CARE HOMES FOR OLDER PEOPLE
Barton Lodge Residential Retirement Care Barton Common Road Barton-on-Sea New Milton BH25 5PR Lead Inspector
Carole Payne Unannounced 03.05.05 9:00am 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 Lodge Residential Retirement Care H54 S12392 Barton Lodge V224058 030505.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Barton Lodge Residential Retirement Care Address Barton Common Road, Barton-on-Sea, New Milton, BH25 5PR 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) 01425 617111 Manucourt Limited Mrs P Torr CRH 39 Category(ies) of OP - 39, PD(E) - 4 registration, with number of places Barton Lodge Residential Retirement Care H54 S12392 Barton Lodge V224058 030505.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Not more than 4 residents in the category PD(E) referred to above are to be accommodated at any one time. Date of last inspection 05.11.04 Brief Description of the Service: Barton Lodge Residential Retirement Care is registered to provide a service to up to thirty nine older persons over the age of sixty five; four of whom may have a physical disability. The home is owned by Manucourt Limited and the registered manager is Mrs Pamela Torr. The home is located in Barton-on-Sea, close to the sea and local amenties. There are close rail links from New Milton to Southampton and Bournemouth and a local bus service operates via a nearby road, a short walk away. The accommodation is arranged on two levels with ramped access to the entrance and level access from within the home to the pleasant and well tended landscaped gardens. Two lifts offer access to the first floor facilties. There are twenty five single and seven double rooms, some of which have the benefit of their own balcony. Twenty four rooms benefit from en suite facilities. The home has two spacious lounge areas, a television lounge, conservatory and a dining room. Barton Lodge Residential Retirement Care H54 S12392 Barton Lodge V224058 030505.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The homes first inspection for this year took place on 3rd May 2005 between 9.00am and 16.00pm. The visit was unannounced. During the inspection discussions took place with seven people living in the home, the manager and five staff members, [four carers and the home’s housekeeper.] Care records were seen for three service users and policies and procedures were sampled. What the service does well:
The service has a clear system for planning care, which includes all aspects of daily living. The service liaises with outside health professionals appropriately to promote the health and well being of people living at the home. Staff members treat service users with sensitivity and respect. The wishes and preferences of service users are recorded and taken into consideration in the daily routine of the home. Family and friends are made welcome. There are opportunities for service users to raise any issues they may have and people said that they felt that they could speak to the provider, manager and staff members if they had any concerns. Staff members are well trained and skilled in the work that they carry out. A supportive induction programme is in place for new staff members. Staff members are encouraged to undertake National Vocational Qualifications in care and training appropriate to the work that they perform. Good vetting processes for new staff members work to ensure that staff members working in the home are suitable for the work that they perform. There are policies, procedures and training in place, which supports staff members in recognising abuse and in protecting service users from harm. All areas of the home seen were maintained, decorated and furnished to a high standard. Communal areas have a sense of warmth and homeliness. They provide pleasant areas for a variety of pastimes. The home’s pleasant and well-tended gardens are delightful and are enjoyed by all service users. Service users rooms are personalised and provide privacy. The home works well to address any areas highlighted during inspection. Barton Lodge Residential Retirement Care H54 S12392 Barton Lodge V224058 030505.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better:
One care plan viewed did not set out the care needed for a service user whose needs for care had changed. Another said that the service user needed help but did not tell the member of staff how to provide that care. The manager undertook to ensure that care required is described and that the care plan for the service user whose needs have changed is updated appropriately.
