Inspection on 11/07/08 for Brick Barn Residential Home

This inspection was carried out on 11th July 2008.

CSCI found this care home to be providing an Adequate 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.

Other inspections for this house

Brick Barn Residential Home 25/09/08

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Brick Barn Residential Home 106 Walton Road Kirby Le Soken CO13 0DB Lead Inspector Pauline Dean Unannounced Inspection 11th July 2008 10:30 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 Brick Barn Residential Home DS0000071233.V368673.R01.S.doc Version 5.2 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. Brick Barn Residential Home DS0000071233.V368673.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brick Barn Residential Home Address 106 Walton Road Kirby Le Soken CO13 0DB 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) 01255 673232 01255 673232 brickbarn@gmail.com www.brickbarncarehome.co.uk Brick Barn Care Home Ltd Manager post vacant Care Home 16 Category(ies) of Dementia (16), Old age, not falling within any registration, with number other category (16) of places Brick Barn Residential Home DS0000071233.V368673.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE The maximum number of service users who can be accommodated is 16 5th June 2007 – previous registration. This is the first inspection under this registered provider. 2. Date of last inspection Brief Description of the Service: Brick Barn provides care for up to 16 elderly people. People living at the home have a diverse range of needs associated with their age, mental and physical health. The accommodation is provided in a period property located in a small Essex village between Colchester and Clacton-on-Sea. The home has a large well maintained garden area that is easily accessible. The village has a local shop and public house. The entrance to the home leads directly onto the main road through the village making independent access to the village difficult for most residents. The mobile library service visits the home but there are few other local amenities. The provider advised the Commission on the day of the inspection that the fees charged by the home ranged from £380 to £500 per week(Local Authority rates). Private fees start from £440 per week. In addition people living at the home pay for personal items including hairdressing, chiropody, newspapers and specialist magazines. Brick Barn Residential Home DS0000071233.V368673.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced inspection of Brick Barn Care Home took place on 11th July 2008 over a 9½-hour period. The inspection involved checking information received by Commission for Social Care Inspection (CSCI) since the last key inspection in June 2007. Since that time the business has been sold and a new proprietor – Mr Surinderpal Singh Chana has become the registered provider. At the site inspection, records and documents were inspected and the inspector spoke to the newly appointed manager, the home’s administrator, care staff and the people living at the home. Mr Surinderpal Singh Chana was also present for part of the inspection. An Annual Quality Assurance Assessment (AQAA) had been sent to the home in April 2008. Neither the registered proprietor nor the manager was aware of this and this document had not been completed and returned to the Commission for Social Care Inspection (CSCI). Whilst at the inspection, the proprietor downloaded this document and commenced completing this. It is to be sent into the Commission on completion. A tour of the premises was completed at the site inspection. Surveys were sent to the home prior to the inspection. Eleven surveys were completed by the people living at the home and two staff surveys were completed and returned to the Commission prior to writing this report. Their comments are reflected in this report. During the inspection three people who live at the care home and one carer were spoken with. What the service does well: Brick Barn presents as a homely environment. The lounges and the dining room are informal and relaxed and the large garden at the rear of the home provides a pleasant setting for residents to sit in. Brick Barn Residential Home DS0000071233.V368673.R01.S.doc Version 5.2 Page 6 The new manager and proprietor show a commitment and enthusiasm to the home and are dedicated to making improvements in the care offered at Brick Barn. In addition some renovations and decorations have commenced and further are planned, particularly in the bedrooms. What has improved since the last inspection? What they could do better: There is a need to review all care plans and risk assessments to ensure that all residents receive the care and support they require to meet their needs. The management and the storage of Controlled Drugs requires attention to comply with the Misuse of Drugs (Safe Custody) Regulations 1973 and good practice recommends that records of administration of Tamazepam is recorded in a Controlled Drug Register. This is to ensure that the residents are safeguarded by accurate record keeping and administration of medicines. Arrangements for safeguarding adults through complaint and safeguarding adult abuse alerts