leave if they make a complaint that they remain silent: “I trust information is confidential and my name will not be revealed to the owners as [my relative] worries constantly that they will ask [my relative] to leave – as they have others!” Such statements are in complete contrast to the claims of the management that: “ [in] this home………….the views of the client and their families are embraced and evidenced. Residents who are able to form an opinion are involved in all decision making regarding their ADL. They are consulted about meals, meal times, choice of food and service, bathing, activities, positioning of furniture in their living areas, getting up and going to bed, clothes, etc. Residents families have been invited to review care plans with the manager in January 2008 to ensure that we are meeting their needs by listening to, and acting upon their views.” It is concerning that there is such a contrast in perceptions between the management of the home and some of its clients and their relatives. The providers and manager demonstrated that they knew how to respond appropriately should there be a suggestion of abuse. A detailed and up to date Barton House DS0000064471.V356544.R01.S.doc Version 5.2 Page 20 policy on adult protection was available for staff, and indeed the owner trains care staff in other home on abuse issues. Staff at this home are therefore well aware of issues surrounding adult abuse. Barton House DS0000064471.V356544.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, 20, 21, 23, 24, 25, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who live at Barton House live in a homely home, but one which needs to be made safe, while on-going refurbishment and decoration would enhance the quality of life for those who live there. EVIDENCE: The owners and manager write in the Annual Quality Assurance Assessment (AQAA) that: “We strive to create a safe, happy and relaxed atmosphere in our residents home. We have a cleaning schedule so we can maintain a clean and fresh environment. This includes regular bed changes and residents personal laundry done on a daily basis. Staff recognise the need for diligence in all aspects of health and safety and report any matter of concern via the message book, maintenance book or senior staff on duty so the issue is dealt with and feed back given. We have regular fire drills and training.” Barton House DS0000064471.V356544.R01.S.doc Version 5.2 Page 22 As part of the inspection process we consulted most people who live in the home. We also consulted the providers, manager and staff. We examined documentation in the home and questionnaire returns from staff, relatives, visiting professionals and people who live in the home. Examination of this documentation and consultations confirm and contrast with the statements as above. Barton House is an end terraced property close to all local facilities in Dawlish. The home had long benefited from a passenger lift, which facilitated people who live at the home with mobility difficulties living on the first floor. That convenience of having a lift has become a necessity, given the increasing frailty of people who live at the home. This has become more urgent owing to the recent refurbishment of the second floor into en-suite bedroom accommodation for an additional four people. Only the very fittest people are able to climb up and down the many stairs from the ground floor to the third floor. The owners therefore bought a brand new “state of the art” lift which unusually could be used if necessary to evacuate people in the event of a fire from the first and second floors. Unfortunately, this lift has not worked for much of its short life. An expert in lift installation claims the good lift has been badly installed, is dangerous and should be put out of action, which it now is until rectification work is undertaken, which is subject to litigation. The unavailability of this lift has considerable adverse consequences for the home. People who live above the ground floor who are unable to climb the stairs unaided are now unable to join in activities downstairs whilst even those who live on the ground floor are unable to visit their friends within the home unless they are very fit. Aids and adaptations as required are provided, though few are necessary for people who currently live at the home. The home does not have a hoist. Such a large piece of equipment would be difficult to use in a couple of the bedrooms. Many bedrooms are quite small, though all now meet the revised National Minimum Standards. The house is unsuitable for people with major disabilities. The rear patio and garden are popular areas where people who live in the home can enjoy morning coffee, or lunch, or afternoon tea in the summer, or perhaps a glass of wine or sherry in the evening. Until recently the home boasted two small lounges downstairs, allowing people who live at the home to choose where or with whom to sit. The large lounge, which used to additionally serve as the dining room no longer houses the large dining table, which makes the available space much larger in that room. The dining room can be used for board games and the like when not used for eating. The creation of the four new bedrooms on the second floor, and the extension of the lift to that second floor has also resulted in the creation of a reading area in the room which houses the lift on the second floor. Because that room houses the lift it could not be used as a bedroom. However, it can be used as a comfortable second lounge where people who live in the home Barton House DS0000064471.V356544.R01.S.doc Version 5.2 Page 23 can read, watch television or receive guests. Some bedrooms contain items of furniture belonging to people who live in the home as well as smaller personal items. Whilst all rooms now meet the revised spatial requirements of the National Minimum Standards, some are nevertheless quite small. In the past year the owners have renewed the ground floor bath, bath hoist and floor covering. Slip resistant floor covering has been applied to the ground floor toilet and laundry room. The owners have purchased a tumble drier, to alleviate the problem of wet clothing hanging in the laundry. There are adequate toilets and bathing facilities, but the home does not have a shower. A relative commented: “The main change I would like to make is installation of a wet room or shower as [my relative] refuses to bath and I now have to take [my relative] to my home to do this myself weekly or more often.” The owners should consider installing a shower as a matter of priority so that people who live at the home who do not like baths