Inspection on 17/09/07 for Manor Barn Nursing Home

This inspection was carried out on 17th September 2007.

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

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

Other inspections for this house

Manor Barn Nursing Home 03/03/08

Manor Barn Nursing Home 20/04/07

Manor Barn Nursing Home 21/11/06

Manor Barn Nursing Home 25/10/05

Manor Barn Nursing Home 03/05/05

Manor Barn Nursing Home 08/02/05

Manor Barn Nursing Home 14/05/04

Manor Barn Nursing Home 11/02/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Manor Barn Nursing Home 2 Appledram Lane South Fishbourne Chichester West Sussex PO20 7PE Lead Inspector Clare Hall Key Unannounced Inspection 17th September 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Manor Barn Nursing Home DS0000024175.V344984.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. Manor Barn Nursing Home DS0000024175.V344984.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Manor Barn Nursing Home Address 2 Appledram Lane South Fishbourne Chichester West Sussex PO20 7PE 01243 781490 01243 813713 manorbarn@care-homes.org 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) Rhymecare Limited Vacant post Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30), Physical disability (5), Physical disability of places over 65 years of age (5) Manor Barn Nursing Home DS0000024175.V344984.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No more than 30 service users may be accommodated at any one time. 20th April 2007 Date of last inspection Brief Description of the Service: Manor Barn is a care home that provides residential and nursing care, and is registered to accommodate up to 30 residents in the category of old age, not falling within any other category. The fees are between £500 and £725 per week. Manor Barn was originally constructed in the sixteenth century, since then it has been extended and converted. The home is situated near the village of Fishbourne. Rhymecare Ltd operates the service. The person registered for the service on behalf of the company is Mrs Sheila Wyatt and her husband Mr Wyatt is a company Director. Manor Barn Nursing Home DS0000024175.V344984.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The information used to write this report was gained from the home’s annual quality assurance assessment completed by the registered individual (Mrs Wyatt), a visit to the service, and comment cards received from staff and relatives. A visit undertaken over ten hours was also made to the premises. Staff were observed going about their jobs and were spoken to randomly. Residents were visited either in their rooms or communal areas. Other information was gathered from the service’s history of events, previous inspection reports, direct conversations with staff, and analysis of information supplied to and recorded by the inspector. During the visit to the home, the newly appointed manager and the provider assisted this inspection throughout the day. The inspector spent time during the beginning and end of the visit discussing evidence and findings with the provider and manager as they were raised. At the end of the inspection the director (Mr Wyatt) also joined the feedback session. The inspector was also able to have a meeting with the catering director in the presence of the provider and manager. What the service does well: What has improved since the last inspection? The service has now employed a manager for the service who has been in post for two weeks. It was stated she would be applying for registration with the commission. Manor Barn Nursing Home DS0000024175.V344984.R01.S.doc Version 5.2 Page 6 They have sent out a questionnaire to staff to test their knowledge regarding policies and procedures. What they could do better: There is a long history of shortfalls being raised regarding a number of issues in the home, one being a lack of needs assessment. This is despite a response from the providers stating they will address these shortfalls. Despite previous recommendations and opportunities given to the provider to address the shortfalls, the evidence indicates a pattern of continuing noncompliance and failure to meet the requirements. The concerns raised at this and previous inspections, which remain unaddressed, include • • • Residents have been accommodated without the service undertaking an assessment to ensure that needs can be met. The home has not provided a written statement of terms and conditions to all those residents accommodated. Staff need to develop further the involvement of individuals or their representatives in decisions or give them a say in how they would like their care to be delivered. Care plans that are in place are poorly developed, generic, out of date and do not reflect the person’s needs. Staff in the home treat people who use the service in a way which does not respect their privacy and dignity. People who use the service state that they do not always feel safe or listened to by staff. Eating and food in the home is not considered to be an enjoyable event and very little thought is given to ensuring residents receive a balanced diet. The complaints received have been poorly managed and records do not show that concerns have been taken seriously. Staff do not demonstrate an understanding of