Inspection on 23/05/06 for Barton Park

This inspection was carried out on 23rd May 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Barton Park 15/03/06

Barton Park 05/07/05

Barton Park 01/03/05

Barton Park 17/08/04

Barton Park 31/03/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Barton Park 15 - 17 Oxford Road Southport Merseyside PR8 2JR Lead Inspector Mrs Joanne Revie Unannounced Inspection 23rd May 2006 10:00 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 Park DS0000017225.V292535.R01.S.doc Version 5.1 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 Park DS0000017225.V292535.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Barton Park Address 15 - 17 Oxford Road Southport Merseyside PR8 2JR 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) 01704 566964 01704 568454 Choice Classic Limited Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (60) of places Barton Park DS0000017225.V292535.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 60 OP Date of last inspection 5th July 2005 Brief Description of the Service: Barton Park is a large and extended detached building situated in a residential area of Birkdale close to Southport sea front. The home is registered to provide nursing care for up to 60 residents over the age of 65. Barton park has been upgraded to provide a number of individual living units comprising of a combination of lounge, bedroom and bathroom facilities and in some cases kitchens. These are known as apartments. The remaining bedrooms are all single. There are shared communal dining and lounge areas on the ground floor and the home benefits from gardens to the front and rear. Choice Classic Ltd owns the home and the Responsible Person is Mr David Barton. Barton Park DS0000017225.V292535.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over seven and a half hours and due to the size of the home involved two inspectors. A variety of documentation was viewed during the visit, which is referred to in the evidence section of the report. Discussions were held with 13 residents and a group discussion was held with five members of staff, the general manager, the proposed manager and the responsible individual. Their views have been included in the summary section of the report. Four surveys were distributed during the inspection and the responsible individual completed a pre inspection questionnaire prior to the inspection taking place. Reference is made to these documents throughout the report. What the service does well: Throughout the inspection residents spoke positively about the service in general. One resident confided that throughout her life she had enjoyed many experiences but had always found a criticism however “ since residing at Barton Park, I have yet to find a “but””. This resident had resided in the home for six months and had close family living at the home that required a high input of nursing care. Those residents who had recently moved into the home stated how nice it was to be visited by staff from the home before admission took place. One resident was particularly impressed with the staffs understanding for her need for privacy once she had moved into the home. This shows that staff respect residents wishes. Residents are issued with clear contracts on admission, which plainly explain what can be expected from Barton Park. These are replaced with updated versions should a change occur. This shows that residents have access to up to date information and that the service tries to uphold resident’s rights. Each resident has a well-written plan of care, which gives clear instructions of the nursing care required. Barton Park DS0000017225.V292535.R01.S.doc Version 5.1 Page 6 This is reviewed and updated regularly by qualified staff. This means that staff have access to up to date instructions on how to care for the residents. The service tries to include residents in the drawing up of these plans, which reflects good practise and helps to promote resident empowerment. Resident’s health needs are closely monitored and staff are quick to act should changes occur. One resident confided that staff drive her to her consultants appointments in Liverpool and stay with her throughout. The resident commented that she found this very reassuring. On the day of the visit one resident was celebrating a birthday. The home had arranged a birthday party and both residents and staff dressed for the occasion. This is good practice and shows that the home is resident led rather than staff led. Residents are encouraged to look after and administer their own medication if they so desire and are able. It was evident that trusting relationships have developed between residents and staff by the comments made when this subject was discussed. The comments included “it is never assumed by staff that they should just give it out”, “If staff think I have forgotten my pills they remind me”,“If they think they should now take charge they discuss it with me and they’re usually right”. This shows that the service encourages residents to have control (were able) over their lives. Residents were particularly complimentary about staff’s ability to maintain resident’s privacy and dignity. One resident was particularly impressed that “ staff never gossip”. Another revealed that she had confided in a staff member regarding recent family troubles and that the staff member had not divulged this information. This shows that staff have integrity. The service provides a nutritious varied diet and is able to provide specialised diets if health needs require it. Residents were complimentary about the food provided by stating “if I don’t want the dish I have chosen I can choose something else and the chef will provide it”, “ the