CARE HOMES FOR OLDER PEOPLE
Barty House Nursing Home Barty House Roundwell Bearsted Maidstone Kent ME14 4NH Lead Inspector
Justine Williams Unannounced Inspection 13 February 2006 13:00 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 Barty House Nursing Home DS0000026146.V270180.R01.S.doc Version 5.0 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. Barty House Nursing Home DS0000026146.V270180.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Barty House Nursing Home Address Barty House Roundwell Bearsted Maidstone Kent ME14 4NH 01622 737025 01622 737725 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) Winterwood (UK) Limited Mr Kaleechurun Daby Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32), Terminally ill (4) of places Barty House Nursing Home DS0000026146.V270180.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 28th November 2005 Brief Description of the Service: Barty House is a large detached property that was previously a family home before being extended and converted into a care home with nursing. The home is located approximately 4 miles from Maidstone town centre. Local shops and other amenities are within one mile of the home. The building stands in extensive grounds and there are areas where service users may sit. The accommodation is situated on ground and first floor and comprises 20 single bedrooms and 6 double bedrooms. All rooms have hand basins installed. There is a nurse call alarm in each room and some of the rooms have been provided with telephone points. The Owner has recently received planning permission to build a large extension, providing a further 26 bedrooms, a new kitchen, and additional day space and hopes to commence work in the spring. Barty House Nursing Home DS0000026146.V270180.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. An unannounced inspection was carried out on Monday 13th February 2006 between 01.15pm and 04.15pm by regulatory inspector Justine Williams. During that time a number of residents, staff and the manager agreed to speak with the inspector both in public and privately. Feedback was given to the manager during and at the end of the inspection. This report contains assessments made from observation, conversation and records. The focus of the inspection was to talk primarily with residents to assess their quality of life in the home, and to assess progress made toward meeting the requirements and recommendations from the last inspection. Many standards were not assessed, having been assessed in full at the inspection of 28th November 2006. To gain a more comprehensive view of service provision it is recommended that the reader access the report of that inspection. What the service does well: What has improved since the last inspection?
Staff have now been provided with a room in which they may take their breaks and store their belongings safely. The manager is working toward meeting the recommendations made by the environmental health officer although there have been delays due to the planned extension. Residents meetings have been reinstated providing a forum for residents to feedback their opinions about the home and to affect how the service is delivered. Environmental temperatures are regularly checked, if areas of the home are too hot or too cold action is taken to address this, ensuring the comfort of the residents. The manager has arranged for the fitting of appropriate flooring in the existing laundry room to minimise infection control risks.
Barty House Nursing Home DS0000026146.V270180.R01.S.doc Version 5.0 Page 6 What they could do better: 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. Barty House Nursing Home DS0000026146.V270180.R01.S.doc Version 5.0 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 Barty House Nursing Home DS0000026146.V270180.R01.S.doc Version 5.0 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): 3,4, Residents have their needs assessed prior to moving into the home. EVIDENCE: Barty House provides care for older people who require nursing care. Residents who exhibit signs of confusion or dementia or other “specialist” needs are closely monitored. If their needs can no longer be met at the home staff liaise with the resident, family and relevant health care professionals to find a placement which will meet the individuals needs. The manager organises meetings with the staff to discuss the admission of a new resident where the resident’s needs are discussed, care staff have an opportunity to ask questions and plan the proposed management of the residents care. A full and comprehensive assessment is undertaken usually by the manager or one of the registered nurses and this is shared with the care staff. The resident is reassessed on admission, and further risk assessments are undertaken as needed.
Barty House Nursing Home DS0000026146.V270180.R01.S.doc Version 5.0 Page 9 Barty House Nursing Home DS0000026146.V270180.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 Residents’ care and health needs are documented and regularly reviewed. EVIDENCE: Each resident has a plan of care which includes nutritional, skin integrity and moving and handling assessments. Staff understand the need for good record keeping and ensure records of the day for each resident are made. This effective record keeping aids tracking the wellbeing of residents. Detailed records of visits and consultations with healthcare professionals continue to be kept and residents said staff organise visits by the GP when they request them, indeed one GP was visiting a residents at the time of the inspection. The home has a detailed medication policy which includes the use of homely remedies. Medicines were stored safely and securely and in line with legislation and good practice guidance. Medication administration records were completed appropriately for the most part however some omissions were seen indicating that medication may not have been administered when it should have been, staff checked the medicines for one resident and this showed the
Barty House Nursing Home DS0000026146.V270180.R01.S.doc Version 5.0 Page 11 medicine had probably be given but the staff member had forgotten to sign the administration record. The home has recently had an independent pharmacy audit, the manager is in the process of implementing the recommendations made. Residents living in shared rooms said they are consulted about new residents moving in with them, this should be documented. Barty House Nursing Home DS0000026146.V270180.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 Residents enjoy the type of activities and lifestyle at the home and are encouraged to make choices about all aspects of their daily lives. EVIDENCE: Residents said they continued to enjoy the range of activities offered at the home, those residents who prefer to stay in their rooms said that the activity staff make an effort to spend time with them for a chat. Residents said that staff respect their right to make decisions about their lives, and that they are asked to exercise their choice about a variety of things such as time of rising and going to bed, menu choices, what they wish to wear etc. Residents relatives are encouraged to visit at any reasonable time and many share a meal with their relatives on a regular basis at the home. The activity coordinator was preparing for an Easter bonnet decorating session that afternoon. Those wishing to continue with religious observance can attend a service given by a visiting religious minister. Barty House Nursing Home DS0000026146.V270180.R01.S.doc Version 5.0 Page 13 Residents’ rooms are very well personalised with photographs and items of furniture. Safety and suitability of personal items, such as furniture and electrical belongings, are discussed with the manager before use in the home. Residents are encouraged to manage their own finances for as long as they are able. Barty House Nursing Home DS0000026146.V270180.