Inspection on 10/01/08 for Hill Barn

This inspection was carried out on 10th January 2008.

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

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

Other inspections for this house

Hill Barn 20/12/06

Hill Barn 26/01/06

Hill Barn 26/05/05

Hill Barn 08/03/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Mabbs Hall Nursing Home

Henrietta House

Firstlings

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Hill Barn Church Lane Sparham Norwich Norfolk NR9 5PP Lead Inspector Mrs Susan Golphin Unannounced Inspection 10th January 2008 09:30 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 Hill Barn DS0000062383.V357871.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. Hill Barn DS0000062383.V357871.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hill Barn Address Church Lane Sparham Norwich Norfolk NR9 5PP 01362 688702 01362 688040 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) Mr Richard Shand Smart Dr Maria Smart Mrs Tracey Joanne Woolnough Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26), Physical disability (1) of places Hill Barn DS0000062383.V357871.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th December 2006 Brief Description of the Service: Hill Barn is a care home providing residential care for twenty-five older people and one older person with a physical disability. The home is located in the village of Sparham. The home is an adapted barn with later extensions including a newly opened ten-bedded wing. All accommodation is located on the ground floor. There are twenty-four single rooms and one shared room. Twenty-one of the bedrooms provide en-suite facilities. The home also offers a choice of sitting in three locations and ample assisted bathing facilities. There is a delightful garden that those service users who choose to, can access very easily. It also provides sheltered areas where people can enjoy the garden. Current Fees are £400 - £470 per week. Hill Barn DS0000062383.V357871.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Care services are judged against outcome groups that assess how well a provider delivers the service to people. The key inspection has been carried out by using information from previous inspections, information from the manager, the residents and staff. This report gives a brief overview of the service and the current judgments for each outcome group. The inspection was carried out in one day. Four residents, the manager of the service and two care staff were seen during the course of the day. The Annual Quality Assurance Assessment (AQAA) was completed and returned on time, the information is detailed and gives a good review of the services and progress of the home throughout the last year. The home has continued to provide a consistently high standard of care to those who use the service. What the service does well: Hillbarn is an established home offering an excellent standard of care. The resource is well managed and the people using the service are provided with good up to date information about the service and facilities prior to coming into the home. An assessment of need for all new service users is carried out prior to admission, and pre admission visits are encouraged and welcomed by the staff. Good quality assessments and care plans are in place that reflect individual needs and wishes. Residents confirmed that they are well cared for and supported by staff who respect their personal lifestyles. Residents seen on the day also expressed complete confidence in the skills and experience of the all the staff describing them as ‘very kind, caring and with very pleasant attitudes.’ Residents also said that the staff listen and act on what they say and that the manager will always deal with any issues or concerns they may have. Residents were also very complimentary about the meals and choices of food saying that there is always a varied and appetising choice of meals. Seven out of fifteen residents comment cards were returned to CSCI and were very positive and complimentary about the service and support provided. In addition there were seven out of twelve comment cards received from relatives who were also happy with the service and saying ‘there is a lovely atmosphere in the home’ and the well being of the residents is given priority’. Another said that the staff are excellent and half a high regard for the residents.’ Hill Barn DS0000062383.V357871.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: There are no outstanding issues in respect of this home and the management continue to review the service to ensure that they remain informed and aware of the trends and changes to maintain consistently high standards of care. The management have recently reviewed the homes brochure and plan to add photographs to the dialogue to give a better all round view of the resource. The providers have yet to establish formal supervision sessions with the manager, but these will be implemented as soon as possible Residents questionnaires are issued annually and the service need to extend the QA survey to include both staff and other health professionals and forward the results to CSCI as part of the AQAA information. Please contact the provider for advice of actions taken in response to this Hill Barn DS0000062383.V357871.R01.S.doc Version 5.2 Page 7 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. Hill Barn DS0000062383.V357871.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 Hill Barn DS0000062383.V357871.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): Standards 1,3,6 People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence, including a visit to the service. People using this service can currently access good relevant information about the home that will assist them to make an informed choice about where they wish to live. Good assessment processes are in place, including risk assessments that help to safeguard residents and promote independence. There is no separate rehabilitation service provision in this home. EVIDENCE: The home provides prospective residents with clear and concise information about the service and the home. Prospective clients are encouraged to visit the home prior to admission. Residents spoken to on the day said that they were given ample information about the home before they moved in, and the service had met their expectations. Hill Barn DS0000062383.V357871.R01.S.doc Version 5.2 Page 10 People seeking information about the resource can now log onto the website for the service and take a ‘virtual tour’ of the home. The brochure for the service is being updated and photographs will be added to the dialogue providing improved information about the home. Three files were seen during the course of the inspection and the information about the healthcare needs for each person were stated and in place. Each care plan contained an individual risk and a clear assessment of need. The assessment format has recently been amended to include some additional details relevant when residents are discharged from the home. The daily records for each resident made by the staff are brief but reflect the care and support they provided. The home does not have a separate intermediate service. Hill Barn DS0000062383.V357871.