chefs are marvellous, they always make the food look nice”, “ its very tasty”, “I enjoy the lovely food and Excellent. Activities are provided at the home for those residents who wish to take part. Residents confirmed that they are free to come and go as they please and that visitors are always made welcome. A resident commented ” as if they were visiting me in my own home”. Staff understand the importance of offering choice from small choices such as preferred clothing to bigger choices of how residents wish to spend their day. Residents believe that their concerns are listened to and addressed. Comments included” Staff always ask if everything is alright”, “ I am encouraged to say what I think”, “I have had minor concerns which I talked about to my relative but they were put right straight away”, Barton Park DS0000017225.V292535.R01.S.doc Version 5.1 Page 7 “Our happiness is important to them, they are always interested if everything is alright” and “ we help others who may not be able to say what they want by saying it for them, such as “They need another drink”, this helps the staff and they are always very quick to respond”– “we all help each other, like good neighbours”. This shows the trust that residents have in staff and the level of contentment experienced. Residents believe they are in safe hands and were complimentary about the staffs ability to care. Comments included” the nursing care is second to none and I should know”, “staff are not just caring, they’re affectionate” and “I want for nothing, the moments it’s left my lips its addressed, They’re marvellous” Staffing levels are consistent in the home and staff turnover is minimal. This means that there is enough staff to care for the residents and that residents receive care from staff that they know. The home has been commended on its level of cleanliness. All areas viewed were very clean and bright and tidy. Residents commented that staff clean rooms “when I wish them to” and “anytime I want, they will do anything I ask”. Residents are encouraged to make themselves at home by personalising their bedrooms with items of furniture and personal possessions. The areas of home, which are accessible to residents, are very well maintained and decorated and furnished to a high standard. The service employs a number of staff that have achieved professional nursing qualifications overseas. The national minimum standards recommend that a service ensures that 50 percent of staff employed have recognised care qualifications. The service employs a total number of staff that have achieved a care qualification greater than 50 percent. For this reason the service has been commended on this standard. Staff have received training to enable them to meet the needs of the residents. Staff commented that they thought the variety and quality of training offered was very good. The home follows strict recruitment procedures, which comply with the Care Home Regulations 2001. This means that staff are able to care for the residents appropriately and that residents receive care from staff that are fit to do the role. Three residents commented during discussions that they believed that the home was run very well. One commented “like clockwork” another stated that it was very reassuring to know that Mr Barton visited the home so often and played such an active role in its management. The third stated that management were always cool, calm and collected and that potential situations were “quickly nipped in the bud”. A comment was made on a survey that had been completed by a resident that “I would like to stress again the confidence and trust that I have in the management team and owner of Barton Park”. Barton Park DS0000017225.V292535.R01.S.doc Version 5.1 Page 8 What has improved since the last inspection? What they could do better: Although the Statement of Purpose has been developed to meet the requirements of the Care Home Regulations 2001 it could be enhanced further by including information about the residents care plan review. The document promotes empowerment for the residents and an invitation for the resident to join the monthly review would develop this further. Staff should be reminded of the importance of completing all pre admission documentation in full. This will enable the home to fully prepare for the residents admission. Although residents nursing needs are well documented in the plans of care little information is recorded on their social needs. Staff were knowledgeable about these but this information must be recorded so that it is accessible to all staff not just those who know a particular resident well. Barton Park DS0000017225.V292535.R01.S.doc Version 5.1 Page 9 The service has recently received good practise recommendations from the local authority detailing how to implement risk assessments for those residents who are prone to falls. The general manager expressed her intention to implement this and this intention must be followed through. Documentation must be developed to record concerns and complaints. Staff require guidance on this and should ensure that any action taken to address concerns is recorded along with a signature and a date. This will prove that the service is operating within its own complaint procedure timescales. Residents feel protected and staff were able to explain what they would do if they thought a residents rights had been breached. The general manager explained that a need for formal training in this area had been identified and training had been arranged in the near future. This intention must be carried through to ensure staff have a thorough understanding of what to do if they suspect abuse has occurred. The basement areas of the home require organising/developing. This