need to be reviewed and developed in both the home’s policies and procedures and through future staff training. This will ensure that all staff are fully aware of their roles and responsibilities to safeguard residents. Facilities for the residents need to be improved. The stair chairlift needs to be operational and access to the first floor bathroom needs consideration. Confirmation of the installation of a new stair chairlift on 22nd July 2008 was received prior to publication of this report. Staffing levels and recruitment practices and procedures were found to be poor. An Immediate Requirement Notice was issued regarding staffing levels. The timescale was 17th July 2008. The home responded within the timescale to the Immediate Requirement Notice and sent copies of staff rotas as requested. Staff recruitment files had omissions – Criminal Record Bureau (CRB), incomplete application forms, references and no interview notes or letters of appointment were found in the sampled files of staff and volunteers. Failure to have sufficient staff and follow appropriate staff recruitment practices and procedures presents as a significant shortfall to safeguard the people living at Brick Barn. The home needs to progress staff training and development to ensure that all staff have the knowledge and skills to meet the needs of the people living a Brick Barn. Brick Barn Residential Home DS0000071233.V368673.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Brick Barn Residential Home DS0000071233.V368673.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brick Barn Residential Home DS0000071233.V368673.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who come to live at the home can be confident that their needs will be fully assessed. They cannot be assured that their needs will be met for staff lack skills and knowledge without the necessary training. EVIDENCE: Since taking over the home, the new proprietor and manager have not had any new admissions to Brick Barn. On the day of the inspection we were told that there were twelve residents living at the home. Eleven of these placements had been made the local authority – Essex County Council. New admissions paperwork has been introduced by the home. This covered a Pre-admission Assessment and an initial assessment Care Plan, which covered needs assessments on health, social and personal care needs. Brick Barn Residential Home DS0000071233.V368673.R01.S.doc Version 5.2 Page 10 Risk assessments are also considered on admission. A total of eight risk assessments are considering covering Manual Handling, Medication, Prevention of Falls, Scalding and Challenging behaviour. The manager said that this new paperwork would be used alongside the new admission paperwork when residents are admitted. With regard to staff being able to meet the needs of the resident this requires attention for without the appropriate training and skills care staff are unable to meet residents needs. See both the Staffing section and the Management section of this report. Brick Barn does not offer intermediate care. Brick Barn Residential Home DS0000071233.V368673.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live at the home cannot always be assured that their care needs will be fully assessed and met through their individual plan of care and they will be safeguarded by the home’s medication practices and procedures. EVIDENCE: The files of three residents were sampled and inspected as part of the case tracking methodology used at this inspection. In addition a further two care plans were inspected to clarify some aspects of the record keeping used in the home. Of the three care plans seen there was evidence in one care plan of a review being completed with new care planning needs introduced around changes in their accommodation. However for the same person there was no evidence of Brick Barn Residential Home DS0000071233.V368673.R01.S.doc Version 5.2 Page 12 a risk assessment relating to them leaving the home unescorted. There was no record of the level of risk and the measures the home had in place to eliminate the risk. However, it was acknowledged that both the manager and the deputy manager were clear about the arrangements that were in place, although nothing was to be found on the individual’s care plan or in risk assessments. Two of the files sampled had care planning documents, which had been developed by the previous proprietor. These plans identified care needed and the care needs decisions and the required action to ensure that care is delivered in a consistent approach. The manager said that since joining the home in March 2008 they were reviewing the current care planning documentation and they were looking to introduce a more comprehensive care plan and risk assessment document. Templates for completion were seen at the inspection and these offered a comprehensive format for completion. One care plan sampled had the new care planning documentation in place. Whilst care planning objectives for personal care needs, behavioural and emotional needs, mobility, moving and handling and transferring were completed, other care planning objectives relating to activities and leisure still required completion. The manager acknowledged