Inspection on 22/02/07 for Old Barn Close (4)

This inspection was carried out on 22nd February 2007.

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

Other inspections for this house

Old Barn Close (4) 12/01/09

Old Barn Close (4) 18/01/08

Old Barn Close (4) 17/07/06

Old Barn Close (4) 15/02/06

Old Barn Close (4) 27/09/05

Old Barn Close (4) 15/03/05

Old Barn Close (4) 13/07/04

Old Barn Close (4) 23/02/04

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Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Old Barn Close (4) Gawcott Bucks MK18 4JH Lead Inspector Andy McGuckin Unannounced Inspection 22 February 2007 13:30 DS0000023095.V328763.R01.S.doc Version 5.2 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 DS0000023095.V328763.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000023095.V328763.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Old Barn Close (4) Address Gawcott Bucks MK18 4JH 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) 01280 821006 01280 821006 4oldbarn@nildram.co.uk Hightown Praetorian & Churches Housing Association Ms Dawn Mayhew Care Home 4 Category(ies) of Learning disability (4) registration, with number of places DS0000023095.V328763.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Ms Mayhew is to have completed her NVQ Level 4 / Registered Managers Award by the 1st January 2007. 17th July 2006 Date of last inspection Brief Description of the Service: 4, Old Barn Close is situated in a quiet residential area of the village of Gawcott. This village is a short distance from the town of Buckingham, which has a variety of shops and other local amenities. Gawcott is served by infrequent local bus services, with more extensive transport accessible in Buckingham. The home is part of the Hightown Praetorian Housing Association. 4, Old Barn Close is a modern bungalow, which is home to 4 male service users with behavioural problems, learning and communication difficulties. The home has an enclosed garden, which provides service users with a safe external area in which they can walk unhindered and in safety. The garden contains swings for service users, and is planted with flowers and shrubs. Entry to, and exit from, the home, has to be facilitated by staff, and an alarm alerts staff if the door is opened at other times. All service users are accommodated in single bedrooms, which possess washbasins. A separate shower and bath are present in the home, as well as a kitchen, laundry, staff sleep over room, dining and lounge areas. All service users are registered with a general practitioner, and access to other healthcare professionals, such as community nurses and dieticians, is through direct contact by staff, or through GP referral. The home currently has one vacancy. Fees range from £2031.33 to £2140.30 per week. Information supplied by the manager at the time of inspection. DS0000023095.V328763.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced “Key Inspection”. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s manager, and any information that the CSCI has received about the service since the last inspection. A site visit was made toi the home. The inspector observed the interaction between staff and residents. The service manager and deputy manager added imput into the inspection process. Staff views were sought. All residents are non verbal so the inspector was unable to establish directly how residents experienced the home. Relatives and friends were asked to input their views and no negative views were expressed to the inspector. The inspector toured the building which was found to be safe and secure and equipped to a satisfactory standard. From the evidence seen by the inspector and comments received, the inspector considers that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs . No complainant has contacted the Commission with information concerning a complaint made to the service since the last inspection. The inspector would like to thank the management, staff and residents for their help, co-operation and patience during this inspection. What the service does well: Service user plans are in place for each person living at the home, outlining their care needs in order that they receive the assistance they require. Service users are enabled to make decisions, with assistance from staff, to exercise choice in their everyday lives. Risk assessments are in place to support service users to be as independent as possible, which provide them with stimulation and variety and involvement in the community. Service users are supported to remain in contact with family and friends, to maintain important social contacts. DS0000023095.V328763.R01.S.doc Version 5.2 Page 6 The daily routines within the home are flexible, promoting independence and respecting responsibilities and rights. Mealtimes are well managed, with a range of meals provided for service users, to meet their nutritional needs. Service users receive the personal support they need, ensuring that care needs are met. Staff enable physical and emotional needs to be met, helping service users to keep well. Management of medication is well handled and monitored to ensure that service users receive the medicines they require. Effective complaints procedures are in place, to listen to the views of service users’ representatives. Adult protection is being effectively handled, to ensure that the risk of harm to service users is minimised. Staff have a good understanding of their roles and repsonsibilities and are competent to provide care to service users. A manager is in place at the home, to ensure consistency of care. Effective monitoring is undertaken by the provider, to ensure that service users receive the care they require. There is due regard for health and safety, to minimise the risk of injury to service users, visitors and staff. A comfortable, clean and homely environment has been created for service users, providing them with a safe and attractive place to live. Needs arising from equality and diversity are well met. What has improved since the last inspection? DS0000023095.V328763.R01.S.doc Version 5.2 Page 7 Residents are now weighed on a regular basis. All residents have future dental appointments made. Assessment of risk is undertaken for residents refusing dental treatment. The organisation has reviewed and changed their recruitment practices and the inspector feels they are now satisfactory. 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. DS0000023095.V328763.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000023095.V328763.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. 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. The home provides information to service users in a variety of formats to enable as much understanding and involvement as is possible. EVIDENCE: The home uses many different methods to communicate with prospective service users including visual aids and one to one sessions. Prospective service users are assessed by a multi disciplinary professional team. Service users spend some time in the home prior to admission and have a period of mutual assessment prior to a permanent offer being made. The homes assessments are all geared to establishing that the home will meet the needs and aspirations of its service users and those who are already permanent residents. Nominations are being put forward at present for the vacancy and all candidates will have the opportunity to visit and spend some time in the home in order to meet the residents and staff. DS0000023095.V328763.R01.S.doc Version 5.2 Page 10 Residents relatives or their advocates have access to and copies of the homes terms and conditions as do the residents care managers. Comment was received from a parent of a resident that she was originally very upset that she was not given a choice of home. However she ended her comments by saying “ As a parent I’m very happy with the care my son receives. He has a full social life and new doors have been opened enabling him to have a much better quality of life “ DS0000023095.V328763.