was discussed with the responsible individual who had identified this need and was intending to have building works carried out. These plans were put on hold following the outcome of the Care Standards Tribunal. This area should be revisited and the intention by the responsible individual to address these concerns carried out as both could impact on Health and Safety of staff. The shelving to the bottom of the kitchen units must also be considered as part of this review. Resident’s commented that the responsible individual of the home is very attentive to their needs. The general manager has been in post for some time, which offers stability. However, the responsible individual must ensure that he continues to pursue the application for the proposed manager. Although residents believe that their views are listened to, documentation needs to be developed to support this. Surveys should be developed for completion by residents, relatives and visiting health care professionals. The results should be analysed and a report sent to CSCI on an annual basis detailing the outcome and any action taken. It became evident that staff and management were using the handover period to discuss other topics/concerns/procedures rather than just the care required by the residents. Because of this all staff and management did not feel it would be useful to hold staff meetings. In view of this, topics that do not relate directly to the residents care should be recorded as evidence of good practice and communication between the staff. Efforts are made to ensure that the home complies with health and safety. Staff confirmed that practise evacuations are carried out so that they would understand what to do if a fire occurred. This event is not recorded and should be as evidence of good practice. Barton Park DS0000017225.V292535.R01.S.doc Version 5.1 Page 10 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 Park DS0000017225.V292535.R01.S.doc Version 5.1 Page 11 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 Park DS0000017225.V292535.R01.S.doc Version 5.1 Page 12 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 Quality in this Outcome area is good. Judgement has been made using available evidence including a visit to the home. The Statement of Purpose meets the required standard but could be developed further to promote residents involvement in the planning of care. Residents have written documentration about their rights. All prospective residents have a pre admission assessment undertaken but not all information is always recorded. EVIDENCE: A requirement was made following the last inspection which related to the information contained within the homes Statement of Purpose and Service Users guide. Viewing the document showed that this requirement had been met but following a discussion with management further suggestions for improvement were made. The original document puts a strong emphasis on residents autonomy however there is no mention of residents being involved in the monthly review of their plan of care. This could be viewed as contradictory to the documents aims.Senior management of the home agreed to alter the dopcument so that the empahisis on residents empowerment is consistent. Barton Park DS0000017225.V292535.R01.S.doc Version 5.1 Page 13 Four copies of contracts of terms and conditions of residency were viewed. Each was signed and dated by a representative for the home and the resident or residents representative. The contract was written in plain english and included expectations of the service and what the service would offer in return. The level of fees including breakdown was also clearly documented. One resident commented that a new contract is issued should anything change and that this is always fully explained. The general manager for the home confirmed that residents recieve a copy of this document on admission. This view was also supported by a resident. Two care plans were viewed which contained information which had been gathered prior to admission taking place. Both had been completed by a qualified nurse, however, not all sections had been fully completed on one of the forms viewed. A resident who was admitted recently, remembered being visited by a nurse and commented that it was nice to meet someone from the home before they left hospital. They also commented on how supportive staff had been when they had first come to live at the home. Discussions with another resident also revealed that a pre admission assessment had taken place to find out what her needs and wishes were. This resident was impressed with the support provided by staff upon admission to make her feel included in her care planning and provided support when she required it. She was also impressed with the ability of staff to adapt to her need for privacy. The resident confirmed she had received information from the home prior to admission which was helpful to her and her relatives. Her main reason for wishing to come to the home of her choice after a period in hospital was she knew people who had resided there, and their opinion on the care given to them was excellent and, therefore, their recommendation was good enough for her and the home has lived up to its reputation. Barton Park DS0000017225.V292535.R01.S.doc Version 5.1 Page 14 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. Each resident has a well written care plan which reflects their health needs but not their social needs.Residents are consulted about changes to their care. Residents health needs are monitored and staff take action should changes occur. Medicines are managed adequately by the service. Residents are supported to take charge of their medication according to their needs.Staff fully