this. In a second newly created care plan once again personal care needs and mobility had been completed, but the risk assessments related to these had not been introduced. The manager acknowledged these shortfalls in the care planning and risk assessment paperwork and was aware of the need to review all care plans to ensure that all residents receive care and support as they require to meet their needs. Daily records were seen in place on all of the files sampled and overall these did give sufficient information as to the care received and were relevant to the care planning objectives. Record keeping relating to health care needs had been reviewed and new systems introduced. As well as the separate record sheets held on the individual care planning files a new file entitled ‘Care Professionals’ had been introduced. As with the care planning records this held visits and information of district nurses, incontinent nurse and GP visits and appointments. The manager said that this new central file aided the carer to continue care as directed by the doctor for the doctor was asked to enter details of the care needed in this file. Currently all of the residents have doctors from two local practices. One resident spoken to said that the home would call the doctor should they need them. All eleven surveys completed by residents said that they ‘always’ receive the medical support they needed and one person added ‘I see Doctors when I want, Nurse comes to do my dressing.’ Brick Barn Residential Home DS0000071233.V368673.R01.S.doc Version 5.2 Page 13 Whilst three residents were spoken with at the inspection, the frailty of these people prevented a clear and reliable way of understanding how the service meets the needs of the residents from their perspective. This was further confirmed in the survey work completed by the residents, for it was evident that all survey work completed by residents had been completed with the assistance of a carer. This was confirmed by the manager, who said that without this assistance they would not have been able to complete this survey work. Medication administration, record keeping and storage was sampled and inspected for the three people who were part of the case tracking exercise. Medication is held in a secure medication trolley and a wall cabinet located in the rear lounge. Both the manager and deputy manager were present when the arrangements for medication administration was inspected. Boots the Chemist are the suppliers of medicines to the home. The Monitored Dosage System (MDS) is used in the home, with the majority of medication held in blister packs. The Medication Administration Records (MAR) were sampled and inspected for three residents and records and medication were found in good order with appropriate coding used as needed. These record sheets were used for the auditing of medication as it enters the home and records of returns were seen in a returns book and with these processes in place residents were assured that they received their medication and the home was holding sufficient supplies. Medication held in bottles, creams and as droplets had the start date recorded when opening these medications were opened and started. The same practice should be used when administering medication held in tablet form in boxes. This will assist with the auditing of medicines in the home. Records were seen of fridge temperature checks where medicines are stored. Records are kept of temperatures in both the morning and evening and these were in good order. On the day of the inspection, the home was holding and administering Tamazepam. This was stored in a cash box held in the medication trolley and records of administration were seen in a separate notebook. This does not comply with requirements. Secure storage in a Controlled Drug metal cupboard is required under the Misuse of Drugs (Safe Custody) Regulations 1973 and good practice recommends that records of administration of this Schedule 2 Controlled Drug is recorded in a Controlled Drug Register. This is to ensure the safety and welfare of all residents. Residents were seen to be supported by carers in a kind way. The manager gave examples of the ways in which residents privacy and dignity are Brick Barn Residential Home DS0000071233.V368673.R01.S.doc Version 5.2 Page 14 considered when the doctor visits. A resident confirmed that they would see the doctor in their room. During the inspection we noted that carers knocked on bedroom doors before entering a room and a note had been taken of the preferred term of address of each resident. This was noted on a care plan. Brick Barn Residential Home DS0000071233.V368673.