can be properly washed without their relatives having to take them to their own home to do it. We tested the temperature of the hot water from the taps of both the ground floor and first floor baths and wash hand basins, using both of the bath thermometers. Whilst the bath water temperature measured was safe (though each thermometer gave a different reading) the water from the wash hand basins was off the scale, excessively and dangerously hot. People who live in the home are at risk of scalding from the water of the taps of these wash hand basins. The temperature of the water from these must be reduced to a safe level as a priority. Most of the outside of the house, one of the lounges and some bedrooms have been repainted over the past year or so. The owners have renewed the fire protection to a ‘L1’ level system (the highest grade), gained certification for the electrical installation and organised for fire risk assessment by an external provider. However, redecoration and refurbishment throughout the building would benefit the quality of life of people who live at the home. The intensive building works going on at the home has continued longer than the owners planned, which has therefore put back the level of progress they would have liked to make. As a previous resident put it: ”This house is not the smartest I looked at but is always clean and well maintained”. Another commented: “This is an old house and the previous owners had let it get a bit run down (the buildings and contents that is). The new owners however are addressing this and gradually updating the processes”. In contrast to the AQAA statement that: “We have a cleaning schedule so we can maintain a clean and fresh environment. This includes regular bed changes and residents personal laundry done on a daily basis” a relative writes: “sometimes I need to tell them to change the bed linen, but having said this it is always clean as [our relative] isn’t incontinent as yet”. A visiting professional commented that Barton House “provides a homely environment”. The home Barton House DS0000064471.V356544.R01.S.doc Version 5.2 Page 24 was also clean, but the hot water from the bathroom wash hand basins must be reduced before it could be deemed safe. Barton House DS0000064471.V356544.R01.S.doc Version 5.2 Page 25 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, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at the home are cared for by motivated staff, usually in sufficient numbers to meet their needs. Recruitment processes protect vulnerable people who live at the home. EVIDENCE: The owners and manager write in the Annual Quality Assurance Assessment (AQAA) that: “This home has recruited a well balanced mixture of skills in its staff. We have began a comprehensive and extensive training programme for our team. All staff undertake induction programme. This home is fully staffed with a motivated team.” As part of the inspection process we examined the personnel files of four staff who in the home. Examination of this documentation, consultations with and questionnaire returns from the providers, manager, staff, relatives, visiting professionals and people who live in the home substantially evidence the statements as above. The home implements a system of key worker, whose responsibilities include “to get to know your client well, make a connection.., be aware and record any changes on social, emotional, health, religious, or sexual needs of your client“. Barton House DS0000064471.V356544.R01.S.doc Version 5.2 Page 26 The home uses a proper application form with a declaration of no convictions, and undertakes a CRB (Criminal Record Bureau) check. This includes a check of the POVA list. This is the Protection of Vulnerable Adults list, a database of people considered unsuitable for work in care settings. The home undertakes proper references, identity verification, induction and a probationary period. The owners are fastidious as to the staff they employ, and many have not been offered contracts at the end of their probationary period. This is one reason which has resulted in considerable staff turnover. Only a few staff remained from the time before the new owners took over to the last inspection. Of the nine care staff then employed, six had left by the time of the last inspection. This staff turnover has been repeated again. All but one current staff member has been employed since the last inspection. The owners accepted the resignation of the previous manager, who had only just been registered, following a whistle-blowing incident about the fire precautions which resulted in the random inspections of May, June and August 2007. Other staff followed her. The manager has set about to recruit a motivated staff team. Some of the staff who left this home have been interviewed as part of the inspection of other care homes where they now work and where they are now regarded and feel valued. Such staff turnover is disruptive to people who live at the home, and has the disadvantage that new staff need a great deal of training. However, staff training is a particular interest of the owners as they also own a training company which specialises in training staff in care homes, as well owning another care home locally. In the past twelve months the home has provided training in twenty-five subjects including health and safety topics, such as Fire Safety, Protection of Vulnerable Adults and Medicine Management. All current staff hold a current First Aid certificate. The home enables and encourages staff to undertake NVQ’s (National Vocational Qualifications). Currently four of the twelve care staff have NVQ level 2 or above; the remaining eight are working towards obtaining NVQ 2 or above. The current level of 33 is well short of the National Minimum Standard 50 target, though this should rise in time to 100 . Some care staff consulted reported that they were well supported, with a lot of training offered which helped them care for people who live in the home in a more professional manner. However, some staff, relatives and people who live in the home reported that the home was sometimes short staffed. We observed this to be the case when the staff member administering medication had to rush up and down the stairs to respond to call bells and administer medication at the same time. This situation had been largely caused by the unavailability of the lift. However, while it remains unavailable, management must ensure that there are sufficient staff to respond to call bells and administer medication at the same time. Comments from people who live in the home and their relatives include: “This year there