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Inspection on 25/10/05 for Manor Barn Nursing Home

Also see our care home review for Manor Barn Nursing Home for more information

This inspection was carried out on 25th 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 but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The ongoing environmental improvements to the home have created a homely and relaxed atmosphere, whereby residents have begun to take ownership of their surroundings. A number of changes to the staff have lead to residents being supported by a caring and committed team of staff. The team now provides both long standing knowledge and fresh input. There were 25 residents living at the home at the time of inspection. Residents and relatives spoke highly about the services offered at the home and described the staff as friendly and caring. One relative said staff are always so polite. Another relative stated that she was so relieved when her relative was placed at Manor Barn and she could not fault any of the care. Comments from residents included that staff were `fantastic ` `so caring` `always there for you` `I could not want for better care` Relatives confirmed that they were kept fully informed about healthcare issues and invited to attend meetings. Service users are supported with their personal routines and this support was seen to be offered and carried out with dignity and respect.

What has improved since the last inspection?

The Statement of Purpose and the Service Users Guide is now available to all residents. The home now has a registered manager who is starting to improve the quality of care. The staff files at the home are now sufficient to make a judgment about the way people are being employed and if they can meet the residents care needs safely. A review of medication handling was undertaken. Poor stock control of medicines has now been reviewed and improved.

What the care home could do better:

The system of goal setting and monitoring needs to continue, so that residents are continually progressing towards achieving maximum independence and fulfilment from their lives. In order for this to happen, the home needs to develop a more flexible approach to routines. Some policies and procedures need to have review dates and be signed. This is to reflect current practices and to ensure that the home operates using the policies and procedures to safe guard the residents. Meals are varied, balanced and well presented offering both choice and variety. However poor practice was observed regarding the distribution of the food, leaving it to go cold before vulnerable residents could be assisted to eat it. The home has started the process of supervision, however this needs to be more proactive to assist staff to improve the quality of care and provide safety for the residents.

