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Inspection on 12/02/09 for Barton Place Independent Care Hotel

Also see our care home review for Barton Place Independent Care Hotel for more information

This inspection was carried out on 12th February 2009.

CSCI found this care home to be providing an Good service.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Barton Place Independent Care Hotel Wrefords Link Cowley Bridge Exeter Devon EX4 5AX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Michelle Oliver     Date: 1 2 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Barton Place Independent Care Hotel Wrefords Link Cowley Bridge Exeter Devon EX4 5AX 01392211099 01392434607 kh.barton-place@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Barton Place Ltd. Name of registered manager (if applicable) Michaela Jane Harris Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 30. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP - maximum 0f 30 places Dementia aged 65 years and over on admission - Code DE(E) - maximum of 30 places Mental disorder, excluding dementia or learning disability, aged 65 years and over on admission - Code MD(E) maximum of 30 places Date of last inspection 0 0 0 Over 65 30 30 30 care home 30 Care Homes for Older People Page 4 of 33 Brief description of the care home Barton Place is described as an independent care hotel and is a Home offering care, including nursing care, to people over the age of 65 years who have mental health problems; particularly those experiencing confusion or dementia. The stated aim of the home is to provide skilled, sensitive and understanding care to enable residents to achieve the highest possible quality of life whilst receiving the utmost quality of care and accommodation. The home is situated on the outskirts of Exeter in a grand Georgian house, which benefits from several acres of attractive and long established gardens. Current fees charged are £850 week. Inspection reports are available on request from the home manager. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means that people who use this service experience good quality outcomes. This inspection was undertaken by one inspector over the course of 7 hours spent at the Home. We spoke with people living there and staff and also spent time observing the care and attention given to people by staff. Prior to this inspection we sent questionnaires to 10 people living at the home, 10 staff and 5 health care professionals. A number of questionnaires were completed and returned to us from people expressing their views about the service provided at the home. Their comments and views have been included in this report and helped us to Care Homes for Older People Page 6 of 33 make a judgement about the service provided. To help us understand the experiences of people living at this home we looked closely at the care planned and delivered to three people. Most people living at the home were seen or spoken with during the course of our visit. Very few of the people living at the home were able to communicate fully with us about their experience of living at the home. We also spoke with 9 staff including the manager, owner, deputy and ancillary staff individually. The inspector toured the premises freely, including all shared areas and the majority of residents accommodation. A sample number of records were inspected which included care plans, medication records and procedures, staff recruitment files, service and maintenance certificates and fire safety records. The inspector appreciated the time taken by the manager and all staff to assist with this inspection and the inspector found all staff very helpful on the day Currently the fees of between 750 pounds & 850 pounds are charged per week. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site /www.oft.gov.uk . Copies of the inspection report are available from the office. What the care home does well: People who are considering moving to a care home are given good information about Barton Place before any decision to move in is made. Trial visits are encouraged and a suitably qualified member of staff from the home will also carry out a careful, detailed assessment before anyone is admitted to the home to ensure their needs can be met. Not all people spoken to during this inspection were able to recall their admission to the home but all expressed complete satisfaction with the outcome. The home has drawn up individual care plans covering all aspects of care needs. Risk assessments have also been drawn up on all aspects of health and personal care and clearly show how the home identifies potential health risks and puts preventative measures in place. The home has good links with all relevant health professionals and treatment has been provided where needed. The care staff have completed daily reports showing that the care plan has been followed and outcomes are being met. These give a clear picture of daily events for each person living at the home. Medications are stored safely and only experienced staff carries out the administration. Records of medicines administered have been well maintained. Evidence was obtained in various ways throughout this inspection to show that those living at the home are treated in a dignified manner and their privacy is upheld at all times. Those who were able expressed complete satisfaction in the way they are treated by the staff. The staff were calm and unhurried and assisted people in a friendly, caring and respectful manner. Care plans and daily reports showed that people could exercise choice and control of all aspects of their lives and