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Residents are protected from abuse as far as is possible. EVIDENCE: The majority of the staff have received adult protection training and were aware of the homes policy including what they should do in the event of an allegation or suspicion of abuse. The homes policy fits in with the Kent and Medway adult protection policy. Adult protection is included in the induction for new staff. Barty House Nursing Home DS0000026146.V270180.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Residents have a homely and comfortable environment in which to live. Some areas of the home will benefit from refurbishment EVIDENCE: Barty House is a large listed country house, which has been extended in the past. The home was warm and clean and odour free. It is located in a quiet country area where residents can enjoy the extensive attractive grounds. The owner has received planning permission for a further large extension to the rear of the property. Work is expected to start in summer. Bedrooms are redecorated as they become vacant and are pleasant and decorated to a good standard. Some of the bathrooms and hallways would benefit from redecoration. There were threadbare areas on the carpets, wall tiles were chipped and discoloured and a sink was heavily lime scaled making
Barty House Nursing Home DS0000026146.V270180.R01.S.doc Version 5.0 Page 16 adequate cleaning difficult. This was also noted at the last inspection. The manager is regularly risk assessing these areas. The laundry is very small and the flooring is not water-resistant, the manager said the flooring is due to be fitted in the near future once one of the washing machines has been repaired. When the extension is completed the home will have a large new kitchen and laundry area. The home was otherwise clean, odour free and tidy on the day of the inspection. Barty House Nursing Home DS0000026146.V270180.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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): 27,28 Residents benefit from the support and care of competent and skilled staff. EVIDENCE: Residents said staff responded promptly when the nurse call system was used however some residents said staff had no time to chat. Staff said they have been asked to work additional shifts recently and often felt obliged to work the extra shifts. The rota reflected that staff are indeed working extra shifts, the manager said that agency staff are used when necessary but staff are asked if they wish to work the extra shifts first. Sufficient domestic staff are employed to provide good standard of cleanliness. Almost 50 of care staff have NVQ qualifications, and the manager continues to encourage staff to undertake NVQ training. Barty House Nursing Home DS0000026146.V270180.R01.S.doc Version 5.0 Page 18 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): 32,33,35,38 Residents are confident that the home is well managed and safe. EVIDENCE: The manager has re-established residents meetings and one was held in January, this was minuted and minutes distributed to residents. The home also has a suggestion box in the lobby and the manager frequently meets with residents. Regular staff meetings are held, with separate meetings for different groups of staff. The manager said that staff felt they could speak more freely through this system and the information discussed was always relevant. Barty House Nursing Home DS0000026146.V270180.R01.S.doc Version 5.0 Page 19 The manager carries out various audits and the home has recently commissioned an independent pharmacy audit. The manager is in the process of ensuring action is taken to address the recommendations made. The manager does not control or manage resident’s monies, should a resident need assistance the manager will refer them to social services or advocacy services. The manager does not act as appointee for any residents. Residents have lockable storage facilities in their rooms for valuables. The manager ensures so far as possible the health and safety of residents and staff through training of staff, comprehensive policies and guidance, the provision of safe storage facilities and regular maintenance and checks of equipment. Barty House Nursing Home DS0000026146.V270180.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 3 X 3 X X 3 Barty House Nursing Home DS0000026146.V270180.R01.S.doc Version 5.0 Page 21 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations It is recommended that interim measures be put in place in the home to ensure the control of the spread of infection by: 1 OP26 Replacing current flooring with impermeable flooring in the dirty and clean laundry rooms. It is recommended that further advice should be sought from the Environmental Health Officer and Kent and Medway Infection Control Unit to the most suitable and functional laundry facility for a home of this size. This recommendation is repeated from the inspection carried out on the 7th March 2005 2 OP28 It is recommended that 50 of care staff undertake NVQ level 2 or above by December 2005. Barty House Nursing Home DS0000026146.V270180.R01.S.doc Version 5.0 Page 22 This recommendation is repeated from the inspection carried out on the 7th March 2005 3 OP38 It is recommended that issues regarding the upgrading of equipment and ventilation in the current kitchen be dealt with promptly This recommendation is repeated from the inspection carried out on the 7th March 2005 4 OP10 It is strongly recommended that residents be consulted and make a positive choice to share a room with another resident, and this consultation process be recorded. This recommendation is repeated from the inspection carried out on the 28th November 2006 5 OP19 It is strongly recommended the refurbishment of hallways and some bathrooms be undertaken as soon as possible. This recommendation is repeated from the inspection carried out on the 28th November 2006 It is strongly recommended that advice from the infection control team be sought regarding the laundry room and also for the planned extension This recommendation is repeated from the inspection carried out on the 28th November 2006 It is recommended that appropriate training be made available for all staff, including COSHH and infection control training for all domestic staff. This recommendation is repeated from the inspection carried out on the 28th November 2006 6 OP26 7 OP38 Barty House Nursing Home DS0000026146.V270180.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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