Inspection on 20/10/05 for Manor Barn

This inspection was carried out on 20th October 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Manor Barn 02/04/08

Manor Barn 19/06/07

Manor Barn 06/07/06

Manor Barn 19/05/05

Manor Barn 22/02/05

Manor Barn 23/08/04

Manor Barn 04/03/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 Manor Barn Wattsfield Lane Kendal Cumbria LA9 5HF Lead Inspector Ray Mowat Unannounced Inspection 20th October 2005 08:00 Manor Barn DS0000022687.V255761.R01.S.doc Version 5.0 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 Manor Barn DS0000022687.V255761.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 Adults 18-65. 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. Manor Barn DS0000022687.V255761.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Manor Barn Address Wattsfield Lane Kendal Cumbria LA9 5HF 01539 735025 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) carol.pounder@oakleatrust.co.uk The Oaklea Trust Vacant Care Home 5 Category(ies) of Learning disability (1), Learning disability over registration, with number 65 years of age (4), Physical disability over 65 of places years of age (4) Manor Barn DS0000022687.V255761.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th May 2005 Brief Description of the Service: Manor Barn is a converted barn, in a residential area of Kendal, Cumbria within walking distance of the amenities of the town centre. It is registered to provide residential care for five people with a learning disability, some of whom may have elderly needs or a physical disability. The accommodation is on three floors. There is ramped access to the property from a car park at the front of the building. There is a small garden to the front and a larger private garden to the rear of the building, which leads to a riverside walk. On the lower ground floor there is a self-contained flat, this has a lounge with a small kitchen/dining area, a single bedroom with fully accessible en-suite toilet and shower facilities. Also situated on the ground floor but separated from the registered accommodation, are several rooms used as offices by the Trust. The middle floor has three single bedrooms, two of which have en-suite facilities and showers. There is a large lounge/dining room leading to a kitchen and utility room. The upper floor has a self-contained flat with a single bedroom, with ensuite facilities and a lounge with kitchenette. Also on this floor is a staff sleepin room, which is also used as an office. Manor Barn DS0000022687.V255761.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. During the course of the inspection I met with the manager, the care staff on duty and the residents of the home. I was able to spend time informally with both residents and staff as they went about their daily routine. I also joined the residents when they went out with staff, for a walk to the nearby river. I examined the resident’s personal files and other records maintained in the home. What the service does well: What has improved since the last inspection? What they could do better: The new contract of terms and conditions must be clarified and agreed with residents or their representative. The home must appoint staff to all the vacant posts and ensure there are enough staff on duty at all times. Although the on-call rota has improved, senior staff must not be on shift in the home, when they are on-call. The content of risk assessments should be looked at, to ensure they include the right information. A choice of activities based on individual needs and choices, should be available to residents. Manor Barn DS0000022687.V255761.R01.S.doc Version 5.0 Page 6 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. Manor Barn DS0000022687.V255761.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Manor Barn DS0000022687.V255761.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5. Planned admissions to the home ensure the residents and the home, have been able to make an informed decision about the suitability of the service to meet individual needs. Information issued to residents needs to be clarified. EVIDENCE: Since the last inspection the home has admitted a new resident, who came to the home initially on an emergency placement. Unfortunately the placement broke down quite quickly, resulting in the resident being found alternative accommodation for a short period. This enabled a phased admission to the home and the current group of residents, to be negotiated and planned with the social worker and other agencies. The planned admission took place over a two-week period gradually increasing the length of the stay. During this period the behaviour intervention team, social worker and community nurse team supported the home. By following this process, both the existing residents and prospective new resident, had time to adjust and make an informed decision. Based on the inspector’s own observations and discussions with the staff and the manager, the phased admission has been effective for the residents and the staff, who all feel more confident and are able to deal with any challenging situations in a positive manner. A new customer agreement (2005 version) has been issued to residents. The document refers to “terms and conditions of the occupancy/tenancy agreement, between the customer (resident) and the housing provider”. This agreement was not available for inspection, in addition although the home is Manor Barn DS0000022687.V255761.R01.S.doc Version 5.0 Page 9 required to issue a contract of terms and conditions, there should be no agreement between the housing provider and the resident, as this would constitute a tenancy. The agreement should be between the housing provider and the residential care provider. The issue of treating residents in a registered care home as tenants, as described in the customer agreement, is something that must be clarified once and for all with residents and their representatives, so they understand their status and the terms and conditions of their residence. Manor Barn DS0000022687.V255761.