some people talked about how they are able to lead their lives just as they want, without unnecessary rules or restrictions. The home provides a good range of activities to suit all interests. Arrangements are in place to ensure family and friends are made welcome at all times and are kept informed and involved in the daily life of the home. All people we spoke to praised the standard of meals provided. The menus are balanced, varied and nutritious and meals suit all individual dietary needs. The home has an excellent range of policies and procedures that have been regularly updated and staff have been given training and instruction on the policies to ensure they are followed correctly. People living at the home and their relatives and visitors can feel confident that complaints and concerns will be addressed promptly and a satisfactory outcome reached. All areas of the home are clean, safe and hygienic. The home employs sufficient staff to meet the needs of those living there. Good recruitment practices ensure people are safeguarded from abuse. Staff are competent Care Homes for Older People Page 8 of 33 and deliver high quality care in a safe manner. The home is well managed. There is an open and positive atmosphere throughout the home. Good quality assurance procedures and systems to safeguard the health and safety of people living at the Home and staff are in place. In response to questionnaires sent before this inspection commented included: Choosing Barton Place was one of the best decisions I have ever made It was the third home we had visited My (relative) has only been at Barton Place for a weekend and I am very pleased by how easily she seems to have settled. My (relative) was not fit to visit homes but I received adequate information. Responses to questionnaires from staff included Information about the needs of people are given daily if they are important, another I am able to get information about the needs of people by either the trained staff or matron informing me and I can get it from the persons file and I feel I am well informed and included re the needs and changing needs of our clients. Information is recorded separately in their care plans with the relevant information being discussed and acted upon. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 9 of 33 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home provides clear, detailed information to people considering moving in. People can be confidant that they will receive the care and support they need if they do move into the home. Evidence: Significant time and effort is spent planning to make admission to the home personal and well managed. Prospective residents and their families are treated as individuals and with dignity and respect for the life changing decisions they need to make. There is a high value on responding to individual needs for information, reassurance and support. We received responses from 8 of the 10 people living at the home that we sent questionnaires. Relatives had completed the majority of the returned questionnaires. Care Homes for Older People Page 12 of 33 Evidence: All confirmed that they had received enough information about Barton Place when they initially made enquiries. A relative told us,My [relative] has only been at Barton Place for a weekend and I am very pleased by how easily [they] seems to have settled and another My [relative] was not fit to visit homes but I received adequate information. One person told us Choosing Barton Place was one of the best decisions I have ever made and another It was the third home we had visited. The service is highly efficient in obtaining a summary of any assessment undertaken through care management arrangements, and insists on receiving a copy of the care plan before admission. For people that are self funding, a qualified member of staff, usually the manager or their deputy, undertakes an assessment. Individuals are supported and encouraged to be involved in the assessment process as much as they are able and information is gathered from a range of sources including other relevant professionals. During this inspection we spoke to several people living at Barton Place but none could remember their admission to the Home. We looked at files for three people living at the Home including that of the most recently admitted person. All were very detailed and included assessments of any risks, the involvement of relatives, carers and other health care professionals in the assessment. Comprehensive information had been gathered and recorded about peoples current health and social care needs and in depth social histories to enable staff to know people as individuals and to be aware of how they chose to live their life before living at Barton Place. The service does not provide rehabilitation. Care Homes for Older People Page 13 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Barton Plave can be confident that arrangements will be made to ensure their health and social care needs will be met. People living at the Home are protected by the homes policies and procedures for dealing with medicines. They can feel confident that they will be treated with respect and that their privacy will be respected Evidence: The home is continually working towards improvement and care plans continue to improve resulting in staff being well informed about individual needs and wishes of people living at Barton Place. Assessment of potential risks to people living at the home is undertaken as part of the care planning process and kept under review. This includes the risks of falling and nutrition. During this inspection three peoples