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service People who live at the home can expect to be given choices about how they spend their time, visiting arrangements and meals. EVIDENCE: At the inspection we were able to speak with three residents who informed us that they were able to make choices around their routine of daily living. They said that they were able to choose whether to sit in one of the lounges or in their own rooms. One resident said that they chose to spend their time in their room where they chose to have their meals. Two residents said that they enjoyed reading and there was evidence of books in their rooms. The manager said that four residents continue to attend a local day centre each week and four residents go to church regularly. Parishioners provide transport. In addition visiting clergy visit the home and give Holy Communion to those who wish to participate. Brick Barn Residential Home DS0000071233.V368673.R01.S.doc Version 5.2 Page 16 All eleven surveys completed by residents said that there are ‘always’ activities arranged by the home that they could take part in. One person confirmed that they attend the local day centre twice a week and they ‘like watching TV.’ In the dining room there was evidence of puzzles, games and videos for use by the residents and a wipe board displayed activities on offer. However, at the time of this inspection because of staff shortages no activities were on offer. Furthermore two residents were unable to come downstairs as the chair lift was out of use. See further details in the Environment section of this report. These residents had been provided with a lounge on the first floor where a television had been provided and some puzzles and games had been provided. On the day of the inspection there were no visitors to the home. One resident said that they have a regular weekly visit from a relative and when they visit they are made very welcome. They said that they are able to see them in private in their room. This was confirmed in their completed survey. Another two residents said that their family visit regularly and they are able to see them in their rooms or in the quiet lounge at the front of the house. We were informed that residents are able to bring in personal possessions and as we went around the home there was evidence of personal items such as pieces of furniture, pictures, books, photographs and ornaments in their rooms. The manager said that they had started to collate a list of each person’s personal possessions including their clothing. This was to be added to their care plan file. This was seen on some files sampled. Brick Barn has an eight-week summer rotation menu. This detailed one main choice at lunchtime. However, we were told that alternatives are offered. On the day of the inspection two choices had been offered – fried fish or chicken pie. The majority of people had had chicken pie, whilst two people had had the fish. The manager said that they are currently reviewing how they could offer choice to their residents for they recognised that the current practice is not suitable for all of their residents. They and the deputy manager told us that they are looking towards offering a pictorial menu to aid with selection. Nutritional records detailed that one person was diabetic, one person had a liquidised meal and one person requires a liquidised meal. Two people were said to have a small meals as they found this sufficient and easy to digest. Four people chose to have their meals in their rooms and trays are set up for these people. The remainder of the residents ate in the dining room. At the time of this inspection there was limited seating in the dining room. See the Environment section of this report. With the provision of another dining room table and chairs, residents should be able to chose where the wish to eat their meals. Brick Barn Residential Home DS0000071233.V368673.R01.S.doc Version 5.2 Page 17 Within fridges and freezers a variety of fresh and frozen food supplies were seen. The manager said that the home uses local supermarkets and wholesalers. Local greengrocers and farms provide the fruit and vegetables and a local butcher provides the meat. The manager said that this ensures that the home is able to provide a varied and nutritious diet. Brick Barn Residential Home DS0000071233.V368673.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live at the home can expect their concerns to be taken seriously by the care home. EVIDENCE: The new proprietor had reviewed and revised the home’s Complaints Policy. This policy concentrated on what the home would do on receiving a complaint either in writing or orally. The document detailed the stages a complaint would go through and the timescale for dealing with complaints. These were within the National Minimum Standards maximum of 28 days. A recommendation was made that the details and role of the Commission for Social Care Inspection (CSCI) should be added to this document. It was recognised that the Commission will not undertake a complaint investigation if the complainant is not satisfied with the home’s response and subsequent investigation. It was agreed that this would be added. The home’s administrator is to do that. The manager and proprietor said that they had not received any complaints since taking over the home in February 2008. If they should receive a Brick Barn Residential Home DS0000071233.V368673.R01.S.doc Version 5.2 Page 19 complaint it was agreed that they would record this in a central log and on each individual’s file. A policy entitled ‘Protection of Service Users Policy’ has been developed by the home. This document clearly defined the different types of abuse, identified possible abusers and spoke of the role and accountability of staff with regard to abuse. It outlined