Inspection on 28/02/06 for Barton Place Independent Care Hotel

This inspection was carried out on 28th February 2006.

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

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

Other inspections for this house

Barton Place Independent Care... 12/02/09

Barton Place Independent Care... 05/02/07

Barton Place Independent Care... 11/10/05

Barton Place Independent Care... 28/02/05

Barton Place Independent Care... 19/08/04

Barton Place Independent Care... 05/03/04

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

CARE HOMES FOR OLDER PEOPLE Barton Place Independent Care Hotel Wrefords Link Cowley Bridge Exeter Devon EX4 5AX Lead Inspector Stephen Spratling Unannounced Inspection 28th February 2006 09.50 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 Place Independent Care Hotel DS0000030876.V274612.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 Place Independent Care Hotel DS0000030876.V274612.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Barton Place Independent Care Hotel Address Wrefords Link Cowley Bridge Exeter Devon EX4 5AX 01392 211099 01392 498230 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) Barton Place Ltd. Nina Griffith Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (30), Old age, not falling within any other category (30) Barton Place Independent Care Hotel DS0000030876.V274612.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The staffing notice dated 28 November 1990 of North and East Devon Health Authority continues. [Morning 1 RMN and 6 care assistants, afternoon 1 RMN and 3 care assistants, evening 1 RMN and 5 care assistants, night 1 RMN and 2 care assistants]. To admit one named person outside the categories of registration as detailed in the notice dated 10th August 2005 The maximum number of persons accommodated at the home, including the named service user, will remain at 30 On the termination of the placement of the named service user, the registered person will notify the Commission in writing and the conditions of registration will return to those held on 8th August 2005 11th October 2005 2. 3. 4. Date of last inspection Brief Description of the Service: 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. The Owner/Manager purchased Barton Place in July 2002. She has implemented many positive changes to the organisation and fabric of the Home and continues to carry out improvements, with planning permission for a large extension already in place. Barton Place Independent Care Hotel DS0000030876.V274612.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out by one inspector (Stephen Spratling) from 09.50 am until 1.45 pm. During the day the inspector spoke with the registered manager, two of the registered nurses, two carers, the activities organiser, the home administrator, three of the homes housekeeping staff and nine of the people living at the home. The mental frailty of many of the residents who the inspector spoke with prevented them for being able to express clear views about the service they receive. Additionally some of the policies and other records kept by the home were looked at. Five commission comment cards were received back from visitors to the home. A limited number of the National Minimum Standards were looked at during this inspection and for a fuller picture of this service the reader is advised to also see the last inspection report of 11th October 2005. What the service does well: What has improved since the last inspection? What they could do better: Evidence that all house-keeping staff have been properly recruited needs to be obtained. Clear written guidance should be available for staff to refer to if they are concerned that a resident is being miss-treated. Barton Place Independent Care Hotel DS0000030876.V274612.R01.S.doc Version 5.1 Page 6 A more systematic approach to quality assurance needs to be developed. When the home is looking after resident’s money, withdrawals and deposits should be signed for. 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 Place Independent Care Hotel DS0000030876.V274612.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Barton Place Independent Care Hotel DS0000030876.V274612.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed during this inspection. EVIDENCE: Barton Place Independent Care Hotel DS0000030876.V274612.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 Robust systems, which are properly implemented, help to ensure that residents receive the medications they need safely. EVIDENCE: The inspector looked at six medication administration charts, which showed record of medicines received into the home being checked in and signed for. A record sheet was seen showing that medication fridge temperatures are now recorded daily and appropriate action taken when temperatures fall outside the required limits. Other elements of this standard were looked at during the last inspection and were found to be satisfactory. Barton Place Independent Care Hotel DS0000030876.V274612.R01.S.doc Version 5.1 Page 10 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 Resident’s benefit from being helped to take part in activities and entertainments that match their interests and ability. Resident’s benefit from being supported to choose where and how they spend their time. And from contact with friends and relatives who are made to feel welcome. Good food is provided, served in a pleasant atmosphere, with individual support given discreetly as needed. EVIDENCE: The inspector spoke with the activities coordinator who is employed for 27 hours per week. He said that he is currently doing an NVQ 3 focused on therapeutic activities with people who have dementia. He demonstrated a clear understanding of his role and had a clear program, which he was seen discussing with residents. The program included individual and group activities. A new residents record showed evidence that their need for support to be active and stimulated had been included in assessments and that this person had within the first week of being at the home had four individual sessions with the activities co-ordinator. Six other records, briefly looked at, showed evidence of residents being helped to participate in both group and individual Barton Place Independent Care Hotel DS0000030876.V274612.R01.S.doc Version 5.1 Page 11 activities several times a week. Care staff said that they are encouraged to participate in activities and to spend time sitting and talking with residents. Though no visitors were at the home the morning of the inspection staff confirmed that visitors are welcome at anytime, without appointment. All five relatives who returned commission questionnaires also confirmed that they are always made to feel welcome and that they can see their loved ones in private if the wish. One person commented on their questionnaire that their mothers “moods have improved” since being at the home. The menu for the day was clearly written up in each dinning area and included a choice of main meals. Staff confirmed that residents are asked what they would like for lunch early morning but that they can change their mind when the meal comes around if they wish. Residents were seen being assisted sensitively, with individual attention being paid by staff where needed. Several residents were able to say that they like the food provided. Barton Place Independent Care Hotel DS0000030876.V274612.R01.S.doc Version 5.1 Page 12 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): 18 Residents can be confident that staff would act to protect them if they were being miss-treated, but the absence of clear written guidance increases the risk that any response would not be in line with agreed and best practices. EVIDENCE: All care staff spoken with said they had received training about what to do if they were concerned that a resident was being abused and showed