files were looked at in detail and all included Care Homes for Older People Page 14 of 33 Evidence: comprehensive information to ensure that staff are aware of how to meet individual daily health and social care needs. The plans are developed with people individually wherever possible and relatives are involved with the persons consent. Plans are based on an up to date assessment covering all aspects of their health welfare and social care needs. Plans focus on individuals strengths, abilities and wishes and include information for staff to treat people as individuals rather than focusing on their illness. Gathering and recording this information means that staff have the information to encourage people to lead purposeful fulfilling lives as independently as possible. Plans of care were informative, detailed, well written, clear and easy to understand. There are also daily notes written by care staff that show how peoples personal and social care needs are being met. All staff members we spoke to during this inspection knew those people living at the Home well. They told us how people like their care to be delivered but this information had not been consistently recorded in care plans. This could mean there is a risk that changes to the way care is delivered or changes in peoples health may not be monitored. It also means that people could experience some inconsistency of care if information is not recorded. We discussed this with the manager who agreed that staff strive to continually improve the quality of the care provided and changes are not always documented. We saw nothing to indicate that people at the home were anything but well cared for and that staff knew them well. People living at the Home have access to healthcare outside of the Home. Staff make sure that those who are fit and well enough are encouraged to be as independent as they can, have regular appointments and visit local health care services wherever possible. The health care needs of those unable to leave the Home are managed by visits from local healthcare services. When people move to Barton Place they are given a choice of continuing to be registered with their own doctor, if the doctor is within the area of the Home, or being registered with a doctor from a local practice who visits once a week to carry out a surgery, and also when requested. The home monitors peoples dental and optician checks and chiropodists are used according to peoples needs. Information relating to the involvement, and advice from health care professionals such as skin care specialists and nutritionists were included in peoples plans of care. This means that they benefit from the involvement of health care professionals to ensure that health care needs are met. The manager described a good relationship with health professionals such as specialist nurses, pharmacist and doctors. Care Homes for Older People Page 15 of 33 Evidence: The Home providers people living there with appropriate aids and equipment they need and these are well maintained to support them and staff in daily living. We spoke to a maintenance person employed at the Home, who told us of the routine maintenance programme in place for equipment such as wheelchairs and bed rails, which promotes the health and safety of people living at the Home. Care plans are reviewed regularly and appropriate changes are made to reflect changing needs and individual choice. Individuals, and relatives, are encouraged and supported to be involved in this review, but this is not consistently recorded. Clear details are recorded of any changes and but does not include the persons perception of reasons for changes. Medication is well managed at the home. Records were accurate, up to date and indicated that it is appropriately administered. Medication records were fully completed, included required entries, and were signed by appropriate members of staff. Photos of individuals are kept with the administration records to reduce the risk to people, who are not always able to confirm their identity, of receiving incorrect medication. During our inspection we saw several containers of creams and ointments that had been opened but no date of expiry had been indicated which means that they may no longer be beneficial. Also staff do not consistently record when creams or ointments are applied. This means that the efficacy of them cannot be fully judged and could result in treatment not being carried out as prescribed. Details of any changes to a persons medication are also recorded in their plan of care. Staff who handle medicines have received training in the safe handling of medication. This means that people are kept safe by the homes management, storage and administration of medicines at the home. Staff told us they promote peoples privacy and respect all those living at the Home both as the people they are and for the lives they had led before living at Barton Place. We saw staff knocking on doors and waiting before entering even when the person in the room was unable to invite them in. Details relating to the persons understanding or ability to respond had been clearly recorded in their care plan. We also saw staff responding to peoples personal care needs discreetly and with patience and understanding. All of the 8 people who responded, or whom relatives responded on behalf of, to questionnaires felt they always or usually received the care and support they needed. Care Homes for Older People Page 16 of 33 Evidence: All staff that responded to questionnaires confirmed that they are always given up to date information about the needs of people. Comments made in questionnaires