protection and safeguarding procedures and what constitutes abuse. People who use services say areas of the home are noisy, cold and not well lit. • • • • • • . Manor Barn Nursing Home DS0000024175.V344984.R01.S.doc Version 5.2 Page 7 • The home is generally clean and tidy, but there are some areas which are not clean and are in need of attention. Staff have a poor understanding of infection control procedures and the principles of cross infection. The service has a poor recruitment procedure, which continues to place residents at risk. Staff continue to be appointed and start working without references or other important documentation being received or held at the premises. The staffing levels are not meeting the needs of the service, with the health and welfare of people being adversely affected. Staff have not received the training to ensure they are competent to undertake their role. • • • The lack of leadership in the home has had adverse effects on the care provision and this has been shown in the failure of the service to show any sustained improvement. Training development and supervision of staff is inconsistent. Policies and procedures are not reviewed or kept up to date and quality assurance monitoring is not regarded or implemented as a core management tool. . 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. Manor Barn Nursing Home DS0000024175.V344984.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 Manor Barn Nursing Home DS0000024175.V344984.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): 2,3 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents have been accommodated without the service undertaking an assessment to ensure that their needs can be met and the home has not provided a written statement of terms and conditions to all those residents accommodated. This puts people who live at the service at risk. EVIDENCE: The inspector case tracked only the residents admitted since the last inspection so that an accurate reflection was made of these standards. The providers had since the last inspection submitted their annual quality assurance assessment which they reported - Manor Barn Nursing Home DS0000024175.V344984.R01.S.doc Version 5.2 Page 10 • • • They have introduced a new contract that requires signature by all residents even those who are fully funded to ensure the terms included in the Home’s contract are extended directly to such residents. They will ensure that social needs are fully recorded in assessment documentation. They wish to review the interaction of local authority contracts with the Home’s contract to ensure both financial and service terms are complementary. Of the files assessed neither had a contract nor had records available to show they had had their needs assessed prior to admission. The manager and provider were given the opportunity to find these records and were unable to produce them, despite conversations with long standing staff to ascertain where they could be. This has been a previous requirement. The provider had advised that “people accommodated in the home have a written contract/ terms and conditions of residence, which informs them of the agreement the home have made with them” and that “people living at the home have received an assessment of their needs before they were admitted to the home to ensure that their needs can be met. “ The provider further stated that full assessments are carried out as outlined in the Statement of Purpose, Service user Guide and terms and conditions. We did not find evidence that service users were receiving pre admission assessment and contracts. Manor Barn Nursing Home DS0000024175.V344984.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, Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Risk assessments and care plans do not reflect the up to date needs and issues of people putting them at risk. People living at the home are not involved in any meaningful way or encouraged to communicate their needs. Staff in the home treat people who use the service in a way which does not respect their privacy and dignity. EVIDENCE: When auditing one care plan and assessment with the manager one record identified a resident having a feeding tube and catheter. It was established that this resident had neither. These records had not been updated. Manor Barn Nursing Home DS0000024175.V344984.R01.S.doc Version 5.2 Page 12 The care plans contained limited information and were not person centred to show how to meet individual needs and were not signed by the resident or their representative. Staff responses indicated in their surveys that they are not always given up to date information about the people they support and said they sometimes have to ask. In the care records residents have what the home describes as “cot sides” put on their beds. There are signatures from next of kin demonstrating permission has been sought to use them but there was no evidence of this being based on a risk assessment or that a bed rail risk assessments had been undertaken. One resident who had recently suffered a fall did have this recorded in the accident and incident record but no notes were made of this in her daily record. The falls risk assessment was not updated with this recent event. Manual handling risk assessments were in place. However they did not