Inspection on 03/03/08 for Manor Barn Nursing Home

This inspection was carried out on 3rd March 2008.

CSCI found this care home to be providing an Good service.

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 17/09/07

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 Ed McLeod Unannounced Inspection 3rd March 2008 08:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Manor Barn Nursing Home DS0000024175.V359584.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.V359584.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 Ltd Mrs Susan Jane Bush Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability (0), Physical disability of places over 65 years of age (0) Manor Barn Nursing Home DS0000024175.V359584.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with Nursing (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 2. Physical Disability (PD) The maximum number of service users to be accommodated is 30. Date of last inspection 17th September 2007 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 £550 and £750 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. The registered manager is Mrs Susan Bush. Manor Barn Nursing Home DS0000024175.V359584.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The inspection visit was carried out by one inspector and was arranged to follow up requirements made at the previous key inspection and random visit, and to assist us in assessing the home’s compliance with the key standards of the national minimum standards for care homes for older people. Planning for the visit took into account information received on the service since our key inspection, including the improvement plan completed by the home manager and the random inspection visit completed on the 3rd December 2007. On the day of the visit we were on the premises for seven hours, and spoke with five people living in the home and two visiting relatives. We also spoke with the manager Mrs Bush, the responsible individual Mrs Wyatt, the catering manager, and three care and nursing members of staff. We sampled four sets of admission assessments and the individual plans of care for five people living in the home. Other records sampled included recruitment and training records for four members of staff, the record of complaints, and records relating to health and safety issues in the home. We visited the main areas of the care home and six bedrooms. We observed a number of interactions between people living in the home and staff, and observed the arrangements for lunch. What the service does well: Manor Barn Nursing Home DS0000024175.V359584.R01.S.doc Version 5.2 Page 6 People stay in a well maintained home that is homely, clean, pleasant and hygienic. Staff respect people’s wishes and assist them to maintain their independence as far as possible. Personal care which respects people’s dignity and privacy is provided. The home is assessing people’s needs before a placement is offered. The home has a plan of care that the person, or someone close to them, has been involved in making. What has improved since the last inspection? The progress in care provision noted at the random inspection on 3/12/07 has continued. Statutory notice requirements in relation to care planning, protecting people in the home, and staff supervision were found to have been met at this visit. The staff team is being managed better, and staff are now more aware of their responsibilities and team work has improved. There has been an increase in staffing numbers. There has been an improvement in the information and guidance provided in individual care plans, which has included a summary of the person’s care plan which is being introduced to ensure people and their relatives, and the staff team, know how the care is going to be provided. Improvements to the home environment have included some redecoration of bedrooms, a new sluice, and soap dispensers have now been provided in communal bathrooms. Manor Barn Nursing Home DS0000024175.V359584.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Manor Barn Nursing Home DS0000024175.V359584.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.V359584.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are confident the home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. The service does not offer intermediate care at present. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care Manor Barn Nursing Home DS0000024175.V359584.R01.S.doc Version 5.2 Page 10 home that includes how much they will pay and what the home provides for the money. EVIDENCE: At our random inspection visit on the 3rd December 2007 we sampled copies of the contract/terms and conditions of residence held on the individual’s care records, which now include information on the fee to be paid and by whom and the room or rooms to be occupied. We found these were being held together with the service user guide in each person’s bedroom which we visited. The requirement made 17.9.07 concerning this was found to have been met at that visit. At this visit we looked at the contract/terms and conditions for three people accommodated, and found that where appropriate it was being advised to them who was paying what part of the fee and rooms to be occupied. During our random inspection on 3rd December 2007 we found that proper assessments on people admitted had been carried out. We also found that copies of letters from the manager to the company confirmed that the assessment had been completed and the home could meet the person’s needs. The manager said that this letter was also copied to the relative or representative of the person to be accommodated. The requirement made concerning this was found to have been met at that visit. During this visit we looked at four sets of pre-admission assessments and found that appropriate needs and risk assessments are being carried out before a person is admitted to the home. Manor Barn Nursing Home DS0000024175.V359584.R01.S.doc Version 5.2 Page 11 The manager, Mrs Bush, advised us that intermediate care is not being provided by the home as facilities to provide the appropriate rehabilitation programme were not at present provided. Manor Barn Nursing Home DS0000024175.V359584.R01.S.doc Version 5.2 Page 12 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, people manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. EVIDENCE: Manor Barn Nursing Home DS0000024175.V359584.R01.S.doc Version 5.2 Page 13 During our random visit on 3rd December 2007 we found some adjustments had been made to care plans, but that visitors we talked to said they were not aware of the content of their relative’s care plan, and that copies of the care plan were not always being given to the person accommodated and their representative or relative. At that visit, we said that the care plan lacked a summary of needs and action to be taken which could be easily assimilated by the resident or their relatives, and we noted that the recording of reviews of the care plan continue to be very brief, and may not be fully indicating changes made to the care provided. The provider’s improvement plan dated December 2007 advises us that people living in the home and their relatives are invited to review the care plan with nursing and care staff at Manor Barn. At this visit we sampled five sets of care plans. Records seen indicated that more information is now being recorded in care plans which will support staff in providing the care people need. The home has been introducing a care plan summary copies of which are to be provided to people receiving the care and their relatives, and copy of which will be available in bedrooms for people including staff to refer to. We looked at three sets of the care plan summaries which have been completed so far, and we would anticipate that these will contribute to the consistency of the care provided. We also looked at the record of care reviews carried out by the local authority on three people accommodated, and these indicated that the local authority believes the care and health needs of those people are being met. We discussed with the manager (Mrs Bush) and the responsible individual (Mrs Wyatt) about how the recording of care plans could better support people’s social needs being met, and there is a requirement concerning the meeting of social needs in the Daily Life and Social Activities section of this report. Manor Barn Nursing Home DS0000024175.V359584.R01.S.doc Version 5.2 Page 14 At our previous key inspection visit we made a requirement that the provider ensure that fluid charts were completed and reviewed. During our random visit on 3rd December 2007 we found that regular recordings were taking place for the two sets of food and fluid charts which the manager had advised us of. The requirement concerning this was assessed as met at that visit. At this visit we discussed with care staff about how continence care is being provided, and how staff undertake the role of key worker which further supports people’s care needs being met. These discussions indicated that good practice is in place in providing care needs. People receiving a service and their relatives who we talked to during this visit also indicated that there had been a significant improvement in how managers and staff were meeting the care and health needs of people. Staff we talked to provided examples of how they are providing personal support in a way that helps people maintain their dignity. We looked at some of the arrangements in place for administering medication in the home, and discussed these with a senior member of nursing staff. We found that where a person had been assessed as able to administer some of their own medicines, there was a risk assessment in place to support this. We found that there were appropriate arrangements in place for the storage of medicines, and for the recording and administration of medicines (including the disposal of medicines and the administration of controlled medication). The manager, Mrs Bush, advised us that none of the people accommodated at present are receiving palliative care, so this standard was not assessed during this visit. Manor Barn Nursing Home DS0000024175.V359584.R01.S.doc Version 5.2 Page 15 We discussed with Mrs Bush that the local hospice had been offering to nursing homes the opportunity for staff to observe hospice practice. Mrs Bush advised us that this would be considered at an appropriate time for nursing staff in the home. Manor Barn Nursing Home DS0000024175.V359584.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability and sexual orientation. They are part of their local community. The care home has been obtaining people’s views on how it can help them to follow personal interests and activities, but has not put in place arrangements to meet those needs. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious meals and snacks at a time and place to suit them. Manor Barn Nursing Home DS0000024175.V359584.R01.S.doc Version 5.2 Page 17 EVIDENCE: During our random visit on 3/12/07 we were advised that a once per week activity involving music, a quiz and reminiscence, was now taking place twice per week, and that activities arranged around Christmas were a party, carol singing, and a concert. At the random visit the manager told us that people living in the home had been asked to fill out a questionnaire on what activities people would like to be provided, and that most people had responded in favour of the need for individual activities rather than communal activities. The manager told us that such activities had not yet been put in place or included in the individual plan of care. Our assessment on 3/12/07 was that while there has been progress in identifying people’s social needs, the key inspection requirement concerning meeting people’s social needs was found not to have been met. The home’s December 2007 improvement plan advised us that care plans would be recording how the individual’s social needs would be met, that reminiscence sessions would be increased to twice weekly, staff numbers would be increased to offer more social interaction, and the addition of further activities would be explored. The care plans and care plan summaries which we looked at did not include what individual activities would be provided for the person. The manager advised us that generally the surveys they had received indicated that people would rather do individual than communal activities (with the exception of reminiscence and quizzes). The manager said that when some people had been approached about doing something like coming