understand the importance of respecting residents privacy and dignity. EVIDENCE: Two care plans were viewed. These were completed to a good standard and staff were keeping daily records regarding the residents progress and wellbeing. No information could be found regarding the risk of falls. This was later discussed with senior management. The general manager confirmed the document which had been produced by the local authority called slips, trips and falls had been received but had not yet been implemented. Care plans showed evidence of consultation with the residents regarding medical procedures and whether they preferred their bedroom door to be locked. Barton Park DS0000017225.V292535.R01.S.doc Version 5.1 Page 15 A keyworker system is in place and two of the residents spoken with confirmed who their keyworker was. Staff keep records of residents general observations such as weight, BP. pulse and temperature. It was evidenced that staff take action if there is a change in any of these. Discussions were held with six residents on a one to one basis about their experience at the home. All residents spoken with commented very positively on staffs ability and the level of care provided. Records showed that a variety of G.P.s visit the home and other professionals such as specialist nurses from the Primary Care Trust , Chiropidists, and dieticians also visit. During discussions one resident confided staff support her to visit her consultant in Liverpool by escorting and driving her there and back. A pharmacy inspection was carried out by a pharmacy inspector shortly before this inspection took place. The pharmacy inspection concluded that medicines are managed adequately by the service. A requirement was made regarding the management of homely remedies and advice and guidance was given in the form of good practice recommendations for medications that are to be given as and when required This report is available to the public as a seperate document from this inspection report. The pharmacy inspection also evidenced that improvements have been made through the development of a more robust checking system. Discussions with four residents confirmed they are offered choice as to whether they self medicate. Residents care plans include a document that records if the resident wishes to self medicate or requests the home to administer the medication. Residents confirmed that they were consulted about their medication. Observation of one resident receiving medication revealed that it was given in a dignified way, quietly, and without drawing attention to the resident. The member of staff waited until they were satisfied it had been taken. Residents were aware of their care plans and records examined verified that what was written was being delivered, or changed by discussion with the residents. Two Care plans viewed were based upon a medical model and did not include plans to meet social and emotional needs, these need to be improved. One resident stated that the daily visits from her sister were vital to her and that she very much missed her pet cat. This information was not available on the plan of care and would have given a clearer insight into what was important to this resident. Residents observed during the visit were very well presented. One resident was observed to be resting in bed. The resident confirmed he felt well cared for and viewing care records and his appearance supported his opinion. Barton Park DS0000017225.V292535.R01.S.doc Version 5.1 Page 16 Residents spoke positively( three) of the staffs ability to respect their privacy and dignity. One resident was partcularly impressed that family affairs which had caused worry were kept confidential by a staff member. Barton Park DS0000017225.V292535.R01.S.doc Version 5.1 Page 17 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. Residents are supported to take part in activities of their choice but this could be further enhanced through the development of care plan documentation. Visitors are welcomed by the home. Residents are supported to go out as they wish. Residents feel in control of their lives. Staff understand the importance of offering choice.The service provides a choice of nutritional meals and specialised diets which are enjoyed by the residents. EVIDENCE: There is an activities record which describes the activities available. The introduction of themed days, reminising, birthday celebrations are reflective of discussions with residents. In a group discussion with residents, they confirmed there was a variety of activities available within the home and they have the option to join in or not.Also residents confirmed that there is information about Southport and whats going on, this information was viewed in the hall of the home.On the day of the inspection a resident was celebrating a birthday. Barton Park DS0000017225.V292535.R01.S.doc Version 5.1 Page 18 The resident had sent out invitations to residents in the home, and outside of the home,each resident had dressed for the occassion and staff had done the same. There was music, dancing and food, and everyone appeared to enjoy themselves. Efforts had been made to ensure that everyones individual tastes in music were catered for. Residents confirmed they had interests of their own outside the home, but thought it Good that there are activities provided that include people who may not have anyone to visit. Residents know each day what activity is available and at what time, posters are placed around the home,which were viewed, and staff in discussion with residents confirmed the activity for the day. For a resident, with limited concentration, there was provision for staff to read the newspaper to her and engage in conversation, this was observed