Barton Lodge Residential Retirement Care H54 S12392 Barton Lodge V224058 030505.doc Version 1.30 Page 7 Three shortfalls were identified with regard to medicines being administered to individual service users. In each case the manager undertook to take immediate action to rectify the issue. Staff members have been trained in the administration of medicines and the manager outlined the regular supervision of practices that she was implementing. There was confidence, therefore, that any issues would be properly responded to. Three service users said that there were not enough activities going on in the home. The home has a programme of events. Service users, however, would be keen to have a varied programme of planned events and outings available on a daily basis in the home. The representative of the provider confirmed that the manager is going to undertake a suitable course. Plans are also being developed to provide dedicated time to socialising both in groups and on a one-to-one basis. It was confirmed that once an extension to the home is completed an activities coordinator would be recruited. The home’s laundry is very small given the number of people living at the home. There are plans in place to build an extension, which will provide enlarged facilities for washing laundry. Plans are in place to commence work late in the summer of 2005. The manager has confirmed that risk assessments have been undertaken in relation to a sloping floor in an en suite bathroom, and a portable heater in a service user’s room, which presents a risk of scalding. The manager is working to ensure that any identified risks are minimised. 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 Lodge Residential Retirement Care H54 S12392 Barton Lodge V224058 030505.doc Version 1.30 Page 8 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 Lodge Residential Retirement Care H54 S12392 Barton Lodge V224058 030505.doc Version 1.30 Page 9 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) These standards were not assessed on this occasion. EVIDENCE: These standards were not assessed on this occasion. Barton Lodge Residential Retirement Care H54 S12392 Barton Lodge V224058 030505.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 10 Clear care plans outlining aspects of daily living support staff members to provide care. However, in some instances, they failed to tell the carer how care was to be carried out and to record changing needs. Effective liaison takes place with healthcare professionals to promote the well being of service users. Good organisation of training supports care staff to carry out the administration of medicines. Shortfalls in procedures identified, where immediately responded to by the manager. Service users are treated with sensitivity and their privacy is respected. EVIDENCE: Three care plans were viewed for service users living in the home. The plans told of the health, personal and social care needs of service users. Two care plans said that the service user needed help with washing and dressing but did not tell the carer what they needed to do to provide that support. One care plan did not identify any needs in relation to continence care, but the daily records showed that the service user was experiencing problems. Reviews of care plans are completed in consultation with each service user. Plans included areas of identified risk and the involvement of service users. Barton Lodge Residential Retirement Care H54 S12392 Barton Lodge V224058 030505.doc Version 1.30 Page 11 From discussion with the manager, and staff members, service users’ health is promoted through regular and appropriate contact with the General Practitioner and other members of the multi disciplinary team. Records are maintained of contacts with healthcare professionals outside the home. The manager was concerned about the health of one service user during the visit and was liaising with a senior carer who was in contact with the General Practitioner. The manager was taking appropriate action to seek help with caring for two-service user with healthcare problems on the day of the inspection. A self-administration risk assessment was viewed for a service user who was keeping and taking her own medicines. The obtaining of consent from the service user and the General Practitioner was discussed and the manager undertook to act on this straightaway. A pot of topical cream was found in a communal bathroom. The pot was labelled for use in the bathroom and did not have a service user’s name on the label. Creams must not be utilised for communal use. The manager undertook to remove the cream immediately and remind staff members of the appropriate way of keeping, labelling and using creams for topical application. At lunchtime a senior carer was responsible for administering medicines. She said that she had received training in giving medicines. She put due medicines into a pot, gave to the service user and once the tablets had been taken, signed the medication administration chart. Paracetamol for one service user was prescribed to be given as and when required. The medicine had been given on a regular basis. The manager undertook to consult with the General Practitioner to ensure that the medicine is administered as it is prescribed. Staff members supported service users with kindness and sensitivity, using service users’ preferred names and supporting gently with care giving. Staff members knocked on service users’ door before entering and service users said that they could enjoy time alone in the privacy of their own rooms. Senior carers in the home have responsibility for ensuring that service users’ rights are upheld in the home; for example in relation to choices, privacy and dignity. Barton Lodge Residential Retirement Care H54 S12392 Barton Lodge V224058 030505.