on a shopping trip or going for a walk, they had not shown an interest in doing that at that time. Manor Barn Nursing Home DS0000024175.V359584.R01.S.doc Version 5.2 Page 18 We looked at the report and summary the home had completed on people’s wishes and interests, and noted that a number of people had expressed an interest in things such as being assisted to make telephone calls, shopping trips, quizzes and having someone read to them. Our discussions with the manager indicated that the information given by the person and guidance to staff on how those needs should be met had not been developed in their care plan. We talked to people living in the home, and asked if staff spent time chatting with them. One person answered that “staff haven’t the time to chat with me”, and another said “staff don’t have the time to sit and talk, they’re always busy”. This indicates that people’s social needs are not being addressed, and the statutory notice requirement concerning this was assessed as not met. The provider also needs to consider if staffing levels and arrangements are sufficient to ensure that social needs, including the time to sit down and chat, are being met. Our interviews with people living in the home indicated that their relatives are welcomed when they visit, and people are able to keep in touch with family, friends and representatives. The provider needs to note, however, that several people in the survey forms they completed for the home said they would like assistance with making telephone calls. Staff we talked to gave examples of how people are being supported to keep up their life skills and to do things with support rather than assistance when this is possible. People we talked to also gave examples of the choices people are offered in the provision of their care. Manor Barn Nursing Home DS0000024175.V359584.R01.S.doc Version 5.2 Page 19 One person we talked to said she had discussed getting up earlier in the morning with managers, and this had been arranged for her. A member of care staff we talked to told us that staff respect people’s wishes in when they like to get up, when they’d like to wash and be assisted with dressing, and in choosing the clothes they would like to wear. Mrs Bush advised us that more time is being spent supporting people to retain or recover their mobility, and examples were given of this. Equipment to assist people in maintaining their ability to eat meals without assistance has also been purchased. The manager advised us in the improvement plan dated December 2007 that regular meetings and review of menus were taking place with the catering manager, and there were now daily discussions between people living in the home and caterings staff. At this inspection visit Mrs Bush said that as more people in the home are being supported to eat in the dining room, meals have become more social occasions. We observed a lunch sitting and found that people who needed support with eating or cutting their food were receiving this. The lunch was relaxed and unhurried. We visited the kitchen and found that arrangements were in place to meet specialist diets such as diabetic, vegetarian and soft food diets. People living in the home gave us different views on whether the meals were to their liking or not, but overall the opinion seemed to be that people thought the meals had improved. We talked to the catering manager for the home, who acknowledged that different people had different food preferences but that they were “catering for the majority” in what they provided. Manor Barn Nursing Home DS0000024175.V359584.R01.S.doc Version 5.2 Page 20 The provider may like to consider how the food preferences of people could be more often be met – for example with regard to how well cooked different people like their vegetables to be, and how everyone’s preferences in this regard could be met. We found that people were being offered a choice of meals. Manor Barn Nursing Home DS0000024175.V359584.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. If people have concerns about their care, they or other people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. EVIDENCE: During our random visit on 3rd December 2007 we sampled three complaints records completed since the previous inspection. We found that the complaints had been appropriately investigated and acted upon within agreed timescales, and that complainants had been advised of the outcome. During that visit the previous key inspection requirement concerning this was found to have been met. Manor Barn Nursing Home DS0000024175.V359584.R01.S.doc Version 5.2 Page 22 The provider’s December 2007 improvement plan advises us that complaints and incidents records are now in place, and that the complaints policy is published in the home’s Statement of Purpose and précised on the Information Board in Reception Hall. We looked at the complaints file during this visit. We noted that no complaints had been recorded. We looked at a record made concerning an issue raised by a visitor concerning medication. This had been properly recorded and responded to within the home’s complaints timescales. We advised the manager that it would be appropriate to record this matter as a complaint. Monthly reports carried out by the provider which we looked at during this visit indicated that the complaints file was being regularly audited. A person living in the home we talked to told us that staff were kind, and that she would “talk to Sue the manager” if she had a concern or a complaint. At our key inspection visit on 17/9/07 the provider was required to ensure that all allegations of abuse are dealt with in line with local safeguarding procedures and records maintained at all times, by 30th November 2007. At our random visit on the 3rd December 2007 we found that more staff had undertaken training in the safeguarding of vulnerable adults, and that the manager had arranged to attend a study day on West Sussex County Council’s safeguarding policies. At this visit the manager Mrs Bush advised us that she had attended a briefing on local safeguarding procedures, and had provided feedback to staff on this. The home now has a copy of the updated local safeguarding procedures. Staff training in safeguarding continues to be provided for staff. Manor Barn