from staff included,We have responsibility to also seek information for ourselves. We cant expect to be spoon fed and Care plans are very valuable, as it gives a lot of information. All staff have a handover from a senior member of staff when they report for duty. During this inspection we sat in when a handover was being given to two carers who had come on duty at 2pm. They were asked when they had last been on duty and were updated about all people living at the Home. Daily handover sheets are completed for staff to refer to, which also include person centred information of how individuals wish to be approached and treated. This means that people living at Barton Place are treated as individuals. Care Homes for Older People Page 17 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Everyone living at the home is offered good choices in all aspects of daily living. Social activities are well managed. They provide daily variation and interest for individuals and create opportunities for increasing their independence. Meals are nutritious and balanced and provide individuals with choice and variety. Evidence: We were told that proving appropriate activities for people living at the home is of great importance at Barton Place. A full time activities coordinator is employed and part of their role is to help to encourage and support facilitate peoples needs and wishes. As part of the Homes induction training new staff work along side the activity coordinator for a morning, learning about the benefits of their involvement in peoples social needs. In response to a questionnaire an occupational thereapist commented the home does well as they Provide activities[range of] on one to one and group basis. Care Homes for Older People Page 18 of 33 Evidence: Plans of care include details of individual preferences in relation to social activities, interests, hobbies and contact with the community. Plans are regularly reviewed and details were made to meet peoples changing needs, choices and wishes. A record is kept of all activities people take part in. In response to a question Are there activities arranged by the home that you can take part in four people who returned Commission questionnaires responded always three answered usually and one sometimes. The service has close links with a local church and representatives visit the Home and provides monthly and weekly services. People living at the home are also offered the services of a local preacher who takes a small service monthly. The local donkey sanctuary and PAT the dog visit the Home regularly and three local entertainers visit the home monthly to entertain people. We were told this is very successful and greatly enjoyed. People living at the home are also offered the services of a weekly hairdresser, chiropodist, optician and aroma therapist. During this inspection several people enjoyed a hand massage from the aromatherapist who was visiting the Home. The activities organiser told us that special occasions, such as birthdays and holidays, are celebrated at the Home. A Valentines Day Party was currently being organised and some people had been involved in making cards. The home has two lounges, one on the ground floor and another on the first floor and a quiet lounge where people can meet visitors and have a greater degree of privacy if they wish. Although safety measures have been put in place to ensure people do not use stairs between the three floors unaccompanied, people living on all floors are able to mingle and visit either lounge according to their choice. Throughout the day we saw staff taking time to talk to people with patience and understanding. Some people took pleasure from possessions that they kept with them. Magazines and papers were available in the lounges and quiet lounge. Music was playing softly and their was a relaxed atmoshere throughout the time we were at the Home. The Home has an open visiting policy and refreshments are offered to all visitors. We were told that this breaks down barriers and is the same as a people would do in their own home. A coffee morning is held every 2 months for people living at the Home, families and friends. We looked at the visitors book and it was clear that many people Care Homes for Older People Page 19 of 33 Evidence: received visitors and they came at different times of the day. In response to questionnaires comments included Visitors are always welcome and offered refreshments. A weekly menu is displayed in each of the lounges and people living at the Home are asked daily for their choice of meals for that day. There are usually four choices available at lunchtime and we saw people talking with staff, being encouraged and supported to make choices of what they wanted for lunch and what they would like to do. We sat in one of the lounges during lunch and the meal was well presented, was of a size that suited individuals and was hot. We saw staff assisting those who needed encouragement discreetly in an unhurried manner. We visited the kitchen and spoke to the cook who has been employed at the home for several years and had known several of those living at the home well. A list of individuals, likes and dislikes, and sizes of meals, was displayed in the kitchen. Staff encouraged people to have drinks throughout the day and a varied choice of cold drinks was available in the lounges and in peoples rooms. Care staff are sensitive to the needs of those who find it difficult to eat and gave assistance with feeding maintaining an awareness of the importance of assisting at the pace of the person, making them feel comfortable and unhurried. In response to