in her assessment. All residents spoken with confirmed they were free to come and go as they please. Those who are able go out to visit families or shop. All spoken with confirmed that their visitors were always made to feel welcome when they visited. The contract between the home and the residents details that the home has an open visiting policy but that visitors can be refused if it is likely to impact on other residents health and safety. Viewing the visitors book showed that vistors are free to come and go at a variety of times during the day. Through discussions with three residents and five staff it was evident staff were aware of what was important to individual residents and how those residents wished to spend their time. However this information was not recorded on the plans of care. Discussions with two residents who require support with personal care showed that staff offer choice whenever possible. Examples were given such as - I choose the clothes from my wardrobe and staff help me dress. and I go to bed and get up when I choose. More independant residents are free as quoted by one to do as I please when I please. When asked three of the residents stated that they felt in control of their own lives and that they didnt have to wait for staff to have time to attend to their needs. Discussions with catering staff and observation of the menu, and discussion with residents, indicated that personal preferences of residents regarding food are catered for. In discussion with the Chefs, it was established they have been at the home for a number of years. They knew the dietary needs of the residents, and demonstrated their ability to adapt the menus according to the wishes of the residents. Barton Park DS0000017225.V292535.R01.S.doc Version 5.1 Page 19 They understood the concept of cooking for individuals that might have cultural food requirements and were able to give examples of situations where this might be needed. Copies of menus were viewed which showed that the home plans a four weekly menu with choices available at each mealtime. Staff confirmed through discussions that they consult the residents on a daily basis about what they would like to eat. Residents confirmed they received food in accordance with their dietary requirements. One resident who is diabetic discussed her food with the inspector, she was fully conversant with her condition and confirmed that the chefs knew about her needs and catered for them. All residents spoken with commented positively on the food provided. Barton Park DS0000017225.V292535.R01.S.doc Version 5.1 Page 20 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. Residents believe that their concerns are listened to but documentation needs to developed to support this further. Residents believe they are in safe hands. Staff understand how to protect residents rights but in some cases require formal training. EVIDENCE: A complaint was made against the service earlier this year. This was appropriately investigated by the responsible individual and was concluded by CSCI that no breaches had occurred in the Care Home Regulations 2001. The service has a complaints procedure, which meets the required standard. A complaints book was viewed. The complaints recorded within this book were recorded well and included the date the complaint had been resolved and the action taken. However, there was no signature showing who had taken this action. Through discussions with staff it became evident that staff believed this book should be used when residents and relatives stated that they wished to formally complain. Staff need to ensure that they record all concerns also as evidence of good practise. Barton Park DS0000017225.V292535.R01.S.doc Version 5.1 Page 21 In discussion with residents as a small group (7) and individually (4), residents confirmed if they had any complaints they would feel able to discuss these with the management. In the returned resident comment survey responses were positive. No Reason here for complaints. Always know how to complain. You can talk to staff confidentially and they do not gossip The service has a copy of the local authorities Protection of Vulnerable Adults procedures. The general manager confirmed she has arranged for the Adult Protection Officer to deliver training on this subject to staff at the home. Viewing certificates and training files showed in some cases this had taken place. A discussion was held with five members of staff who although had not training were able to expand on what abuse was and what they would do if they suspected it had occurred. Three residents agreed that they believed that they were in safe hands. Barton Park DS0000017225.V292535.R01.S.doc Version 5.1 Page 22 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): Quality in this outcome area is good.This judgement has been made using available evidence including a visit to the home.Residents live in a comfortable well maintained home and are encouraged to make it their home through personalising their bedrooms. Some areas which are not acessible by residents are not as safe as they could be. The home is kept very clean. EVIDENCE: A tour of the building was made.The home has one communal lounge and one communal dining room. Both areas are converted to dining rooms/lounges according to the time of day. It was recorded on the pre inspection questionaire that there is one domestic person. Given the size of the home this appeared an insufficient number of staff, however, this is not reflected in the homes standard of cleanliness.The standard of cleanliness observed throughout the home was exceptional. Bathrooms, toilets were clean, bright, with soap, towels,and bins. Barton Park DS0000017225.V292535.R01.S.doc