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 At the moment there are not enough activities going on in the home to meet the needs of service users. Events that are arranged give great pleasure to the people living at the home. Family and friends are made welcome to spend time at the service with their relative. People living at the home are supported to make choices about the way they live. EVIDENCE: There is an activities calendar in the home. Recent events held include a visit from some animals, entertainers and extend exercise sessions. One service user said that she enjoys walking around the gardens, listening to a pianist, sometimes dancing, and welcoming her visitors to the home. Three service users said that they did not feel that there were enough activities going on in the home. In the mornings staff members are usually busy with the daily routine. The manager said that representatives of different denominations visit service users on request. One service user goes out to church. Barton Lodge Residential Retirement Care H54 S12392 Barton Lodge V224058 030505.doc Version 1.30 Page 13 One service user said how much she enjoys visits from family members. The manager confirmed that relatives and friends are welcome to visit; private meals can be shared in the home’s conservatory. A service user was pleased to show the inspector around her home. Service users said that they enjoyed a good quality of life at the service. I ‘do what I want to do when I want to.’ Service users wishes are recorded on care plans. For example, the plans said what time service users like to get up, what they like to eat and social interests. Staff members were also seen consulting service users about what they would like to do. Regular residents’ meetings are held. Barton Lodge Residential Retirement Care H54 S12392 Barton Lodge V224058 030505.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 18 The home is open in encouraging, listening and responding to service users’ concerns. There are good policies and training in place to support staff members in protecting service users from harm. EVIDENCE: The home has a complaints procedure, which is included in the service user’s guide. Two service users said that they felt confident that they could come to a member of staff, or the manager, with any concerns or issues that they have. One service user said that she also found the proprietor very approachable. At residents’ meetings service users can raise and discuss any complaints that they have. There is a format for recording complaints. During the course of the visit the manager described an issue, which had been, raised which she was going to record in the complaints log. A member of staff showed a good understanding of action required if an allegation of abuse is made. An awareness of protecting vulnerable adults is promoted from the induction programme, and more structured sessions, using a variety of study and questionnaires, to support understanding. The home has adult protection and whistle blowing policies and copies of local guidance. Barton Lodge Residential Retirement Care H54 S12392 Barton Lodge V224058 030505.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 26 The service is maintained, decorated and furnished to a high standard. The well-tended grounds are a credit to the home. Communal areas are well designed conveying a sense of warmth and homeliness; suitable for service users to enjoy a variety of pastimes. Individual rooms are sensitively decorated; personalised to reflect service users’ wishes. The provider has worked to address any areas highlighted previously, showing commitment to providing a safe, clean living environment for the people living at Barton Lodge. EVIDENCE: All areas of the home were well maintained, comfortably furnished and well cared for, presenting a warm and homely environment. The home stands in extensive well tended gardens, which offer pleasing views from many of the windows and as one service user said ‘ are lovely to take a stroll in.’ The home has two main lounge areas, a television lounge and a conservatory. There is also a sitting room on the first floor, which provides extensive views across the gardens, green and towards the sea. All of these rooms are furnished and decorated to a high standard. One service user was sitting and enjoying quiet
Barton Lodge Residential Retirement Care H54 S12392 Barton Lodge V224058 030505.doc Version 1.30 Page 16 time, another said that she liked to sit in a recess by the reception area, where the comings and goings of the day can be seen. Another room had puzzles and games and housed the home’s piano. The conservatory is often used for service users to enjoy a meal with their relatives. The main dining room is spacious and furnished and laid out to provide pleasant dining surroundings. Personal rooms seen were furnished with personal possessions and well maintained. Suitable locks are fitted to bedroom doors. Balcony areas are fitted with railings and an appropriate risk assessment was sampled regarding safety. The manager said that a carpet in one room, which needed renewing, had been replaced. The manager said that items highlighted in the last report have been addressed. The gap under the lounge door has been reduced; a fly screen has been fitted in the kitchen; an occupational therapist’s assessment has been carried out; work has been undertaken to control the water temperature to protect service users from the risk of scalding. The manager confirmed that water temperatures are monitored and recorded. Water temperatures sampled during the inspection were within satisfactory limits aside from the temperature outlet of a basin located in an assisted bathroom. The manager assured the inspector that service users did not use this basin, but appropriate steps would be taken to ensure that any potential risk is minimised. During the last inspection it was noted that some service users were having a problem with the height of new chairs in the dining room. No problems were observed on this occasion. Since the last inspection the parker bath has been serviced as required. This took place according to the home’s maintenance records in March 2005. It was noted in the last inspection report that an unused bath was being used to wash commodes, as there is no sluice in the home. This remains the current practice. The manager had agreed to try and get disposable commode bowls. This had been looked into and was felt to present more of a problem with regard to disposal, without a macerator in place. It was suggested that the manager ask the infection control nurse for advice. All areas of the home were clean, fresh and free from offensive odours. The home has a small laundry facility. On the day of the visit it was clean and well organised. There is not sufficient room to carry out ironing at present, which is undertaken in a recess of the home’s corridors. The laundry is due to be redesigned as part of the home’s planned extension. Barton Lodge Residential Retirement Care H54 S12392 Barton Lodge V224058 030505.