CARE HOMES FOR OLDER PEOPLE Manor Barn Nursing Home Appledram Lane South Fishbourne Chichester, West Sussex PO20 7PE Lead Inspector Judith Farrell Announced Friday, 25 October 2005, 08.00am, V247665 th 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 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 H60-H11 S24175 Manor Barn V247665 211005 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Manor Barn Nursing Home Address Appledram Lane South, Fishbourne, Chichester, West Sussex, PO20 7PE Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01243 781490 01243 813713 manorbarn@care-homes.org Rhyme Care Ltd Post Vacant CRH 30 Category(ies) of OP-30 registration, with number of places Manor Barn Nursing Home H60-H11 S24175 Manor Barn V247665 211005 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 03/05/05 Brief Description of the Service: Manor barn is a care establishment that provides nursing care, and is registered to accommodate up to 30 residents in the category of old age, not falling within any other category. Manor Barn was originally conctructed in the sixteenth century, since then it has been extended and converted. The home is situated near the village of Fishbourn. Manor Barn Nursing Home H60-H11 S24175 Manor Barn V247665 211005 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over six hours on 21st October 2005. This is the second statutory inspection of this year. The purpose of this inspection was to assess compliance with the requirements of the last inspection and to generally monitor care practices. This report must be seen in light of the previous inspection report, which was carried out in May 2005. Two inspectors were involved in the inspection. Mrs Farrell who was the lead Inspector and Mrs Peel was the second inspector. A tour of the premises took place, rotas and care records were inspected. Thirteen of the residents, three visiting relatives, one visiting professional four staff and the Manager were spoken with. The residents have different levels of communication abilities and therefore it was difficult to ascertain all their views on how their needs are met. Part of the workforce is from oversees. There has been one additional unannounced visit made since the last inspection. Letters sent to the registered person following this visit can be obtained from the CSCI office on request. What the service does well: The ongoing environmental improvements to the home have created a homely and relaxed atmosphere, whereby residents have begun to take ownership of their surroundings. A number of changes to the staff have lead to residents being supported by a caring and committed team of staff. The team now provides both long standing knowledge and fresh input. There were 25 residents living at the home at the time of inspection. Residents and relatives spoke highly about the services offered at the home and described the staff as friendly and caring. One relative said staff are always so polite. Another relative stated that she was so relieved when her relative was placed at Manor Barn and she could not fault any of the care. Comments from residents included that staff were ‘fantastic ‘ ‘so caring’ ‘always there for you’ ‘I could not want for better care’ Relatives confirmed that they were kept fully informed about healthcare issues and invited to attend meetings. Service users are supported with their personal routines and this support was seen to be offered and carried out with dignity and respect. Manor Barn Nursing Home H60-H11 S24175 Manor Barn V247665 211005 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Manor Barn Nursing Home H60-H11 S24175 Manor Barn V247665 211005 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Manor Barn Nursing Home H60-H11 S24175 Manor Barn V247665 211005 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4,5,6 The homes Statement of Purpose and Service Users Guide is adequate and provides sufficient information so that prospective service users are clear about the services the home provides to meet their needs. Arrangements are in place to ensure that the health care needs of residents are identified and recorded. Staff must have sufficient knowledge and abilities to meet the needs of the residents admitted otherwise this could potentially place the resident at risk. EVIDENCE: The homes Statement of Purpose and the Service User Guide are now available to all residents. The manager was advised that if services change particularly if it has been a long standing arrangements such as the residents were always accompanied to hospital appointments by staff and that this is no longer to happen when it should be stated in the Service Users Guide. Four pre admission assessment documents were looked at and they clearly showed that the admission procedure was thorough and well recorded. This procedure ensures that new residents needs are properly assessed and planned for. Six residents spoken to were able to provide significant information about their care needs, these had all been recorded. The staff Manor Barn Nursing Home H60-H11 S24175 Manor Barn V247665 211005 Stage 4.doc Version 1.40 Page 9 members on duty were aware of the assessments and were able to fully undertake the care needs. In discussion with the manager and documental evidence no person is admitted to the home without a full assessment. In the event of an emergency the manager still goes to see and produces a written assessment before a potential resident is admitted. There was evidence to demonstrate that residents are offered a trial period at the home, before a placement becomes permanent. This should be followed up by the home informing residents in writing that they are able to meet their needs at the end of the trial period. This home does not provide intermediate care. Manor Barn Nursing Home H60-H11 S24175 Manor Barn V247665 211005 Stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10,11 Residents are involved in developing the plans in place to support them. Progress has been made on improving arrangements to