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): Standards 7,8,9,10 People who use the service experience excellent quality outcomes in this area. This judgement has been made using a range of evidence, including a visit to the service. Residents receive excellent standards of care based on their assessment of need and care planning processes. Residents are treated in a dignified way and their personal wishes and choices respected by the staff at all times. There is a robust medication policy in place that promotes safe practices and procedures. EVIDENCE: From the information submitted in the Annual Quality Assurance Assessment residents receive an excellent standard of care and are well supported by the staff and community health services. Three care plans were seen during the course of the day and each offered a clear picture of the person and their healthcare needs. Reviews and reports monitoring the care of the residents is in place and up to date. The manager Hill Barn DS0000062383.V357871.R01.S.doc Version 5.2 Page 12 has established good working relationships with other health care professionals and residents and staff benefit from this positive network. There is evidence to show that both residents and their relatives are involved in the care planning processes and reviews are carried out on a regular basis. Four residents were interviewed on the day and all were very positive about the service stating that the staff are caring and kind, respect their privacy and dignity and are courteous at all times. Residents also said that the staff have good personal attitude to the work and were referred to as ‘smart and elegant’ when on duty. During the discussions with staff it was said that they are well supported and supervised by the management and receive relevant and up to date training. They spoke confidently and competently about their work, roles and responsibilities to the residents, and could demonstrate a good understanding of resident’s needs and expectations. Over the last year it has been acknowledged that some of the residents needs have changed and more support is needed and as an outcome of these changes additional staff have been employed so that there is an overlap at the beginning and at the end of the day to meet demand. There is a written policy in place for the management and administration of medication and recent changes to the way the pre packed medication is prepared and packaged has helped to streamline the procedure and improve the safety aspects for both residents and staff. The medication storage and recording is well managed and reviewed regularly, on the day of the inspection the area was in good order and well maintained. Hill Barn DS0000062383.V357871.R01.S.doc Version 5.2 Page 13 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): Standards 11-15 People who use the service experience excellent quality outcomes in this area. This judgement has been made using a range of evidence, including a visit to the service. Residents are offered a varied and well balanced diet. The social and recreational activities provided at this home meet the needs and expectations of the residents. Residents are encouraged and assisted to maintain family and community contacts as far as they are able. EVIDENCE: From the information submitted in the Annual Quality Assurance Assessment document (AQAA) it states that residents are encouraged to manage their daily lives as they wish. There is an activity / social interest in place on most days and residents are made aware of any forthcoming activities or entertainments. Information is displayed on the resident’s notice board and they also have a list in each of their rooms. Hill Barn DS0000062383.V357871.R01.S.doc Version 5.2 Page 14 A volunteer has recently been recruited by the manager and will take responsibility for managing the social activities and interests of the residents. The manager said that initially she would like the volunteer to establish residents needs and wishes regarding activities and social interests so that she can provide a very personal service and offer individual activities as well as group ones. The residents talked of interesting events that take place and things that they can do and all were engaged in some small handcraft activity during the discussions. Residents spoken to on the day were enthusiastic about the inhouse entertainments including quizzes and competitions and of course the regular bingo sessions. There is well established contact with the local community including the church and the school and both visit regularly. From the AQAA it states that the Reepham Rover community bus visits monthly providing residents with the opportunity to maintain contact with people in the locality.Residents meetings take place on a regular basis and the outcomes are implemented by the home. Residents manage their own financial and personal affairs and are encouraged to maintain an interest and control in the way they live. All the residents seen said that the meals are ‘delicious, well cooked and presented’ and there ‘is always a good choice’. Of the four people seen on the day of the inspection, all could remember the menu options and also what they had chosen for their main meal of the day. All four had elected to have something different. The times of the main meal have altered slightly to allow more time for residents to select their meal from the menu. The two small dining rooms are homely in style and well equipped. Tureens are used for vegetables and offer residents greater choice. The staff and management have a good understanding of resident’s nutritional requirements and all have been screened using the MUST nutritional tool. The manager stated that the screening exercise has highlighted some dietary needs for residents and these are being monitored on a regular basis including being alerted to any weight gains or losses. This practice is to be commended. Hill Barn DS0000062383.V357871.R01.S.doc Version 5.2 Page 15 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): Standards 16,18 People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence, including a visit to the service. People who use the service are aware of the homes complaints procedure and are confident that any concerns about the service will be dealt with. The staff receive training in safeguarding adults which helps them to recognise and respond appropriately to allegations of abuse. EVIDENCE: No formal complaints have been received about the service in the last year. The manager or deputy manager makes a point of contacting each of the residents every day. This provides them with an opportunity to discuss any issues residents may have or want to raise. The home maintains a complaints and compliments file, and all contacts or queries are recorded, including any action taken or outcome reached. The manager is monitoring this process and how the information is recorded to include a clearer audit trail. Residents seen on the day said that they are very contented and happy at Hillbarn and if they have any concerns they talk to the staff or the manager. The staff records show that regular training in safeguarding adults and challenging behaviour take place on a