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 28 29 30 Staff members who work in the home are employed in sufficient numbers to care for service users. Clear roles are being defined in the home, matching skills and giving suitable responsibilities to appropriately qualified and experienced staff members. The home has a rigorous recruitment procedure to ensure that staff members working in the home are suitable to work with service users. There is continuous monitoring of training requirements to ensure that staff members are suitably skilled and updated to meet the needs of people living at the home. EVIDENCE: A copy of a roster was seen. A senior carer and three members of care staff work during the day. The manager of the home is additional to the staff team working. Two members of staff are awake at night and a senior carer is available on sleep in duty. One person in the home said that sometimes there are only two carers on duty during the day in addition to the senior carer. The manager said that this would rarely occur when a member of staff may phone in sick at short notice and agency cover was not available. The manager said that the use of agency cover was being reduced significantly. On the day of the visit staff went out about their work in an unhurried manner. A service user said that staff members ‘have time to care.’ One service user commented that staff members are ‘wonderful’ and will do anything that they can to help. The manager has appointed three senior carers to lead the daily routine and to take on designated responsibilities from the manager. The manager was developing clear lines of accountability. One senior carer, who has an NVQ 3, said that she is enjoying the additional duties she has been given.
Barton Lodge Residential Retirement Care H54 S12392 Barton Lodge V224058 030505.doc Version 1.30 Page 18 The manager has set up a useful system for recording training, and identifying training needs. Two members of staff who had recently started working at the service said that they had felt well supported and had worked alongside another carer. One member of staff who had not undertaken care work previously said how much she was enjoying working at the service. The manager has devised a format for week one of the induction, to cover essential aspects of working, including fire, working conditions and principles of safe working practice. An induction programme according to the National Training Organisation’s standards follows this. One booklet, which was underway, was seen and showed progress of the new member of staff, since starting the programme. The manager was working to address issues related to supporting staff members on night duty to undertake training. Three members of staff are currently taking a National Vocational Qualification. Three sets of recruitment records were seen for members of staff who had recently started working in the home. The manager has amended the application form to produce a clearer format. Records contained two written references, proof of identity, photograph and terms and conditions. A Criminal Records Bureau check was present in two of the three files and in the third there was confirmation of a POVAFirst check. The manager confirmed that this member of staff was working under supervision as required under the Department of Health Guidelines for the Protection of Vulnerable Adults. Barton Lodge Residential Retirement Care H54 S12392 Barton Lodge V224058 030505.doc Version 1.30 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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) 38 These standards were not assessed in detail on this occasion. However, the manager has dealt with three shortfalls regarding maintaining safety in the home appropriately. EVIDENCE: A bottle of stain remover, which was identified as a hazardous substance, was removed from a bathroom. A portable heater was being used in one of the individual rooms and may have presented a risk of scalding. There was also a slope in an en suite bathroom, which presented a potential risk of slipping to the person in the room, who uses a tripod as a mobility aid. The manager has confirmed, since the inspection, that appropriate risk assessments have been undertaken. Barton Lodge Residential Retirement Care H54 S12392 Barton Lodge V224058 030505.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 x 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 2 13 3 14 3 15 x
COMPLAINTS AND PROTECTION 3 3 x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 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 x x x x x x 2 Barton Lodge Residential Retirement Care H54 S12392 Barton Lodge V224058 030505.doc Version 1.30 Page 21 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 Regulation Requirement Timescale for action 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 Lodge Residential Retirement Care H54 S12392 Barton Lodge V224058 030505.doc Version 1.30 Page 22 Commission for Social Care Inspection 4th Floor, Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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