Version 5.1 Page 23 Residents rooms were comfortable,clean,and personalised, well furnished with personal items of furniture and items provided by the home. It was established that staff, when not providing direct care to residents do on occassions clean. Linen was individualised, clean, and ironed.Residents commented positively upon the cleaning of their rooms. The laundry area was organised, clean and tidy.Machines were well maintained. Discussion with residents revealed they were happy with their rooms, they felt they could use the lounge/dining areas if they wanted to,and had free access to any area in the home, except the kitchen, which is Understandable. There are other sitting areas available in both reception halls which were observed as being used by different residents during the day. The kitchen area is small compared to the size of the home, although the chefs felt this was to their advantage. Generally the area is organised, but the bottom storage shelving racks appeared well worn and in need of upgrading. There is a fridge in the kitchen, but not a freezer which means all the frozen items are kept in the basement area which is accessed by leaving the building. Observation of this area revealed it was not as organised as it could be. The Freezer is inside the entrance to the basement,and the entrance door is left open. This could have implications for Health and Safety, if the freezer is opened to remove items of food on a regular basis, with the access door left open this area could attract flies, wasps ect. The basement area contained unwanted items such as boxes and discarded equipment. Concern was expressed to the owner as the light in this area was held up by wire. The owner explained that this area was to be developed, however, due to the Care Standards Tribunal all work had been suspended. The food store was observed to be organised and tidy, if somewhat sparse in supplies. In discussion with the Chefs it was evidenced that all supplies of meat, veg, bread, pulses, and biscuits are fresh, therefore, there is very little need for frozen or tinned food. The chefs confirmed that they produce an order and this is obtained through the general manager. Barton Park DS0000017225.V292535.R01.S.doc Version 5.1 Page 24 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): Quality in this outcome area is good. This Judgement has been made using available evidence including a visit to the home. The home provides sufficient staff to meet the resident’s needs. Over 50 percent of staff hold a recognised care qualification. The home follows robust recruitment procedures. Staff have undertaken training to enable them to carry out their role. EVIDENCE: Discussions were held with four staff who confirmed that they believed the training offered enabled them to meet the residents needs. They commented that the quality of the training was very good and that there was lots of it.They explained how they reported changes in care to one another and all believed that the staff handover was a vital part of this communication. The staff demonstrated a clear understanding of each others role. Certificates were diplayed in the office which showed that staff have undertaken a variety of training in the last twelve months. A training plan was viewed which supported this further. Topics included First aid, Care of ageing skin. Food hygiene, Health and Safety in the workplace, Infection control and Fire awareness, Dementia care and palliative care. The general manager explained that the local authority adult protection coordinator was delivering training in the near future to the staff team on the protection of vulnerable adults. Barton Park DS0000017225.V292535.R01.S.doc Version 5.1 Page 25 Off duties were viewed which showed that the home is staffed with eight staff every morning , six staff until 8pm and three waking night staff. This does not include ancillary staff. During discussions Residents and staff agreed there were enough staff to meet needs.The rotas also showed that a qualified nurse is available 24 hours a day. The service forwarded a pre inspection questionnnaire which stated 36 of staff had achieved an NVQ in Care. However during discussions with management it became apparent that a number of overseas qualified nurses are employed as care assistants. This takes this number to greater than 50 .Discussions with staff showed that NVQ training is on going within the home however the home has reached a standstill with this as the training provider had not been able to fulfill their obligations. Staff files were viewed which showed that the home complies with the Care Home regulations 2001 by requestinbg information which proves the staff members suitability to work in a care environment. This included staff who had been employed from overseas. Barton Park DS0000017225.V292535.R01.S.doc Version 5.1 Page 26 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): Quality in this outcome area is adequate.This Judgement has been made using available evidence including a visit to the home.The proposed manager needs to pursue her intention to be the registered manager for the service.Residents views of the service are sought but documentation needs to be developed to support this.Health and Safety is managed adequately however some parts of the home which are not accessible to residents are not as safe as they could be. EVIDENCE: The responsible individual of the home produced documentation which supported his intention to support the porposed managers application to be the registered manager for the service. A CRB was produced but unfortunately a clerical error had been made which meant the need for a further application. Barton Park DS0000017225.V292535.R01.S.doc