regular basis. Hill Barn DS0000062383.V357871.R01.S.doc Version 5.2 Page 16 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): Standards 19, 20,26 People who use the service experience excellent quality outcomes in this area. This judgement has been made using a range of evidence, including a visit to the service. The home provides a comfortable, safe environment that suits the needs and wishes of the residents. EVIDENCE: Only a brief tour of the premises was undertaken on this occasion. The areas seen were well maintained, and decorated and furnished to a high standard, including residents rooms. The communal rooms are homely and comfortable and meet both the individual and collective the needs of the residents. Work on upgrading the status of the fire doors has been completed and there is good evidence of an ongoing programme of maintenance and redecoration throughout. From the AQAA it states that specialist equipment has been installed in various rooms and new furniture has been purchased in the last year. Hill Barn DS0000062383.V357871.R01.S.doc Version 5.2 Page 17 The external areas of the home offer attractive areas to walk and sit with pleasant views of the countryside from most aspects of the home. All the areas seen were spotlessly clean, bright and maintained to a high standard. Hill Barn DS0000062383.V357871.R01.S.doc Version 5.2 Page 18 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): Standards 27 28 29,30 People who use the service experience excellent quality outcomes in this area. This judgement has been made using a range of evidence, including a visit to the service. Resident’s needs are met by staff with a wide range of skills and knowledge in the care of older people. There are good recruitment and selection processes in place. Staff training including NVQ is promoted. EVIDENCE: From the information submitted in the Annual Quality Assurance Assessment document (AQAA) it states that the home has a well established staff group and does not use agency staff. From the discussions with the residents and from the responses made in the comment cards, the staff are caring, supportive and have a high regard for the people in their care. To maintain the good standards of practice, duty rotas overlap during crucial times of the day ensuring that there is an opportunity for staff to share and pass on information between shifts. Five comment cards from staff were returned to CSCI prior to the inspection all were complimentary about the Hill Barn DS0000062383.V357871.R01.S.doc Version 5.2 Page 19 management of the home and confirmed that they receive appropriate and relevant training and supervision in the care of older people. Three staff files were seen on the day of the inspection and all contained evidence of good recruitment and selection procedures, including identity and Criminal Records Bureau checks. Staff spoken to on the day confirmed that they have received relevant and regular training including courses on Moving and Handling, Fire training, First aid, Basic food Hygiene and Infection Control. NVQ training is encouraged and promoted. Currently six staff have completed NVQ 2 and further five will complete their course this year. Hill Barn DS0000062383.V357871.R01.S.doc Version 5.2 Page 20 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): Standards 31,33,36,38 People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence, including a visit to the service. There is a consistent and well-managed service provided. A quality assurance process for the home is in place that incorporates the views of the people using the service and their representatives but needs to be developed to reflect the service overall. The home is managed by a qualified and experienced manager. Formal supervision of the manager by the registered providers needs to be implemented. Formal staff supervision procedures are in place to promote consistency of care and maintain good standards. The health and safety of residents is protected by good procedures. Hill Barn DS0000062383.V357871.R01.S.doc Version 5.2 Page 21 EVIDENCE: The home has an experienced and professional manager who has been in post for a number of years. Staff seen on the day spoke of good support from the manager and clear direction and leadership. Residents were also complimentary about the manager and that she is very approachable and accessible whenever needed. The manager updates her own knowledge and shares work experiences through regular contact with other health care professionals and managers of care services. The manager meets with the proprietors on a regular basis to discuss the running and management of the home on an informal basis and this does not include formal supervision sessions which the manager acknowledged she would value as part of her own professional and personal development. During the discussions with the proprietors it was agreed that formal sessions will begin as soon as possible. See recommendation Records show that the staff receive formal one to one supervision on a regular basis which is recorded and used to monitor their professional development and skills. Resident’s and relative’s views about the service are sought through the questionnaires issued each year. During the discussions it was agreed that the management need extend the survey to include the views of the staff and other health care professionals and the outcome summarised and made available to everyone including the CSCI as part of the information submitted in the Annual Quality Assurance Assessment document (AQAA) See recommendation. The management do not involve themselves in resident’s financial affairs however they do hold and administer small amounts of personal allowance on behalf of residents. A separate record for each person is maintained. Building, equipment and safety records are in place and well maintained. A maintenance file is kept in date order. Aids and adaptations have been serviced and safety checks carried out on the equipment. Heating and water systems are serviced on a regular basis and records maintained. Hill Barn DS0000062383.V357871.R01.S.doc Version 5.2 Page 22 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 4 x 4 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 4 x x x x x 4 STAFFING Standard No Score 27 4 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x 3 x x 3 x 3 Hill Barn DS0000062383.V357871.R01.S.doc Version 5.2 Page 23 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. 1. Refer to Standard OP33 Good Practice Recommendations It is recommended that the system for monitoring quality be further developed to include the views of staff and other health care professionals and the outcomes published and a copy made available to CSCI as part of the AQAA information. It is recommended that arrangements are put in place for the manager to receive formal supervision to promote personal and professional development. 2 OP36 Hill Barn DS0000062383.V357871.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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. Extracts may not be used or reproduced without the express permission of CSCI Hill Barn DS0000062383.V357871.R01.S.doc Version 5.2 Page 25 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!