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10. Individual needs and preferences were well documented, however a review of risk assessments is required. EVIDENCE: The inspector examined three residents care plan files. The most recent resident to move into the home had a comprehensive social work and multi disciplinary assessment. In addition there were detailed behaviour strategies in place, to guide and support staff in dealing with known difficult or challenging behaviour. The home has also completed their own detailed functional assessment, with assistance from the social worker and behaviour intervention team. This information has been invaluable to the manager and staff, in ensuring a consistent quality of care that meets the individual’s needs was maintained. The home is in the process of introducing person centred planning for the residents, which will be most beneficial in supporting people with major life changes and ensuring valuable personal information is recorded. The manager has recently introduced a new recording system to document individuals “achievements and choices”, which will reflect how residents are participating in life in the home and in the community. Manor Barn DS0000022687.V255761.R01.S.doc Version 5.0 Page 11 The home is developing their risk assessments in relation to individuals and the environment. It is recommended these be reviewed ensuring all residents have appropriate risk assessments in place to support an independent lifestyle. All the records examined were securely stored, with staff showing a good awareness of the need to maintain confidentiality. Manor Barn DS0000022687.V255761.R01.S.doc Version 5.0 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17. There is a need to review the activities provided, based on the needs of the current group of residents. Opportunities for community activities have been inconsistent due to staff shortages. EVIDENCE: Two of the residents continue to enjoy an independent lifestyle both in the home and in the community, with them both accessing a range of community facilities of their choice on a regular basis. Based on daily reports and discussions with staff and residents, the staff shortages has impacted at times, on the ability of the home to provide appropriate activities. In particular since the arrival of a new resident, the dynamics of the home have changed and more structured planning is required, to ensure the success and safety of community activities. With these issues in mind it is recommended the home review the activities it provides and ensures individual needs are recorded and met. During the inspection there was a new member of staff being inducted to the home, if there are only two staff on duty for the five residents and one of the staff is an inductee, then this puts the permanent staff under pressure and will severely limit their ability to effectively induct the new member of staff. The Manor Barn DS0000022687.V255761.R01.S.doc Version 5.0 Page 13 manager said that this was an exceptional situation and normally the new staff would be over and above the normal staffing for the shift. The menu planner and record of meals was displayed in the kitchen and reflected a varied and nutritious choice of lunchtime meals. However meals provided in the evening were on some weeks repetitive and should be reviewed to ensure a varied diet. Manor Barn DS0000022687.V255761.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 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, 19, 20. The home has good systems to record and respond to personal and healthcare needs of residents. EVIDENCE: The home’s assessments and care plans, in addition to specialist assessments, provides staff with detailed information relating to all aspects of a resident’s personal and healthcare needs. The home is also introducing health action plans, which will monitor and record health needs on an ongoing basis. Specific guidelines and strategies have also been developed to guide staff in responding to known difficult and challenging behaviours. And to ensure a continuity of care is maintained, with preferences and routines important to individuals, being responded to appropriately. These have been developed with support and guidance from all the relevant parties. The medical record sheets (MAR charts) were examined and checked against the contents of the medication cupboard. These were on the whole found to be up to date and in order. However there was some cream contained in the cupboard, which was not named. It is recommended medication is clearly labelled with the prescribing pharmacists information. Manor Barn DS0000022687.V255761.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23. The home’s policies, procedures and practice ensure residents are safeguarded from mistreatment and abuse. EVIDENCE: There have been no recorded complaints since the last inspection. Staff were aware of their role and responsibilities in safeguarding residents and have received relevant training, in relation to mistreatment and abuse of vulnerable adults. A handover checklist is completed at the end of each shift, which includes the checking of money tins and medication and any other pertinent information. Manor Barn DS0000022687.V255761.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30. Manorbarn is well maintained and provides a homely living environment that meets the needs of the residents. EVIDENCE: On the whole Manorbarn provides a safe and comfortable environment for the residents. A planned programme of repairs and renewals was being updated, with plans in place for the decoration of the main lounge and the upstairs flat in early 2006. It is recommended the carpet in the main lounge is either thoroughly cleaned or replaced as it is also in need of attention. On the day of the inspection the home was found to be clean and hygienic. This is maintained by the care staff, who follow a daily and weekly cleaning regime, which is displayed in the kitchen. The laundry was well ordered with good hygiene practices in place. The first floor of the home is fully accessible with ramped access to the front door. Weeds and moss were beginning to grow in between the paving stones on the ramp and should be removed to avoid a slip hazard. Resident’s needs in relation to aids and adaptations have been assessed and suitable equipment provided, including a bath chair and standing frame. Residents had personalised their rooms choosing décor and furniture, which reflected individual tastes and needs. Manor Barn DS0000022687.V255761.