questionnaires comments included The food is always good and is presented nicely. I have eaten some myself if I have been visiting at meal times. People moving into Barton Place are encouraged to bring personal possessions and small items of furniture with them to make their rooms feel homely and this is agreed before admission. All of the rooms seen during this inspection were personalised and people seemed to be happy having their own things around them gave them. Care Homes for Older People Page 20 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a clear and simple complaints procedure that ensures complaints are responded to promptly with satisfactory outcomes. Staff have a good knowledge and understanding of the forms of abuse thereby ensuring that residents are protected at the home. Evidence: The manager told us the ethos of the home is that it welcomes complaints and suggestions about the service, and these would be used positively to enable the service to learn from them. The home has a detailed, clear and simple complaints procedure, which is prominently displayed for all people living at the Home and visitors to see. The home has developed a system to maintain records of all complaints received and how they are managed. No complaints had been made to the home or to the CSCI since the last inspection. None of the people living at the home that we spoke to during this inspection were able to tell us what they would do if they were unhappy about anything at the Home and would need assistance to follow the homes complaint procedure. Staff spoken to were aware of this and to ensure that people are not unhappy staff were able to Care Homes for Older People Page 21 of 33 Evidence: describe how they would recognise that they were not happy or concerned about anything. Details of the information given us by staff were also clearly recorded in care plans. This means that all staff are able to access this information and people living at the home benefit from consistent care. Eight people, either living at the home or their relatives, responded to questionnaires sent prior to this inspection. All confirmed they know how to make a complaint and 6 always, 1 usually know who to speak to if they were unhappy. [One person did not respond to the question] One person commented At this moment I have not needed to complain. Staff said that if anyone made a complaint they would report it to the manager,deputy manager, or a senior member of staff and were confident that no issue that was raised would ever be ignored. Nine members of staff responded to questionnaires sent prior to this inspection. All confirmed they would know what to do if a person living at the Home or a relative had concerns about the home. One commented Any concern however big or small has to be addressed and handled correctly, reported, recorded and acted upon immediately, with respect and sensitivity and in a professional manner, and depending on the concern. It is important to recognise which level to take it to and Any concern must be followed through and reported to person in charge another any concerns I would inform the manager as soon as possible or if anything that is involving the home then CSCI. The home operates an open door policy and people living at the home, staff and visitors are encouraged to visit the office with any issues, which concerned them. Records were seen showing that staff have received training in Adult Protection issues. A procedure for responding to abuse is available and staff were aware of this. They were able to describe differing types of abuse and gave good details of what they would do if they suspected abuse was occurring. They were aware of the homes Whistle-blowing policy and that it would support them in reporting bad practice. They felt confident that they would be listened to if they raised concerns about bad practice. Care Homes for Older People Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Barton Place provides a comfortable, clean and safe environment for those living in, working at and visiting the home. Evidence: The providers and manager have worked hard to improve and maintain the home since the last inspection. The manager told us that due to the age of the building maintenance is ongoing and this is continuously reviewed. We were told that improvements to the Home made since the last inspection include the completion of sensory garden, a new fire door fitted in the basement, redecoration to the kitchen, quiet lounge and back corridor and several bedrooms have been redecorated and refurbished. Environmental risk is being well managed and decoration, fitting and fixtures such as furniture, curtains, carpets, pictures and lamps throughout the home are of a good quality. We saw bedrooms that were well decorated, bright and homely. The majority of them had been personalised and people living at the home told us that they were happy at the home. All the homes fixtures and fittings meet the needs of individuals and can be Care Homes for Older People Page 23 of 33 Evidence: changed if their needs change. The home has two lounges that also serve as dining rooms. Ample space is available for activities and for those who like to walk or have mobility problems and need the use of a wheelchair. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in private. T he bathrooms and toilets at the Home are fitted with appropriate aids and adaptations to meet the needs of the people who use the service and are in sufficient numbers and of good quality. The home is well lit, clean and tidy and smells fresh. The management has a good infection control policy. They seek advice from external specialists, such as NHS infection control staff and encourage their own staff to work to the homes policy to reduce the risk of infection. In response to the question is the home fresh and clean, five people responding to Commission questionnaires answered always, and three usually. Two people added comments, one confirming the Home was Excellent and always smells lovely and another commented, could use fresh air spray a bit more. We visited the rooms for all people living at the home during the inspection all of which were well maintained. Some bedrooms are shared but only by agreement with the people concerned. We saw screens provided for privacy and the rooms reflected the chosen decoration and personal belongings of both people. There is a good supply of protective clothing and hand washing facilities at the home and the laundry has equipment that should effectively reduce the risk of cross infection. Everybody was well dressed at the time of this visit and staff told us it is important that peoples clothes are well looked after. Care Homes for Older People Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from having trained, skilled staff in sufficient numbers to support them, and the smooth running of the home. Evidence: On the day of the inspection staff on duty at the Home consisted of a cook, a domestic, a maintenance person two senior carers, seven care staff, a qualified nurse, the manager and deputy. ( Usually there are 6 carers on duty but at the time of this inspection the passenger lift was out of use and an additional carer was on duty to provide additional support) This level of staffing is maintained throughout the day until 8PM when 1 qualified nurse and two carers are on duty throughout the night. We were told that if more staff are required to be on duty the manager would make arrangements for this. Staff confirmed this to be the case and told us of times this had happened when people living at the home have been ill and needed someone to be with them at all times and when people are taken to out patient appointments or on outings. Eight people who returned questionnaires felt there are always or usually enough staff to care for them. The manager has promoted the role of key workers for each individuals with the aim that they know they get to know those living at the Home well and support them with personal tasks. This works towards meeting the homes ethos Care Homes for Older People Page 25 of 33 Evidence: of maintaining person centred care for all people living at Barton Place. People who responded to questionnaires and those spoken to during this inspection said that staff responded to their needs promptly. This was confirmed during this visit when staff responded promptly to peoples needs in a kindly manner. Throughout the day we saw staff asking people if they wanted drinks, were comfortable, giving reassurance, visiting those who wished to stay in their rooms and engaging people in conversation. The manager discussed the recruitment procedure at the home and how it has been developed so that it considers the needs of people living at the home. She stressed the importance, and time taken, to make sure that only good quality carers are recruited so that a high standard of service is offered at the home. We looked at three recently employed staff files. All included evidence that the home had conducted a robust recruitment procedure. Files included details of past employment, application form, previous training, evidence of identity, police checks and at least 2 references. This procedure means that people living at the home are protected by the homes recruitment procedure. All newly employed staff undergo a period of training when they start working at the home to enable them to get to know those living there, the homes philosophy of care, safety and care procedures and the general layout of the home. The time taken to complete this training will depend on past experience and individual ability. Training is a priority at Barton Place. Individual staff files include confirmation of all training undertaken and all planned. This means that all staff are kept up to date with current good practice. Staff who responded to questionnaires all confirmed the manager meets with them to give support and discuss how they are working regularly. All staff also confirmed that checks, such as CRB and references, were undertaken before they started employment at the home.Seven staff confirmed the induction training covered everything they needed to know about the job when they first started and one felt it mostly covered everything. Responses from staff in questionnaires included comments such as I felt it helped me into my role smoothly and efficiently. I was able to understand what was expected of me and it helped me understand the clients needs and preferences. It gave me confidence within the team. I felt comfortable to ask questions and develop new skills. I have recently completed induction awareness training. Care Homes for Older People Page 26 of 33 Evidence: Nine staff confirmed they are being given training which is relevant to their role and helps them understand and meet peoples individual needs. Staff confirmed they feel they have the right support, experience and knowledge to meet the different needs of people living at the home. Comments made in questionnaires included I am always well informed. If not I will always ask for advice and information and Ive had a lot of experience since doing my NVQ and speaking to manager about any concerns has helped. I feel I can support any individuals with any different needs. One