include the type and size of sling to be used and how the resident should be supported i.e. from bed to chair, chair to toilet or to bath. The risk assessments describe only some of the information known for the abilities of individuals and processes which should be undertaken in moving and handling residents safely. The nutritional risk assessments that were in place did not contain details associated with the needs of individuals, the care they need and an appropriate review of the issues. The care plans used by staff are pre written templates and were not adjusted to show the individual needs of people. These generic care plans have not always been updated so the current care needs were not reflected. One care plan generically written for someone in pain did not identify the individual’s person centred assessment for pain, nor a plan to manage or review this issue. Resident’s preferences were also not recorded within the care records. The times that individuals were got up and their needs met throughout the day did not indicate staff had done this through consultation with the individual. It was reported by staff that a new process to get a number of residents up and washed by night staff had been implemented. This was so staff could finish their care at a reasonable time the manager stated. Manor Barn Nursing Home DS0000024175.V344984.R01.S.doc Version 5.2 Page 13 One resident seen by a general practitioner recently for a headache, which she said she still had on and off when visited by the inspector, did not have this issue recorded on her care plan. The significance of this in relation to her health and welfare as her medical history indicated she had a stroke had not been evidenced. One senior nurse was observed administering medications. This process was observed to be undertaken safely and in line with recommended practices. Controlled drug storage was also checked along with their records of disposal of which there were no concerns. Good practice seen was that the care staff recorded when they checked the residents blood monitoring equipment to ensure it was calibrated and working accurately. It was noted that the staff had been provided with an up to date British National Formulary drug reference so medications checks could be undertaken when there was a concern. Residents had drinks provided in lidded plastic beakers. No other type of cup was seen in use. The care assessment records did not identify the abilities of individuals and promotion of abilities and independence. Resident’s records did indicate that they needed a beaker but the records did not indicate why. Residents were seen with their doors open and some were in a state of undress. For residents at risk of dehydration the nurses provided records for fluid balance. These were erratically completed and no evidence of review had been given to what the records were indicating. One fluid chart had no output recorded at all. One fluid chart showed a total fluid intake of 60mls taken over a period spanning one day. The three records made were 09.00 hours, 21.10 hours and 23.20 hours. There was a mixed response from staff when the inspector asked about resident choice, preference and consultation. Two staff referred to times for baths and routines, and one who was new referred to seeking the views and choices of the residents prior to undertaking any care. Manor Barn Nursing Home DS0000024175.V344984.R01.S.doc Version 5.2 Page 14 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, Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents who are able to express their wishes and who are more able have a good quality of life. They are happy with the food provided and the interests they undertake. Those residents who rely heavily on the staff to support them with their diets and social wellbeing are not being supported. EVIDENCE: One relative stated that people in the home “need something more to stimulate them.” Manor Barn Nursing Home DS0000024175.V344984.R01.S.doc Version 5.2 Page 15 Discussions with staff and visitors indicate there are group activities on for two hours a week. Only four of the 20 residents were in the lounge for the duration of the ten hours the inspector was in the home. It was noticed that when two staff had finished their tasks they sat at a table in the lounge but did not engage in any meaningful activities with people living in the home. Throughout the day there was little to no conversation, social interaction and only the television made a background noise. The conservatory was empty all day and the dining table area was not used by residents. Except for the four residents in the lounge the remainder of the people living in the home were in their rooms. One resident was seen in her room on a number of occasions as the inspector passed her room. She was observed rocking in her chair and speaking to herself. No care staff were seen talking or visiting her and nor was she observed engaging in any meaningful activity. It was observed that four residents were seen lying in bed. At no time did the inspector see any meaningful activity or interaction, or staff sitting with individuals and speaking with them. There was no evidence to show this was the choice of people living in the home. One gentleman spoken to told me he was bored and we observed he was