the steps the home takes to prevent abuse occurring and the action they would take should an allegation of abuse be presented to the home. Whilst there is reference in this document of the need to make a referral to the Safeguarding Adults Unit, the Police and Commission for Social Care Inspection (CSCI), it was acknowledged that it would be useful to attach details – addresses and telephone numbers of these authorities to ensure staff know who to contact. In addition a copy of the local authority Alert Concern form was downloaded and this is to be attached as an appendix to the policy to ensure that carers have easy access to these documents should they need to make a referral in the manager’s absence. The manager said that two staff have completed an external Safeguarding Adults training session since the new proprietor took over the home and they will be reviewing staff training requirements in this aspect of care as part of the home’s training and development plan. Survey work completed and returned by eleven residents and one staff member to the Commission stated that they did know what to do should they need to raise a complaint or concern. A staff member spoken to said that should they have any concerns they would refer them to the home’s manager. Since taking over the home the proprietor and manager have had a safeguarding alert which had a number of allegations relating to staffing, staffing levels, staff training, care practices and health and safety issues. Some of these issues related to practices of the previous proprietor. All of these allegations had been addressed through social care services. The proprietor and manager had assisted with the investigations. The outcome of the investigations had been shared with the home and action has been taken by the home to address outstanding shortfalls. It was recognised that there is a need for better communication between the home and the placing authority and the proprietor had acknowledged their shortfalls and said that overall they had found the referral process and the contact with Social Services positive. For this had resulted in closer liaison with the local Social Services team and there are now ongoing quality and monitoring visits in place. Brick Barn Residential Home DS0000071233.V368673.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live at Brick Barn should be assured of homely, comfortable and safe surroundings, which are kept clean and tidy. EVIDENCE: A tour of the premises was undertaken which included all of the communal areas and some of the bedrooms. At the rear of the property accessed through the dining room there is a large enclosed garden. It is mainly set to lawn with flowerbeds and borders. On the day of the inspection gardeners were cutting the grass and a gazebo for the residents to sit under was erected. The home now employs a cleaner four days a week from Monday to Thursday, four hours each day. The home was clean and free from offensive odours. Brick Barn Residential Home DS0000071233.V368673.R01.S.doc Version 5.2 Page 21 Since taking over Brick Barn in February 2008, the proprietor said that a number of bedrooms have been decorated, ten new bedroom carpets have been fitted and dedicated bed linen has been purchased for each resident. Four new wash hand basins have been fitted in four bedrooms and a further three sink units are to be replaced. The home has a total of fifteen bedrooms, eleven having en-site facilities, one having a shower facility. Brick Barn is a period property, which has various steps and irregularities to the floor levels in the home. Some ramps have been added to assist with these variations. However, as stated at the last inspection under the previous proprietor, the home would benefit from a review by a person skilled in advising care homes on the best way to assist people with a dementia to navigate and identify rooms to maximise their independence. Having recently taken on the home this would be an opportune time to consider this as the proprietor undertakes renovations. Already in consideration are the bathing facilities in the home. Brick Barn has two bathrooms, one that has an assisted bath (sitting hoist) and is located on the ground floor. This is in regular use. The second bathroom is located on the first floor and has two steps down into the room. Residents who are able to climb these stairs and use the ‘normal’ bathing facilities use this bathroom. However, with the gradual increase in the frailty of the residents who have more complex needs, the availability of bathing facilities had decreased in real terms and they do not now meet the needs of the people living at the home. At the time of this inspection, the home was not fully occupied and this did ease the situation. The proprietor did say that they were giving this some thought and the possibility of installing a shower room with easier access is being considered. On the day of the inspection, the stair chair lift was out of action. The proprietor said that an engineer had been called and a new chair lift was to be installed. We were told that this was on order and it was hoped to have it fitted in the next two weeks. Whilst the majority of the residents were able to go down the