ensure that health care needs of the residents are identified and met. Medication is generally managed well. EVIDENCE: The care needs of residents are set out in their individual files. The inspector examined five files at random including two new residents. This sample of care plans showed a significant improvement has been made in this area. Residents said they were aware that information is recorded about them and that staff members refer to it in order to meet their varying needs. Individual files contained all relevant information, including risk assessments for moving and handling and special dietary needs. From discussion with the residents they gave a clear and concise pen picture of the person. The review notes for one resident included positive feedback from the relevant Social Worker, which highlighted the progress that had been made in respect of her client’s care plan. It was noted that staff did not always follow the risk assessments in practice. Staff need to be made aware of the risks they pose to residents and themselves if they do not follow the advice in the care plans. It Manor Barn Nursing Home H60-H11 S24175 Manor Barn V247665 211005 Stage 4.doc Version 1.40 Page 11 was possible to audit how advice from a range of healthcare professionals had been incorporated into care notes. The inspector observed staff members entering resident’s bedrooms. They knocked the door and waited for permission to enter. Staff members said that there was strict guidance about respecting resident’s privacy. However it was noted that not all bedroom doors have locks on them. This could lead to resident’s dignity and privacy not being respected. The nurse in charge advised that there is now a very good working relationship with the residents GPs, the district nurse service and specialist nurses. The resident’s can choose which GP they wish to register with, in the locality. Staff had access to new policies and procedures and were getting used to the new recording for ordering and receiving medicines. Medicine administration records were clear. There was a written assessment for a resident who retains responsibility for some medicines and a locked drawer was available. Residents spoken with discussed how they are assisted to attend all hospital outpatients, dentist, eye, and hearing appointments. One relative was concerned that the policy of accompanying residents to appointments by staff had now stopped. The manager responded with knowledge and sensitivity explaining the reasons why and how residents could be supported by the local ambulance and hospital transport system. Though not all staff interviewed had attended training on how to look after people who are dying, they did however show considerable compassion and understanding of the dying process. This includes how staff can support the resident’s wishes and their relatives in the event of the resident’s death. Manor Barn Nursing Home H60-H11 S24175 Manor Barn V247665 211005 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,15 Routines in the home could be more flexible. Residents said that their social needs were met as far as possible taking into account their increased physical frailty. Opportunities are offered for residents to be involved in activities and for contact with family, friends and the local community Residents are offered a choice of food and refreshment throughout the day. However to prevent residents from going without food for over 12 hours they do need to be offered a snack in the evening. EVIDENCE: From observations and discussion it is evident that the Manor Barn is substantially routine driven as a home, particularly in relation to meal times and the provision of personal care. There is little flexibility about where residents can take their meals and rotas for getting up, bathing and room cleaning are in place. A programme of activities is provided and staff are encouraged to share their skills, interests and hobbies with residents through this programme. Activities mentioned and enjoyed by residents include music and movement, outings and the quiz. Residents also mentioned that they go out to church. Staff spoke enthusiastically about wanting to spend their time with residents to provide meaningful activities inside and outside of the home. Manor Barn Nursing Home H60-H11 S24175 Manor Barn V247665 211005 Stage 4.doc Version 1.40 Page 13 Residents said that the food is very good and there is plenty of it, comments included, “..food is very good.. home made..very good chef” “the food is very good, 2-3 choices” “the food is very good, plenty of choice and lots of it”. A drink is served to residents in the evening. Feedback indicated that biscuits or a snack are not always offered with this drink, when an evening snack is not provided, the time without food exceeds twelve hours. The inspectors observed staff assisting residents to eat. Staff take food to the residents, this can be served in the lounge, small dinning area, conservatory and the residents own rooms. Once the food is all served. Staff then start to help those who need help to consume their meal. This deployment of staff and food leads to food being left in front of the resident (the inspectors observed) for up to 25 minutes before the resident was assisted to eat. Though the food was covered the inspectors confirmed that it was cold when eaten. Manor Barn Nursing Home H60-H11 S24175 Manor Barn V247665 211005 Stage 4.