left alone in his room for the duration of the day. The only staff seen in his room was in the early part of the morning when giving care. The inspector reported these findings to the West Sussex safeguarding team. There was no coming together of residents at mealtimes. The conservatory was empty and no one sat at the one dining table except for staff. Two able-bodied residents were seen undertaking their own interests of reading and writing, but the less able bodied residents appeared to be without any stimulation. One nurse was seen speaking and interacting with residents during a medication round in a polite, respectful and supportive manner. One resident did comment that they felt the staff only sometimes listened and acted on what they said and that staff are only sometimes available when needed. Another resident commented that the staff did not always listen and act on what they said. Manor Barn Nursing Home DS0000024175.V344984.R01.S.doc Version 5.2 Page 16 There were no food records to indicate what food had been provided except for names and preferences on the daily kitchen selection records. Staff said that some individuals had chosen not to eat despite being described as sometimes eating well, but this was not being recorded. When a senior member of staff was asked about one resident’s food intake and care she explained, “It looks like she had given up and thinks her quality of life is no more, She stopped eating 1 ½ months ago. We involved the multidisciplinary team and everyone agreed we have to go according to her wishes – if she doesn’t want to eat then leave her.” Another resident requiring full assistance regarding her diet was observed unable to reach the food she had been given. Senior staff told us “she eats well, you need to feed her. She eats and drinks well with help but has very poor communication.” The inspector saw a full cup of cold tea by her bed and an abandoned piece of cake. Another resident who staff said had had a stroke was described as taking food very well when helped. These two residents were not in a position where they could help themselves as they were lying in bed, and were not seen to be sat up for eating food or drinking. Beakers were not in reach. When discussions were held with two staff and one relative it was established that the residents are receiving their supper at 5.30pm and not having their breakfast until 8.30 or later the next day. Snacks are not being served with evening drinks. The evening milky drinks are only being provided if the resident asks. One relative told the inspector, “they really should have a late drink /snack.” In response to the shortfalls identified on this visit a requirement will be raised in respect of food and drink. Manor Barn Nursing Home DS0000024175.V344984.R01.S.doc Version 5.2 Page 17 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, Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The complaints received have been poorly managed and service users are not protected from abuse. People who use the service state that they do not always feel safe or listened to by staff. The provider’s annual quality assurance assessment does not reflect the serious shortfalls found. EVIDENCE: The AQAA record provided to the commission recorded 13 complaints and one safe-guarding event in the home. One resident spoken to by the manager and inspector complained of the cold in her bathroom. The manager said the provider knew this and a conversation was over heard to the provider later when the manager said this resident had raised the issue again. The manager provided the inspector with a book where any and all the complaints, concerns and all issues are recorded. Manor Barn Nursing Home DS0000024175.V344984.R01.S.doc Version 5.2 Page 18 This book holds details of all these events including the full details of the allegations, complaints and concerns including the times, places and people involved. The manager and provider could not produce any further records to indicate these issues had been addressed through a complaints procedure. The manager said that all complaints are dealt with by head office. Another extract seen was that a resident complained that the nurse on duty didn’t soak his legs and didn’t do the dressings because she didn’t have the time. Further issues in the complaints book were, • Missed medications. • Resident being slapped by another resident. • One resident had called the police to inform them her dinner was cold. • One service user became locked in their room and the staff had to access through the rear via the window to open a rear door. One other extract describes how a resident discloses to staff that someone has grabbed her and hurt her. Staff record and note four bruises on her lower arm. The staff then record how they undertake their own investigation and decide the situation is to be monitored. As this resident prefers this member of staff not to attend to her needs they decide that the outcome is not to let this care worker have further contact with this resident. The inspector went through some extracts in the book with the manager and the provider photocopied the most recent ones for the inspector directly from the book. No records could be found to how these were addressed and the audit trail could not be produced. The seriousness of