stairs, two residents were unable to. To accommodate them a twin bedroom had been converted into a small lounge, where armchairs, a television and some books and puzzles had been installed in this room. This was said to be a temporary arrangement whilst the chair lift was out of action. The inspector is not aware if the home’s fire risk assessment has been reviewed to cover these arrangements. On the ground floor communal areas of a front lounge, a rear lounge and dining room are found. The majority of the residents used the rear lounge and the dining room on the day of the inspection. We were told that the front lounge tends to used by residents and their visitors and it is the quiet lounge. In this room there is a piano. The proprietor said that the home had recently had this tuned and one of the residents was able to play the piano. Brick Barn Residential Home DS0000071233.V368673.R01.S.doc Version 5.2 Page 22 On the day of the inspection the dining room had a temporary long dining room table. This had seating for eight people. The proprietor said that he had on order a second round table and chairs to replace a second table, which had been discarded. Currently there is not sufficient seating for all of the residents to eat in the dining room should they wish to do so. Brick Barn has a small laundry room located on the ground floor. This room is windowless, but does have an extractor fan, which the proprietor said is now working. It was evident however, that this had been out of use for sometime and as a result the wall and floor surfaces had suffered. The floor tiles were loose and the wall surfaces were bubbled and peeling. Neither are surfaces which are readily cleanable and therefore a possible source of infection. Laundry facilities consist of hand washing facilities, a washer and a dryer. Laundry baskets were marked to separate unwashed and clean items. The manager and proprietor said that as a temporary measure all soiled linen is being sent out of the home to a laundry service. They said that they are looking to re-vamp the laundry, so that all of the laundry can be completed on site. Brick Barn Residential Home DS0000071233.V368673.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live at the home cannot expect to be supported by sufficient staff with skills and knowledge to meet their needs. They cannot be assured that appropriate recruitment practice has been followed to safeguard their welfare. EVIDENCE: The proprietor said that the home is operating on 400 care hours a week. However, we found that there had been a recent reduction in the number of staff working at the home. The manager said that two staff had been suspended following disciplinary action, one carer had left, one carer was on long-term leave and the cook was off sick. They said that these staffing problems had arisen in the last three weeks and whilst they had contacted an agency they had not taken on any agency cover. A night carer, the deputy and the manager were covering the shortfalls. The manager was made aware that this cannot continue for some staff are working in access of 40 hours a week, sometimes 70 hours a week. As a result an Immediate Requirement Notice was issued and the home is required Brick Barn Residential Home DS0000071233.V368673.R01.S.doc Version 5.2 Page 24 to confirm in writing what action they were going to take to deal with these concerns by the 17th July 2008. Within the timescale a respond to the Immediate Requirement Notice and staff rotas were received by the Commission. Within this Immediate Requirement Notice the home has been asked to ensure that at all times there are suitably, qualified, competent and experienced staff working in the home in such numbers as are appropriate to meet the needs of the residents. In addition copies of staff rotas for the weeks beginning the 14th, 21st and 28th July 2008 and the assessed needs of the residents and staffing hours have been requested. This is to ensure that residents are safeguarded and well cared for at all times by staff who have the skills and knowledge to meet their needs. On the day of the inspection it was noticeable that residents were not engaged in any meaningful activity and two residents were seen to be getting up and walking aimlessly around the home during the afternoon. Others were seen in the rear lounge with the television on watching it with little interest. The staff rota for the week beginning the 7th July 2008 was seen at the inspection visit. This was only partially completed with some entries in pencil and some use of volunteers. The manager said that the rota for the week beginning the 14th July had not been completed which was concerning as it did not provide evidence of forward planning for staff or certainty to us that staffing levels would be adequate. Staff recruitment practices were inspected and staff files were sampled and inspected. The paperwork for the two volunteers seen at the home and working on the day of the inspection was inspected. For one volunteer an application had been completed. This had gaps in their employment history and both references and a Criminal Record Bureau (CRB) disclosure need to be taken up. The second volunteer was said to have worked at Brick Barn