an awareness of the different forms abuse can take. All were clear that they must report concerns to managers. The home owner and senior staff nurse were clear what should be done if they have concerns about abuse but could not find the homes policy/procedure which should be available for all staff to refer to if they have a concern. Barton Place Independent Care Hotel DS0000030876.V274612.R01.S.doc Version 5.1 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 The home provides a well-maintained, clean, homely and comfortable environment for residents. EVIDENCE: The inspector looked at all the shared areas in the home and at six bedrooms; all areas were clean and properly maintained. Bathroom doors had appropriate privacy locks fitted, window-opening restrictors were fitted to upper floor windows and hot pipes and radiators appropriately guarded. The housekeeping staff said that they get enough time and the equipment they need to keep the home clean. The laundry was properly organised and the laundry worker was clear about the temperatures that towels and continence sheets should be washed at to ensure disinfection. Residents able to comment said that the home is always kept clean; one visitor completing commission comment card wrote that they think the home is “well maintained, clean and tidy…” Staff said that faults are written in the “maintenance book” when noted by them and that repairs are generally done promptly. Barton Place Independent Care Hotel DS0000030876.V274612.R01.S.doc Version 5.1 Page 14 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): 28 & 29 Resident’s benefit from being cared for by trained, skilled people. Standard of vetting and recruiting care staff are good, helping to protect residents from people unsuitable to care for them. Before residents can be fully confident however, recorded evidence that hall house keeping staff have been properly recruited needs to be obtained. EVIDENCE: Written information provided by the home to the commission in January 2006 states that 56 of care staff hold NVQ qualifications in care and that further 15 are currently working towards NVQs. Both carers spoken with said they had done or were doing NVQ’s. The inspector saw staff relating warmly, gently and patiently with residents. Residents able to comment indicated that they like staff. A visitor completing a commission comment card wrote “staff and management could not be kinder”. All staff spoken with indicated that they belief staffing levels are sufficient to ensure they can care for residents properly and in an unrushed manner. A new member of staff, for whom a protection of vulnerable adults (POVA) 1st check had been received but not a full Criminal Records Bureau (CRB) check, told the inspector that she was working under supervision until full CRB was received and was clear who her supervisor was. The recruitment records of this staff member and another were looked at and contained all the required information. The home has recently contracted out the homes house keeping and kitchen services and while they have recruitment information on those Barton Place Independent Care Hotel DS0000030876.V274612.R01.S.doc Version 5.1 Page 15 permanent staff who transferred to the new company, written confirmation that all pre-employment checks have been completed on new or temporary staff was not available for inspection. The inspector spoke to a manager at the housekeeping company who assured him that all new staff go through a thorough recruitment process including CRB before being supplied. Barton Place Independent Care Hotel DS0000030876.V274612.R01.S.doc Version 5.1 Page 16 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): 33, 35 & 38 Some systems are in place to help monitor and improve the service residents receive. However lack of a systematic approach to quality assurance means that improvements that could be made to the service may not be recognised and acted upon. Service users best interests are largely protected by the way the home looks after their money; but small improvements to procedures would make this protection more robust. The homes well-organised and systematic approach to maintenance and health & safety helps to protect residents from harm. EVIDENCE: The inspector was shown results of recent quality questionnaires, which had been completed by resident’s relatives. Where a specific issue had been highlighted record was seen of the deputy manager having contacted the Barton Place Independent Care Hotel DS0000030876.V274612.R01.S.doc Version 5.1 Page 17 relative in question to discuss what action that should be taken. The home also sends quality questionnaires to staff. The home does not have a comprehensive system of quality assurance. Currently the home only assists one resident to manage their money. The administrator showed the inspector the system for keeping account of this money, which was clear and easily auditable. Deposits and withdrawals regarding this person’s money are not currently signed for which would make the system more robust. No unmanaged threats to the health or safety of residents were seen on walking around the home. The homes electrical installations safety certificate was seen dated 01/02/06; Gas installations safety certificate seen was dated 16/01/06 and a certificate confirming that the fire protection systems are in full working order dated 16/01/06 was also seen. Maintenance records showed that all portable electrical appliances were safety checked in February 2006. Staff spoken with confirmed that they receive regular moving and handling training. A member of staff on induction confirmed that they had been talked through how to respond if the fire alarm went off and had been asked to complete a fire safety quiz to check their understanding. Barton Place Independent Care Hotel DS0000030876.V274612.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 X 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 X 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 X 28 3 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 2 X X 3 Barton Place Independent Care Hotel DS0000030876.V274612.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP29 Regulation 19 Requirement Where a person is employed by someone other than the registered person. The registered person must not allow that person to work in the home unless they have obtained from the employer of that person written confirmation that all information specified in paragraphs 1 to 7 of Schedule 2; has been obtained and that they are satisfied that it is satisfactory. Timescale for action 28/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP18 Good Practice Recommendations Clear written and accessible procedures should be in place to guide staff as to what to do if they have a concern that a resident is being abused. Policy/procedure should reflect DS0000030876.V274612.R01.S.doc Version 5.1 Page 20 Barton Place Independent Care Hotel Devon “Protection of Adults at Risk” multi-agency guidance. 2. OP33 An effective quality monitoring system based on seeking the views of service users should be in place to measure the success in meeting the aims, objectives and statement of purpose of the home. An annual development plan for the home should be developed. Results of quality assurance process should be made available to all stakeholders and forwarded to the CSCI. 3. OP35 Records of deposits and withdrawals of service users money, held for safe keeping by the home, should be signed by two people; including where possible by the resident. Barton Place Independent Care Hotel DS0000030876.V274612.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY 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 Place Independent Care Hotel DS0000030876.V274612.R01.S.doc Version 5.1 Page 22 - 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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