residents being described in records as being hurt and scared and distressed clearly indicates that a safeguarding referral must be initiated. This was undertaken by the inspector to the Chichester safeguarding team following this inspection. Manor Barn Nursing Home DS0000024175.V344984.R01.S.doc Version 5.2 Page 19 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): 19,24,25,26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that meets the specific needs of the people who live there. The home is comfortable, and has maintenance personnel to improve the decoration, fixtures and fittings. There is slippage, as some areas of the home require attention. The home is generally clean and tidy, but there are some areas which are not clean and in need of attention. Staff have a poor understanding of infection control procedures and the principles of cross infection which puts residents at risk. EVIDENCE: Manor Barn Nursing Home DS0000024175.V344984.R01.S.doc Version 5.2 Page 20 One resident said how nice the grounds were and what pleasure she got from the wild flowers in the front garden and how nice it was for walking in. “There are a unique breed of squirrels, which give me a lot of delight,” she said, “and in that way it is very nice.” The inspector did undertake a tour of the premises internally with the manager. Mostly the home is free from dust and odours and the paint work is in good order, however some area were dirty and dusty. Carpets are worn in places and there is uneven flooring in the lift, which would constitute a trip hazard. There is haphazard storage of cleaning materials and also care products. It was also noted that clean laundry was laid over the edges of the dirty laundry trolley. Cleaning materials were laid in boxes on the floor. The current laundry has an uncovered wood base floor but it was said that this area is being prepared for a new floor to be laid and this was noted within the provider’s annual assessment. The plans to move the upstairs sluice, as it offers no hand washing facilities, remains outstanding. Further concerns noted while touring the premises were, • • • • • • • • Sanitising liquids were seen stored on open accessible surfaces around the home. A number of commodes had torn covers, which would be considered an infection risk. Nursing height adjustable beds were positioned up against the wall. Therefore residents requiring moving and handling cannot be assisted from both sides. Some residents do not have accessible bedside lights, lockers and mirrors in their room. Not all rooms had a lockable space. Doors and skirting around the home have very badly chipped paint. Some service users’ bathrooms had items on the floor, which hampers adequate cleaning of floor surfaces. There were a number of bars of soap in communal areas/bathroom, which are a known source for the spread of infection. DS0000024175.V344984.R01.S.doc Version 5.2 Page 21 Manor Barn Nursing Home • The downstairs main communal toilet has an unguarded radiator. The main hallways were furnished with hard laminate flooring. Staff commented that this was to ease the cleaning as carpets become very dirty. One resident commented that “the home is so noisy. There is never any peace and quiet. I remember when we never heard a sound but now its noise, noise, noise. I am sure it’s the shoes people wear.” These hard floors increased the noise of the traffic through the corridors as the trolleys and staff were heard going about their business. Throughout the home there were a number of light fittings which were dirty with flies and dust. In the conservatory there is a netting scooped across the ceiling which has collected a large number of dead flies and dust. One resident explained how the lights were dirty on the inside with a collection of flies and dirt, “Even when the optician comes they always say there isn’t enough light.” reported one resident. Senior staff were observed using a gel on her hands and then putting on gloves and then going from each resident to give medications. A care worker was asked why she felt the need to wear gloves when assisting a resident to eat to which she responded “I need to maintain asepsis so I don’t put the germs on my hands on the residents food.” All care staff were seen wearing gloves to serve and handle food and while assisting residents to eat. Two residents doors had A5 size yellow notice on the door stating, “infection procedures in place.” The manager explained that she has still not got to the bottom of why these notices were on the resident’s doors. Manor Barn Nursing Home DS0000024175.V344984.R01.S.doc Version 5.2 Page 22 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, Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Staffing levels are not meeting the needs of the service users, with the health and welfare of people being adversely affected. Staff have not received the training to ensure they are competent to undertake their role. Staff recruitment procedures do not protect residents and puts them at risk. EVIDENCE: When discussing ancillary support the manager explained there was a shortfall in cleaning staff. When trying to locate records a lot of information was in boxes as the manager’s offices had recently been moved. During the inspection the provider and manager found it difficult to