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 Complaints are being forwarded to the management from care staff. There has been progress on training staff on the correct way to respond to any suspicion or allegation of abuse and this will safeguard the residents. The recruitment process does protect residents from abuse. EVIDENCE: The complaints book was viewed and this indicated that complaints are recorded, alongside outcomes and actions taken to resolve the complaint. It was reported that most staff have had training on how to protect residents. The staff interviewed were knowledgeable about the vulnerability of residents and what constuites an abuse. A copy of the West Sussex Multi-Agency Policy and Procedure for Protecting Vulnerable Adults was seen at the home. Trained nursing staff spoken with were less confident in describing the importance of the POVA (Protection of Vulnerable Adults) and what they would do if an incident was reported to them. The homes own policy at present does not meet the guidelines. The Inspector advised that a copy of the Department of Health guidance on this topic should be acquired and it is expected that this will be incorporated into the home’s policies and discussed with staff. Manor Barn Nursing Home H60-H11 S24175 Manor Barn V247665 211005 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,25,26 Some improvements to the décor have been made and this provides comfortable surroundings for the people living at the home. However the outstanding matters may constitute a potential risk to the safety for the residents. EVIDENCE: The lounge has now been made more homely by moving the furniture. The environment is subject to ongoing improvement, which is needed to maintain and raise the standard of accommodation. Specialist equipment has been obtained to meet residents needs. Bedrooms are furnished with some items of residents own belongings and meet their needs. The home was clean and tidy and a new resident commented on how often her room was being cleaned. She was pleased with her room, which has views of the garden. A resident also commented that they liked to see the wild life from their window and to have they own plants outside where they could see them. Staff interviewed were clear on the guidelines for the control of infection. Manor Barn Nursing Home H60-H11 S24175 Manor Barn V247665 211005 Stage 4.doc Version 1.40 Page 16 Though it was noted that two member of staff were not following these practice guidelines. Manor Barn Nursing Home H60-H11 S24175 Manor Barn V247665 211005 Stage 4.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 Staffing levels and recruitment procedures have been improved to ensure the protection of residents. Good progress is being made with National Vocation Qualifications. EVIDENCE: On the day of inspection, there were sufficient staff to support the needs of residents as detailed in the care plans. Staff spoken with confirmed that staffing levels were adequate at this time. The residents who spoke with the Inspector commented how nice staff were and how they felt relaxed and happy to ask for help. The Inspectors observed lots of positive interaction between residents and staff. Staff training is ongoing, with two staff having completed and three staff working towards National Vocational Qualifications. New staff undertake an induction in line with the National Training Organisation and it is required that the foundation standards are also completed. Manor Barn Nursing Home H60-H11 S24175 Manor Barn V247665 211005 Stage 4.doc Version 1.40 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,36,38 Residents 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 her responsibilities fully. Regular supervision should be provided to care staff to improve the quality of care. EVIDENCE: The registered manager is very experienced having worked in nursing and residential homes for many years. Relatives said the home is run efficiently for the last six months and they said this they thought was down to strong leadership. Staff made positive comments about the management and gave good examples of best practice. Staff confirmed that regular meeting, handovers and one-to ones were held where the manager informed them of any changes in legislation. Eight staff files randomly selected gave indications of induction, supervision, training and development staff had received. One trained nurse interviewed talked about induction as being three full days with another trained nurse and Manor Barn Nursing Home H60-H11 S24175 Manor Barn V247665 211005 Stage 4.doc Version 1.40 Page 19 then more supernumerary days to become confident and competent. Most staff interviewed reported to the Inspectors that they had had some supervision and their entire mandatory training. The files indicated that supervision had been started but there was insufficient evidence to show that it was occurring six times a year. The registered manager must ensure that supervision is done every other month to meet the National Minimum Standards. This standard will be assessed at the next inspection. The inspectors interviewed the manual handling trainer and were impressed by the way training was carried out, by working with the care staff. Policies and procedures need to be up-dated to include good practice guidelines. Manor Barn Nursing Home H60-H11 S24175 Manor Barn V247665 211005 Stage 4.doc Version 1.40 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 x x x x x 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 3 x x x 1 x 3 Manor Barn Nursing Home H60-H11 S24175 Manor Barn V247665 211005 Stage 4.doc Version 1.40 Page 21 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 10 &24 Regulation 13 Requirement The Registered Provider must provide locks on all residents bedroom doors, which can easily be opened by residents and which staff can override in an emergency (This requirement is outstanding from the last 5inspections. The last time scale was 01/07/05 That all care staff must receive formal supervision at least six times a year ( this requirement is outstanding from the last inspection) The policies and practices of the home ensure that service users are safeguarded from abuse Timescale for action 01/12/05 2. 3. 36 ) 18(a) 01/12/05 4. 18 13(6) 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. Refer to Standard Good Practice Recommendations Manor Barn Nursing Home H60-H11 S24175 Manor Barn V247665 211005 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Ridgeworth House Liverpool Gardens Worthing, West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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