in the past. The manager said that they no completed application form for this person and they said they handed out an application form for completion. The staff recruitment files of a further two carers were also inspected. One was a prospective staff member. They had a completed an application form, but both the references and the Criminal Record Bureau (CRB) disclosure needed to be completed. The manager said that they still have to interview this person and planned to do this when they return from their holiday. The second staff file inspected belonged to an existing member of staff. An application form had been completed and a Criminal Record Bureau (CRB) disclosure was in place. However, there was no evidence of any references, proof of identity, an interview or a letter of appointment. The manager said Brick Barn Residential Home DS0000071233.V368673.R01.S.doc Version 5.2 Page 25 that this member of staff had been taken on in June 2008 and the proprietor may hold some of this paperwork. Staff recruitment practices in this home are poor. Residents are not supported and protected by the home’s recruitment policy and practices and are therefore placed at risk. Staff employed either as volunteers or as paid employees are not adequately checked or recruited to ensure their safety. Since taking over the home in February 2008, the proprietor and the manager have been looking to develop a staff training and development programme. Evidence was seen of training certificates in Safeguarding Adults training (2), a medication update (2), Manual Handling training (6) and Food Hygiene training (4). One new carer is also working on their induction training and a Dementia Awareness training course is booked for August 2008. It is acknowledged that there is a need to promote training to ensure that all staff are competent and trained to do their work. The manager said that two permanent staff members have a National Vocational Qualification (NVQ) Level 2 in Care and a further three carers are currently working to achieve this qualification. The minimum ratio of qualified (NVQ Level 2 or above) is 50 and at present the service does not meet this requirement. Staff surveys completed and returned to the Commission gave different accounts of the training on offer. Both staff members said that they had received Induction Training, but one carer went on to say that they did not believe this was the situation for new staff now employed by the home. They went on to say that did not feel staff are trained to meet the individual needs of the residents such as holding a basic Food Hygiene qualification. This was evident on the day of the inspection for both volunteers were involved in cooking and serving the lunch and there was no evidence that they had received the appropriate training. Brick Barn Residential Home DS0000071233.V368673.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 31, 33, 35, 37 & 38. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live at the home cannot be assured of good management with ongoing staffing and recruitment concerns. However quality assurance and quality monitoring system are in place and health and safety systems are in situ protect the people who live in the home. EVIDENCE: The proprietor employed a new manager in March 2008 and they said that they are looking towards them being registered as the registered manager. The manager who has a qualification as a registered nurse – Mental Health Brick Barn Residential Home DS0000071233.V368673.R01.S.doc Version 5.2 Page 27 confirmed that they are planning to make an application for registration. They said that they had both management and training experience and as such they anticipated presenting and promoting training opportunities in the home. However, with current staffing difficulties, the manager said that they found themselves working as a ‘hands on’ manager. Currently they did not have the time or the opportunity to develop this aspect of their work. This was evidence on the staffing rota seen, for the majority of the day they were the second member of staff on duty. The new proprietor has started to complete Regulation 26 visits and reports. They had completed a visit in March and May 2008. These reports were seen and found to be informative and constructive. The proprietor was advised of the need to complete these monthly and agreed to do this. These reports will form part of the quality monitoring processes of the home and will ensure that residents are well cared for and safe. Since taking on the home, the proprietor and manager have conducted a number of audits covering resident’s clothing, facilities, furniture and equipment in the home. Records have been collated and an ongoing audit of these resources is being completed. Survey work has commenced in the home. The manager said that they had sent a survey to the next of kin of each resident and a deadline has been set. They said that they are now in the process of looking at these results and deciding how to ensure that families are made aware of the findings. They said that they anticipate calling a meeting to share the results and would respond personally to relatives as needed when action is required. The proprietor said that the