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 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, 34, 35, 36. The shortage of staff is having a negative impact on the quality of life of residents and is also putting the permanent staff under pressure. EVIDENCE: The home was experiencing difficulties with staff cover, due to long term sickness absence and vacant posts due to people leaving. On the rota for week ending 23.10.05, the staffing levels were below the agreed amount. The total number of care hours showing on the rota was 141.5, with only three permanent staff in place. The home must maintain adequate levels of staff at all times and this issue is subject to a requirement. On the day of the inspection a new relief member of staff was undergoing an induction to the home. Based on discussions with them they had found the recruitment process a positive experience and talked about a thorough in house induction and planned, formal induction and foundation training. Staff files were examined, which recorded all relevant training information. It was evident a good range of training had taken place and further training planned. The Trust’s central training unit send out a planned programme for a twomonth period that has been developed based on feedback from home managers. A list of staff that require refresher training is also supplied, to ensure training needs are met in the required timescale. Supervision records were also up to date, with annual appraisals taking place. Training needs and Manor Barn DS0000022687.V255761.R01.S.doc Version 5.0 Page 18 personal development targets were agreed with individuals, which are monitored through the year. Although there are staff shortages, the core group of permanent staff were well trained and had a good understanding of their role and the individual needs of residents. Manor Barn DS0000022687.V255761.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 42. The home has experienced a difficult period with staff shortages and the introduction of a new resident. However the manager and staff have minimised the disruption to the residents and are working hard to ensure a continuity of care is maintained. EVIDENCE: The manager’s hours have been increased, on a temporary basis, to accommodate the introduction of the new resident. This will be reduced to 25 hours when a permanent appointment is made to the manager’s post. The acting manager Ms Shelley Stokes has recently completed the fit person process with the commission. The manager is trying hard to establish a consistent staff team and minimise the disruption to residents caused by the staff shortages. She is working closely with her own staff and other agencies, to ensure individual needs are acknowledged and responded to. Team meeting minutes were sampled, which contained examples of staff sharing relevant information relating to the ongoing care and support of individuals and the smooth running of the home. Also acknowledged in the Manor Barn DS0000022687.V255761.R01.S.doc Version 5.0 Page 20 meeting was a letter from the operations manager complimenting the staff team and acknowledging “the good work undertaken by staff”. Positive feedback and recognition of staff commitment is good practice and makes staff feel valued by the organisation. Satisfaction surveys had also been completed with the results published and issued to the home. A requirement was made at the last inspection regarding senior support staff covering the on-call service whilst on shift in the home. This system was reviewed by the organisation and improvements made. However on examining the on-call rota, senior staff were on duty in Manorbarn, at the same time as being named on the on-call rota. This was raised with the manager and must be addressed. Routine health and safety checks had been carried out and records maintained, which were found to be up to date and accurate, ensuring a safe environment is maintained. Manor Barn DS0000022687.V255761.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 3 3 2 Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 2 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 2 13 3 14 2 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 2 2 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Manor Barn Score 3 3 2 X Standard No 37 38 39 40 41 42 43 Score 3 3 3 X X 3 X DS0000022687.V255761.R01.S.doc Version 5.0 Page 22 Yes Are there any outstanding requirements from the last inspection? 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 YA5 Regulation 5 Requirement The organisation must supply residents with clear contracts of terms and conditions for residential care, in line with the Care Home Regulations 2001. The home must have adequate numbers of suitably trained staff on duty at all times. The on call rota must be reviewed ensuring senior staff are not on duty in the home when covering the on-call rota. Timescale for action 01/01/06 2 3 YA33 YA42 18(1) a 13 & 18 01/12/05 01/12/05 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 2 3 Refer to Standard YA9 YA12 YA17 Good Practice Recommendations It is recommended risk assessments are reviewed ensuring all residents have appropriate risk assessments in place to support an independent lifestyle. It is recommended the home agree a structured programme of activities. The meals provided in the evening, were on some weeks repetitive and should be reviewed to ensure a varied diet. DS0000022687.V255761.R01.S.doc Version 5.0 Page 23 Manor Barn 4 5 YA20 YA24 It is recommended medication is clearly labelled with the prescribing pharmacists information. It is recommended the carpet in the main lounge is either thoroughly cleaned or replaced as it is in need of attention. 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