staff member commented I am always informed of courses that are available and get training on anything Im not sure of another Ive now got my NVQ3 which I need for my job role, also any relevant training my manager would put me on if needed. Two staff, in response to questionnaires, felt there are always, and six usually enough staff to meet individual care needs. Comments included Usually but when sickness arises even though other staff are rung they are not always available to do the shift, it doesnt affect the needs and care of clients and on the occasion we find ourselves short staffed the clients needs, their health safety and comfort etc will be met, this can never be comprimised. A less important task can wait but not a client. We have a good bank shift system in place to ensure cover during staff sickness etc. According to information received prior to this inspection training undertaken in the last in last 12 month includes safe moving and handling, food hygiene, falls awareness and prevention, first aid and protection of vulnerable adults. Training planned to take place during the next 12 months include first aid refresher, food hygiene and manual handling. A meeting of staff on each shift is held when information is shared about individuals and any issues or problems that occur. This ensures that well informed staff care for people living at the home. Ensuring that people living at the home are cared for by a competent team of staff further promotes person centred care and safety that is consistent. Care Homes for Older People Page 27 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a well managed home that is working hard towards trying to make sure the home is run in their best interests. Health and safety is well managed. Evidence: The registered manager of the home is a Registered General Nurse and holds a Registered Managers Award. This means that people living at the home and staff benefit from good management and leadership to ensure the home runs smoothly. Prior to this inspection the manager sent us information about the management of the home and how the home has carried out improvements since the last inspection. Records are securely stored and would be made available to people living at the home, or their representative, with their consent. Records are kept in lockable filing cabinets, Care Homes for Older People Page 28 of 33 Evidence: and those seen were up to date. Peoples feedback about such things as the quality of their life at the home, staffing, meals, cleanliness and activities is sought on a daily basis. The home undertakes annual assurance audits and surveys to ensure that people living at the home are given a say in the homes running. An annual quality assurance survey has been undertaken by the home since the last inspection and the outcomes of the survey have been sent to relatives of people living at the Home. We discussed including the results of surveys in the homes statement of purpose to make them available to other interested parties. Some of the improvements that have been made at the home in response to the outcome of the most recent quality audit include supplying an outside bell from the patio area, providing hand sanitizer for visitors, increasing the churches input to Barton Place, increased activity allocated hours, lowering a mirror in a quiet room and care staff have now taken on the role of a laundry person, which is being regularly monitored. The manager told us all staff engage with visitors when they visit the home and try to implement individual requests as they occur. The manager does not look after money for any of those living at the Home, most people living at the home choose to have personal finances looked after by their family or legal representatives. During this inspection a passenger lift was out of use and the manager had contacted the maintenance company to request immediate attention. This was confirmed during this inspection. All staff that responded to questionnaires, and those spoken to during the inspection, confirmed that the manager or deputy met with them regularly to give support and discuss how you they were working. Comments included Our manager is very supportive and will make time for the staff on the day or by appointment. During appraisals we can discuss our strengths and weaknesses, share concerns, ideas and receive support, discuss further training, discuss how we feel. Information received before this inspection indicated that all equipment used at the Home is well maintained regularly,which contributes towards ensuring that Barton Place is a safe place for people to live. Care Homes for Older People Page 29 of 33 Care Homes for Older People Page 30 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Whenever possible people should be included when regular reviews of the care plans are undertaken, or told of any changes and the reasons for the changes. Plans of care should include details of how people choose to have their individual health and social care needs met. A system to ensure that creams, ointments and lotions when opened, are not used past the shelf should be implemented. The results of quality assurance audits should be made available to all interested parties, including people who live at the home, people who are considering making it their home and the CSCI. [The results of the most recently undertaken survey had been sent to relatives of people living at Barton Place at the time of this inspection] 2 3 7 9 4 33 Care Homes for Older People Page 32 of 33 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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