locate records, some of which were, • Staff recruitment records DS0000024175.V344984.R01.S.doc Version 5.2 Page 23 Manor Barn Nursing Home • • • • • Training records Policies and procedures Resident assessments Contracts Quality Assurance records The manager explained that there are no administrative staff employed to manage records and deal with the administration. It was discussed in the feedback to the providers how much work needs to be undertaken to get the records and administrative systems sorted. One relative described staff as “a nice group of girls and they do anything you ask them to do. The nurses we have got now are very nice to the patients, the manager seems nice too and she has already gone round and improved things.” Further comments were ”the home is better than it was. A couple of poor staff have now gone.” When staff were asked how the service could improve a comment received said “more staff.” It has already been described how the residents lack company, meaningful activities and stimulation by staff. One relative said, “Some things could be improved, I feel this manager will be really hot on this.” Three staff employed since the last inspection were case tracked and their files and records audited. Staff records were not held in the home and were brought in upon request. One staff member did not have any dates on her employment history or state any gaps in her previous employment. A new staff member of staff did have a POVA check at the home but there was no file at the home with her references or application form. The inspector was told that she is on her first day induction only and that these records were at head office. Staff stated in there surveys that, • • • All the appropriate checks necessary for their employment had been undertaken prior to employment They were supervised and received good training That they provided good care to the residents. Manor Barn Nursing Home DS0000024175.V344984.R01.S.doc Version 5.2 Page 24 The provider’s self assessment stated “we are confident that our recruitment policies and their operation act to safeguard our residents.” Areas of concern raised and evidenced throughout this report identify that staff lack adequate training in, • • • • • Safe-guarding, Complaints management, Person centred planning and core values. Infection control, Risk assessment including nutrition, falls, manual handling and communication and meeting the social needs of individuals. Manor Barn Nursing Home DS0000024175.V344984.R01.S.doc Version 5.2 Page 25 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): 31,32,33,34,35,36,37,38, Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The lack of leadership in the home has had adverse effects on the care of residents. Failures include training, development and supervision for staff. Policies and procedures are not reviewed or kept up to date, and quality assurance monitoring is not regarded or implemented as a core management tool. EVIDENCE: There is now a manager in post who has been employed for two weeks, but for the last four years the home has mostly been without a registered manager. Manor Barn Nursing Home DS0000024175.V344984.R01.S.doc Version 5.2 Page 26 The inspector read five thank you cards sent to the home. These cards and letters thanked staff for the care, support and attention given to their respective relatives. The management team acknowledge that improvements were needed in the home. The manager and provider could not show records to indicate that staff had received one to one sessions and supervision to address their clinical practice learning and development needs regularly as required in their improvement plan. Senior nurses had recently been given a questionnaire to fill in which asked them about their knowledge of the home policies and procedures and the manager explained this was preliminary to starting their supervision but this was for the trained staff only. During a tour of the premises the laundry door was wedged open with a wooden wedge. The upstairs external fire exit/staircase had not been maintained against hazards and had a moss coating in some areas on the steps. The escape route was also overgrown and obstructed by equipment, foliage and garden implements. During the visit the provider and manager were unable to find an up to date fire risk assessment. The complaints book also had a note written in by staff stating during a recent fire to which the fire and rescue service was in attendance they had found there was no fire plan clearly attached to the fire panel and that they struggled to enter the home as the entrance to the home was too narrow for their truck. (The registered individual, Mrs Wyatt, has advised us since the inspection that the entrance to the property was extended subsequent to the incident). The manager was asked to produce the last Environmental Health (EHO) report dated 10/07/07 because the safer food records had not been maintained and a previous requirement had been made. The environmental health officer’s findings and recommendations were to complete and implement safer food better business pack, which the home had already received. It also identified unlabelled food in the fridge (this was also found to be the case during our visit) and recommended all food used within its use by date for