majority of residents are assisted with their financial affairs. Services and goods are charged at cost and relatives are invoiced. The proprietor holds the receipts for the purchases. All records held in the home are in the office. Staff files are locked in a filing cabinet whilst policies and procedures and care planning files are located in the office. Records were said to be held in accordance with the Data Protection Act 1998. The arrangements in place for ensuring staff follow safe working practices have been considered early in this report in the ‘Staffing’ section. Training opportunities relating to health and safety issues have been offered e.g. moving and handling and food hygiene and more basic training courses are to be offered. This will mean that staff are skilled and qualified to perform their duties. Systems are in place for health and safety checks. Records were seen of weekly fire alarm and fire door checks and monthly emergency lighting checks. Brick Barn Residential Home DS0000071233.V368673.R01.S.doc Version 5.2 Page 28 Evidence was seen of fire drills and fire training. The most recent had been completed in April 2008. As stated earlier in this report, it was not evident that a fire risk assessment had been reviewed and updated whilst the chair stair lift was out of action. The proprietor told us that a new chair stair lift was on order. No written confirmation was seen at the inspection. With regard to the poor state of the laundry, the proprietor said that he would ask the home’s maintenance person to look into this the next week. Shortfalls in the management of the home are highlighted in poor staff recruitment practices and procedures and poor staffing levels found at the home on the day of the inspection. The Annual Quality Assurance Assessment (AQAA) was sent to the home on 2nd April 2008. Both the proprietor and the manager said they were not aware of receiving this document. Without this document it is difficult to see what the home has done, what they are planning to do and what they could do to improve the care in the home. At the inspection a copy of the AQAA was downloaded and the home did start to complete this document to send to the Commission. Brick Barn Residential Home DS0000071233.V368673.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 1 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 3 3 Brick Barn Residential Home DS0000071233.V368673.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No. This is the first inspection under this provider. 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 OP7 Regulation 15(2)(b) (c), Schedule 3 (1)(b) Requirement Timescale for action 22/08/08 2. OP9 13(2), 17(1)(a, Schedule 3(3)(i) 3. OP19 13(4), 23(1)(a) (2), 39(h) People living in the home must be assured that all of their care needs will be set out with reference to identified detailed risk assessments in an individual care plan which details the action to be taken by care staff to ensure all aspects of the health, personal and social care needs are met. These care plans must be appropriately frequently reviewed. People living in the home must 22/08/08 be assured that Controlled Drugs are stored in a metal cupboard, which complies with the Misuse of Drugs (Safe Custody) Regulations 1973. and receipt, administration and disposal of Controlled Drugs are recorded in a Controlled Drug register. People living in the home must 22/08/08 be able to access all areas of the home as stated in the home’s Statement of Purpose and Service Users’ Guide. This is with regard to the provision of a chair lift. DS0000071233.V368673.R01.S.doc Version 5.2 Brick Barn Residential Home Page 31 4. 5. OP26 OP27 13(3), 16(2)(e) (f)(j) 18(1)(a), 19 6. OP29 19(4)(c), 12(1)(a) The walls and floor of the 22/08/08 laundry must be non-permeable and readily cleanable. People living in the home must 11/07/08 be assured that at all times there are suitably, qualified, competent and experienced staff working in the home in such numbers as are appropriate to meet the needs of residents. This is the subject of an Immediate Requirement Notice. People living in the home must 22/08/08 be assured that they are safeguarded by thorough staff recruitment processes of all staff including volunteers. 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 OP16 Good Practice Recommendations The role and details of the Commission for Social Care Inspection (CSCI) should be added to the home’s complaints procedure to ensure that all staff are fully aware of the Commission‘s role in complaint investigations. The building would benefit from an assessment by a person who is qualified and experienced in delivering services for people who have a dementia to ensure that the environment maximises opportunities for people to be as independent as possible. The staff compliment is recommended to be trained to ensure that at least 50 of staff employed are qualified to NVQ level 2 or above. Staff would benefit from a training and development assessment and profile to identify shortfalls in knowledge and skills. 2. OP19 3. 4. OP28 OP30 Brick Barn Residential Home DS0000071233.V368673.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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