Nursing Home DS0000024175.V359584.R01.S.doc Version 5.2 Page 23 The manager also advised us that training on protecting people from harm is also included in the induction programme for new staff. Subsequent to the random inspection visit a safeguarding matter was referred to the local authority. At this visit, the manager and the responsible individual advised us that the home had been cooperating with the investigating officers on this matter. We were advised that an advocate had been arranged for one person living in the home, which can assist the person in making their wishes and concerns known. Manor Barn Nursing Home DS0000024175.V359584.R01.S.doc Version 5.2 Page 24 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People stay in a well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. Their rooms feels like their own, it is comfortable and they feel safe when they use it. EVIDENCE: Manor Barn Nursing Home DS0000024175.V359584.R01.S.doc Version 5.2 Page 25 At the key inspection on 17th September 2007 requirements were made that the provider ensure that flooring through out the home is safe and secure, provide hand washing facilities in the upstairs sluice, ensure that bars of soap are not provided in communal areas, to make safe a radiator in the downstairs communal toilet. It was also required that the provider ensure that bathroom floors are free from obstruction to thorough cleaning and to ensure that the positioning of beds is such that for those residents who need support this can be provided from both sides. During our visit on the 3rd December 2007 the manager told us that liquid soap dispensers had been ordered, and in the meantime staff were being reminded to ensure bars of soap are not used communally. We also found that the flooring in the lift had been replaced and made safe. Bathrooms visited were found to be tidy, and the manager advised that drawer systems were being introduced to further ensure items are not left on bathroom floors. We looked at the positioning of beds where these were placed with one side against the wall, and found that these were hospital beds that could be moved on their wheels with little effort into a position to facilitate easier lifting if needed. It was seen that the space is available within the rooms for this to take place. We found that the radiator in the downstairs toilet has now been removed, and that hand washing facilities are now being provided in the upstairs sluice. The requirements covering these matters were found to have been met at that visit. At this visit we found that improvements to the home environment have included some redecoration of bedrooms, a new sluice, and soap dispensers have now been provided in communal bathrooms. We were told by Mrs Bush and Mrs Wyatt at this visit that improvements planned include redecoration in the sitting room, a larger screen television for the sitting room, new crockery and Manor Barn Nursing Home DS0000024175.V359584.R01.S.doc Version 5.2 Page 26 linen. Bedrooms visited had been individualised by or for the person living there and generally the standard of decoration and furnishing is good. All areas of the home visited were found to be clean and hygienic. Manor Barn Nursing Home DS0000024175.V359584.R01.S.doc Version 5.2 Page 27 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People have safe and appropriate support as there are enough competent staff on duty at all times. The home needs to ensure that suitable checks and information have been obtained on temporary staff working in the home to make sure that they are safe and suitable to care for people in the home. People’s needs are met and they are cared for by permanent staff who get the relevant training and support from their managers. The home needs to ensure that temporary (agency) staff employed in the home have received the relevant training. EVIDENCE: It was required at the key inspection on 17/9/07 that the registered person shall, 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 Manor Barn Nursing Home DS0000024175.V359584.R01.S.doc Version 5.2 Page 28 such numbers as are appropriate for the health and welfare of service users. At this visit, Mrs Bush and Mrs Wyatt advised us that staff numbers had been reviewed and that registered nurses on duty had been increased from one to two on morning and afternoon/evening shifts, and that care staff had been increased from four to five for morning and afternoon/evening shifts. The view of Mrs Bush was that staff were now more aware of their responsibilities, which were now better defined, and that better team-working was now in place. When we spoke with staff during this visit, they indicated that this was so, and that people now had more things they were taking individual responsibility for. We observed a staff handover meeting, and discussions taking place indicated that the staff team is working to maintain continuity of care for the people living in the home. The requirement relating to staffing numbers was assessed as met at this visit. It was required at the key inspection on 17/9/07 that staff must only be confirmed in post only following completion of satisfactory checks. At this visit we looked at four sets of recruitment records for staff. We found that satisfactory checks were being obtained for staff and the above requirement was found to have been met. At this visit we found that the home was not always obtaining information on checks, references and training for staff working temporarily in the home. We noted that in February 2008 three care shifts had been worked by temporary (agency) staff for whom the required information had not been obtained by the home. Manor Barn Nursing Home DS0000024175.V359584.R01.S.doc Version 5.2 Page 29 It is therefore possible that temporary staff working shifts have not been cleared as safe to work with people in the home (for example the criminal records bureau (CRB) check) or have the required skills and training to work with people in the home (for example training in hoisting or lifting and assisting people with transferring). A requirement has been made concerning obtaining required records for staff employed at the home, including temporary staff. Mrs Bush advised us that two staff were due to commence national vocational qualification (NVQ) in care training. Mrs Wyatt advised us that new staff had been appointed who were NVQ qualified. A registered nurse we interviewed advised us she had just completed NVQ training at level 4, and that the training had increased her skills in managing staff and meeting the needs of people being cared for. Training records we looked at indicated that there has been recent training in fire awareness, infection control, safeguarding adults, moving and handling. We spoke with the manager of the catering service which provides meals in the home. He advised us that all kitchen staff working in the home had received training in food hygiene and had undergone the required checks. Manor Barn Nursing Home DS0000024175.V359584.R01.S.doc Version 5.2 Page 30 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. EVIDENCE: Manor Barn Nursing Home DS0000024175.V359584.R01.S.doc Version 5.2 Page 31 A requirement was made at the key inspection on 17/9/07 that the registered person must appoint a skilled and experienced manager. Mrs Bush was appointed as manager in October 2007, and has been registered with CSCI as manager for the service. It was noted at the random inspection on 3/12/07 that six of the ten statutory notice requirements made in September 2007 had been met. At this inspection it is noted that further previous requirements are now assessed as met, including three of the four remaining statutory notice requirements. This report also notes that more consistent care is now being provided for people living in the home. This view is supported by people living in the home and their relatives. One person living in the home said “things have improved, including the cooking”. A relative we spoke to on the day of our visit said “things have greatly improved” and that the manager is dedicated and “takes an interest in all the people living here”. A repeat requirement (from April 2007) was made at the key inspection on 17/9/07 that the registered person must 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. The home’s December 2007 improvement plan tells us that meetings with staff, residents and relatives will be conducted to seek views and feedback, and that audits and satisfaction surveys will be carried out. The plan advises that feedback will be reviewed and action taken. Our discussions with Mrs Bush and Mrs Wyatt indicated that the home has not yet fully sought the views of relevant people and Manor Barn Nursing Home DS0000024175.V359584.R01.S.doc Version 5.2 Page 32 developed an action plan accordingly at the present time, and the requirement concerning this was therefore assessed as not met. At our key inspection visit on 17/9/07 the provider was required to ensure that staff were appropriately supervised by 30th November 2007. During our visit on 3rd December 2007 we found that supervision been started for four members of staff, and that all staff had completed a self-assessment which would contribute to their annual appraisal. We sampled the four sets of supervision records completed, and found that these covered the required topics for sitdown supervision. At that visit the manager said that the plan was for a newly recruited registered nurse who has undertaken a clinical supervision course to provide supervision for all staff. The manager said there was not a timetable in place for when all staff would be receiving supervision. At the random inspection visit on 3/12/07 we therefore found that while the provider has begun to put a system for staff supervision in place, it was not fully in place and therefore this requirement was assessed as not met. The home’s December 2007 improvement plan tells us that recorded supervision by nominated supervisors is in progress, and that the manager is to identify and recommend relevant training for nominated supervisors. At this visit, we looked at four sets of staff records, and found supervision records were provided for all four staff. Supervision records seen indicated that proper supervision arrangements were in place. Care staff we talked to told us their supervision is provided by nursing staff, and nursing staff we talked to told us their supervision was provided by the manager. The previous requirement concerning staff supervision was assessed as met. Manor Barn Nursing Home DS0000024175.V359584.R01.S.doc Version 5.2 Page 33 We looked at the most recent monthly environmental risk assessments and room audits, and found that these were detailed and action taken was being recorded. Mrs Bush and Mrs Wyatt advised us that no personal money is held on behalf of people living in the home, and extra expenses such as hairdressing are billed to the person themselves or the person managing their money. Care staff training records seen indicated that staff are receiving training in health and safety topics such as control of infection and fire safety. Mrs Wyatt advised us that the fire training provided for staff has been improved by changing the training provided which now gives staff more practice in using fire extinguishers and doing fire simulation exercises. Manor Barn Nursing Home DS0000024175.V359584.R01.S.doc Version 5.2 Page 34 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 3 3 x x N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 x X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 X 3 Manor Barn Nursing Home DS0000024175.V359584.R01.S.doc Version 5.2 Page 35 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 OP29 Regulation 17.2, schedule 4 Requirement Timescale for action 07/04/08 2. OP12 16 The provider must maintain a record of all persons employed at the care home (including temporary staff) including his full name, address, date of birth, qualifications, experience, training and references. 07/06/08 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 and 17/9/07. 3. OP33 17, Schedules 3 4 The registered person must 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, and stored and handled in lines with Data protection. DS0000024175.V359584.R01.S.doc 07/06/08 Manor Barn Nursing Home Version 5.2 Page 36 Kept under review. This is a repeat requirement from 17/9/07 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.V359584.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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