safety. Manor Barn Nursing Home DS0000024175.V344984.R01.S.doc Version 5.2 Page 27 The home subcontracts a catering company to run the kitchen and provide all the food for the home. When undertaking an audit with the manager a number of concerns were identified. • • • • • Lack of records pertaining to food storage and handling. Food was being decanted without date labelling. Food spills were on the carpets in the food storage areas and the general standard of cleanliness was poor. The records recommended by the food safety and environmental agencies had not been maintained. Freezer and fridge temperature records but there were gaps in the records for cleaning and other food records. The manager and provider were unable to produce the evidence that any quality assurance surveys had been undertaken. The responsible individual or delegated person does not undertake the Regulation 26 visits regularly. Manor Barn Nursing Home DS0000024175.V344984.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 1 1 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 3 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 3 3 3 X 3 2 2 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 3 N/A 1 1 1 Manor Barn Nursing Home DS0000024175.V344984.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP2 Regulation 5 Requirement The provider must ensure all residents are aware and have received the terms and conditions in respect of the accommodation to be provided including information about the charges. The provider must not provide accommodation to a resident unless the needs of the resident have been assessed and it has been confirmed in writing that the care home is suitable for the purpose of meeting the residents needs. The registered person must ensure the care home is conducted to make proper provision for the health and welfare of service users and to make proper provision for appropriate treatment and in a way which respects their privacy and dignity. Care plans must provide sufficient guidance for staff and information for people using the DS0000024175.V344984.R01.S.doc Timescale for action 19/11/07 2 OP3 14 19/11/07 3 OP4 12 and 4 19/11/07 4. OP7 15 19/11/07 Manor Barn Nursing Home Version 5.2 Page 30 service on how all their assessed needs, including social needs, will be met. This is a repeat requirement from April 2007 5 OP12 16 The provider needs to ensure that people receiving the service are being supported to lead an active lifestyle, have their interests encouraged and activities provided which they enjoy. This is a repeat requirement from April 2007. 6 7 OP8 OP16 16 22 and 17 Residents must be provided with adequate food and drink. All complaints must be investigated and handled in line with the home’s procedure and recorded in a manner, which complies with data protection and confidentiality. All issues raised which constitute possible abuse must be dealt with in line with local safe guarding procedures and the residents’ safety maintained at all times. The home must meet the needs of the residents and must be, suitably furnished and safe, especially the sluicing areas in the home. Height adjustable beds must be positioned so as to facilitate safe moving and handling and Bathrooms must be risk assessed and heated if cold. This is a partially repeated requirement from April 2007 19/11/07 19/11/07 19/11/07 8 OP18 13 19/11/07 9 OP19 23 and 16 19/11/07 Manor Barn Nursing Home DS0000024175.V344984.R01.S.doc Version 5.2 Page 31 10 OP27 18 The registered person shall, 19/11/07 having regard to the size of the care home and the number and needs of service users ensure that at all times suitably qualified and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users This is a repeat requirement from April 2007 Staff must only be confirmed in post only following completion of satisfactory checks. 11 OP29 Schedule 2 8 and 9 19/11/07 12 OP37 The registered person must 19/11/07 appoint a skilled and experienced manager. This is a repeat requirement from April 2007 and has been partially met. 13 14 OP36 OP37 18 17, Schedule 3 and 4 Staff must be supervised. 19/11/07 The registered person must 19/11/07 establish and maintain a system for reviewing and improving the quality of care and providing policies and procedures, which are updated and based on best practice guidance and those records must be • Available for inspection. • Stored and handled in lines with Data protection. • Kept under review. The Provider must ensure all health and safety checks and assessments are undertaken and the associated risks are recorded and managed, including food hygiene, food handling and the management of this. DS0000024175.V344984.R01.S.doc 15 OP38 12 and 13 and 23 19/11/07 Manor Barn Nursing Home Version 5.2 Page 32 This is a repeat requirement from April 2007 And in addition • • • • • • COSHH Moving and handling Fire (This was raised in May 2004) Incidents and accidents Complaints Health and safety, noise and infection control and smoking. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Manor Barn Nursing Home DS0000024175.V344984.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Manor Barn Nursing Home DS0000024175.V344984.R01.S.doc Version 5.2 Page 34 - 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. 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