Version 5.1 Page 27 The responsible individual expressed his intention to ensure that this was carried out. The proposed managers staff file was viewed and it was evidenced that she had been recruited in line with the required recruitment standards. The inspector for the service recieves a copy of a monthly visit report which complies with regulation 26 of the care home regulations 2001. Residents stated that the responsible individual visits residents regularly( in some cases daily) to seek their views of the service. The service employs a general manager who is a long standing member of staff During staff discussions staff spoke positively of the proposed managers impact at the home. Three residents spoken with commented very positively on the management of the service.A returmed survey from a resident alos commented positively on this aspect. The home had purchased and were trying to implement an auditing tool to monitor quality assurance. During discussions with residents it become evident that it is common practise for the owner to visit the residents on a daily basis to ensure that they are happy with the service. Discussions took place with the owner and the general manager around what CSCI expected to fufill this standard. This advice was accepted with an intention to implement simple surveys to record residents/ relatives and visiting health professionals views of the home. During a tour of the environment some concerns were expressed as detailed in the Environment section of this report which could impact on Health and Safety. A risk assessment file was viewed which showed that a full assessment had been undertaken on all other parts of the building. This was broken down into risk assessments on the individual accommodation for each resident. Training files showed that staff have undertaken training on manual handling, food hygiene, First Aid and Fire safety plus control of infection. Staff confirmed that they have sufficent supplies to prevent infection occurring and residents confirmed that they had seen them using these. The laundry is organised so that clean laundry is not mixed with dirty which helps to promote this. The service employs a maintenance person who records all actions taken. No rolling programme of planned maintenance existed. However, the home appeared very well maintained so maintenance would appear to be managed well. Records were viewed which showed that random regular tests of water temperatures are carried out through out the home. Fire records showed that the fire alarm is regularly tested and that fire fighting equipment exists and is serviced by an outside contractor. The home is fitted with an emergency lighting system which is also regularly tested.Manangement stated that practice fire evacuations are undertaken but these are not recorded. Barton Park DS0000017225.V292535.R01.S.doc Version 5.1 Page 28 Contracts were viewed for the removal of clinical waste and for servicing of hoisting equipment. Electrical and Gas safety certificates were viewed which were current. Barton Park DS0000017225.V292535.R01.S.doc Version 5.1 Page 29 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 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X 3 X 4 STAFFING Standard No Score 27 3 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X X X 2 Barton Park DS0000017225.V292535.R01.S.doc Version 5.1 Page 30 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP31 Regulation Reg. 8 and 9 Requirement The registered person must appoint a proposed manager who will then be required to apply to the Commission for the post of registered Manager. The registered person must ensure care plans are developed further to include the resident’s social needs and wishes. The registered person must ensure that documentation is developed to identify and reduce the risk of falls occurring The registered person must ensure that staff record all details of concerns along with any action taken, who undertook the action and the date that this took place. The registered person must ensure that the intention for staff to receive training on the protection of vulnerable adults is followed through. The registered manager must ensure that quality assurance systems are developed so that resident’s views are recorded. Timescale for action 10/06/06 2 OP7 Reg. 15. (1) Reg.12. (1) (a) Reg. 22. (8) 01/12/06 3 OP8 01/09/06 4 OP16 31/07/06 5 OP18 13. -(6) 01/09/06 6 OP33 Reg. 24. - 01/12/06 Barton Park DS0000017225.V292535.R01.S.doc Version 5.1 Page 31 Outcomes of this process must be analysed and a report produced with outcomes and sent to CSCI on an annual basis. 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 3. 4. 5 Refer to Standard OP1 OP19 OP3 OP30 OP38 Good Practice Recommendations The registered person should carry through their intention to develop the Statement of Purpose further to include residents’ invites to the monthly care plan review. The registered person should carry through his intention to address the wiring and revisit the food storage in the basement and the bottom shelves of the kitchen units. The registered person should remind staff of the importance of completing all pre admission documentation fully. The registered person should consider recording all topics discussed during staff handover as further evidence of communication. The registered person should ensure that practise fire evacuations are recorded. Barton Park DS0000017225.V292535.R01.S.doc Version 5.1 Page 32 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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 Park DS0000017225.V292535.R01.S.doc Version 5.1 Page 33 - 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. 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