have been quite a few staff changes and so new people to get used Barton House DS0000064471.V356544.R01.S.doc Version 5.2 Page 27 to”. “The staff are always very kind and helpful and seem to genuinely care for the residents”. “There are too many staff with poor English” . “[To improve] the home needs more staff”. “Carers should speak English adequately to understand the needs of the residents”. “There was a flood in the night in the bathroom and there was no resident member of staff who spoke English”. Comments from staff include: “We support each individual to each of their different needs and work well as a team”. “I don’t think all staff know what to do although they say they do, i.e. because they don’t understand our language, or don’t listen”. Barton House DS0000064471.V356544.R01.S.doc Version 5.2 Page 28 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, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live here live in a home in which the owners, manager and staff team strive to provide a stimulating, safe environment that respects and protects them and their best interests. EVIDENCE: The owners and manager write in the Annual Quality Assurance Assessment (AQAA) that: “This homes’ management leads by example. The management demonstrates commitment to the training and support of the team, a passion for excellence in care and a dedication to the physical and mental wellbeing of all the in the house. Staff are trained in good and accurate record keeping and Barton House DS0000064471.V356544.R01.S.doc Version 5.2 Page 29 accountability, and the reasons for this explained to them. Files for residents and staff are kept and are regularly updated. Quality assurance systems are in place and are being constantly enhanced. Regular staff meetings, (with an agenda) and management meetings take place. Regular supervision and support for all the team. A full induction programme, support and ongoing training.” As part of the inspection process we examined documentation and consulted with and / or received survey returns from the providers, manager, staff, relatives, visiting professionals and people who live in the home. These go some way to evidence the statements as above. As well as managing this home Mr and Mrs Child continue to operate their training organisation which specialises in delivering care and associated training mainly to staff in care homes. They have also recently purchased another care home nearby. Mrs Child’s background is as a registered nurse and trainer, and has also been a registered manager of two care homes. Mr Child’s background has been in business. The home has continued to hold the Investor in People Award, achieved by the previous owners. Both owners are undertaking the Registered Manager’s Award, which indicates their commitment to on-going training for themselves. However, Mr and Mrs Child have decided to appoint professional managers to manage both homes and have therefore recently successfully appointed experienced managers to both. Barton House has undergone considerable change since Mr and Mrs Child took over the home in May 2005. They took over a care home which was “tired” and needed modernisation to the fabric of the building, furniture, furnishings and decoration. Care assessment, care planning and other systems needed improving. Staff training and support needed improvement. Mr and Mrs Child made considerable effort and spent a considerable amount of money to bring about these improvements, which include enlargement of the home and the purchase of a “state of the art” lift. Unfortunately, ill health and the time taken on the building works has resulted in improvements taking longer than anticipated. The staffing establishment has turned over completely twice. Mr and Mrs Child have recently appointed a manager to run the home. The owners are determined to meet to the best of their ability the needs, wishes and aspirations of the people who live at the home in a safe, comfortable and stimulating environment. This report indicates how far they have gone in achieving that goal. Barton House DS0000064471.V356544.R01.S.doc Version 5.2 Page 30 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 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 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 3 2 2 2 X 3 3 2 3 STAFFING Standard No Score 27 3 28 2 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 House DS0000064471.V356544.R01.S.doc Version 5.2 Page 31 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 Reg 13 (2) Requirement Medication administration practice must comply with the home’s policies to ensure that people who live at the home are protected from drug errors. The home must ensure that people who live at the home and their relatives are confident that their complaints will be listened to, taken seriously and acted upon. Water from the hot taps in both bathroom wash hand basins must be reduced to prevent scalding. The home must ensure that staff are suitably qualified to care for people who live in the home in a professional manner This relates to the requirement that a minimum of 50 care staff have NVQ level 2 by 2005. This was a requirement at the last inspection. Barton House DS0000064471.V356544.R01.S.doc Version 5.2 Page 32 Timescale for action 14/02/08 2. OP16 Reg 22 14/02/08 3. OP19 Reg 3 (4) 14/01/08 4. OP28 Reg 18 (1) (a) (c) 14/03/08 5. OP28 Reg 18 (1) (a) (c) The home must ensure there are sufficient staff on duty at all times. This relates to having sufficient staff to administer medication and care at the same time. 14/02/08 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. Refer to Standard OP3 Good Practice Recommendations It is recommended that management continue their review of client assessment - care planning - implementation documentation so that it becomes a comprehensive system to enhance resident care. It is recommended that management continue their assessment of the decoration and refurbishment needs of the home, and act accordingly, to enhance the quality of life of people who live at the home. It is recommended that the owners consider installing a suitable shower for those who live at the home who do not like baths. It is recommended that the owners and manager clarify and write down their respective roles and responsibilities to ensure effective and efficient management of the home. 2. OP19 3. OP21 4. OP32 Barton House DS0000064471.V356544.R01.S.doc Version 5.2 Page 33 Barton House DS0000064471.V356544.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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. 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