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. 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. Evidence was found that where possible individual choice and needs are being promoted and addressed. EVIDENCE: The inspector examined all three service users files and documentation and found them to be well presented and easily read by an outside agent. Relevant information was held in sufficient detail to enable staff to identify and meet the needs of the residents. The information was up to date and evidence of yearly reviews was found. Documents are no longer stored in residents bedrooms as was the case previously. The home has access to a room in the home, which is used as an office and sleeping in room. The office is full to its limit , which means much of the confidential information and filing is kept outside of the office in a communal area. It is possible that this may enable a breach of confidentiality DS0000023095.V328763.R01.S.doc Version 5.2 Page 12 to occur but due to the size and door security this is unlikely. The inspector would strongly recommend that the organisation looks at alternatives. Temporary use could be made of the spare bedroom either for storage or sleeping in. The home has appropriate policies and procedures to address risk and evidence was found in service users files that assessments had been done which at the same time enabled residents to undertake tasks in a safe manner. Staff were seen to interact with service users in an appropriate way. Giving time for personal space or interaction. All residents are non vocal and staff are very aware of the methods of communication for each resident and know by facial expression or body language the mood of the resident. There is a system in place whereby residents money is checked and accounted for at each handover. The inspector accompanied staff on the handover and was impressed by the through nature of this system. DS0000023095.V328763.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. 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. Evidence was found at inspection that residents are encouraged to have as varied and challenging a lifestyle as they are willing or able. EVIDENCE: The home keeps a daily diary of residents activities. Staff try to ensure that at least one activity a week takes place away from the home. Activities include lunch out, multi- sensory sessions, swimming, walks, community activities and an annual holiday. There is still an outstanding issue with the homes transport. One resident had use of the vehicle 4 times per week this has now been reduced to three times per week but still has an impact on the use of this vehicle for other residents and means often that activities take place in the home rather than the community. The inspector would recommend that this situation is reviewed to find a solution that is fair for all residents. DS0000023095.V328763.R01.S.doc Version 5.2 Page 14 Photo’s of the resident is available on part of the filing system containing resident information but was not available on the blue file. This file contained much information pertaining to the resident and the inspector would recommend that a picture be added to the front cover. Residents are encouraged to take an active part in the selection purchase and preparation of the days meals as far as they are willing or able. Staff understand that this has to take place at the residents own pace. All food is bought fresh daily and cooked to order as required by residents. Meals take place at set times but there is scope for flexibility within this. Meals are prepared by the shift care staff and residents. Milton Keynes collage are working with residents around selection and preparation of food. Staff were seen to give personal space and allow for residents to have time alone in there own space. Staff knocked before entering and asked permission to enter. All bedrooms are for single occupancy ands are furnished and made to the individuals taste. Equipment required for moving and handling is available and staff have been trained in its use. Sensory equipment is available for those who require it. DS0000023095.V328763.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. 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. Residents have full access to a range of healthcare resources. EVIDENCE: All records inspected showed evidence that care is being provided in a way which is acceptable to the residents. Care plans clearly state the likes and dislikes of the residents and the most appropriate method in which to provide personal care for the residents. General information is also held including weight any significant episodes and any changes in medication. Records of visits to healthcare professionals were recorded including missed appointments. No current residents are able to self- administer their medication. Two staff are involved in the monitoring checking and administration of medication. This is a through system and the inspector commends this. The inspector undertook a spot check of the administration and recording of the medication and found it to be accurate. DS0000023095.V328763.R01.S.doc Version 5.2 Page 16 All residents have booked appointments with specialist dental practitioners. DS0000023095.V328763.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. 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. The inspector viewed the policy and the procedures for residents complaints, concerns and complements and found them to be satisfactory. EVIDENCE: All current residents are non verbal and not able to verbalise their dissatisfaction. Staff within the home are able to identify through body language and facial expression if a resident is not happy. This was observed throughout the inspection. The home has satisfactory procedures for enabling residents, relatives and advocates to make complaints or express concerns. The home makes use of external advocates. The manager and staff have been trained in adult protection and the home has satisfactory policies on whistle blowing and protecting vulnerable adults. Regular handovers and staff meetings together with training ensure that residents changing needs are identified and reviewed. DS0000023095.V328763.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. 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. The inspector toured the building, which was well maintained and furnished to a satisfactory standard. Private and communal areas were available for residents to be alone or with others. EVIDENCE: The home is a large detached bungalow at the end of a quite cul-de-sac in the village of Gawcott. All bedrooms are single and have been decorated and arranged to different tastes and personalised and meets the needs of residents lifestyles. All bedrooms are single occupancy which enables residents to have their own personal space and privacy. The home has access to two bathrooms for residents and a separate staff toilet. DS0000023095.V328763.R01.S.doc Version 5.2 Page 19 Specialist equipment where required has been provided and staff have been trained in its use. The garden is being well maintained and provides a pleasant area in which residents can relax and enjoy the outdoors in a safe manner. The home presents a homely comfortable and safe environment. All areas of the home were light and airy and well ventilated and communal rooms were comfortable and of adequate size for the number of service users. An old sofa has been removed making the lounge quite spacious. The home is set out on one level enabling wheelchair access to all areas of the home. On the day of the inspection the home was clean and well maintained DS0000023095.V328763.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. 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. The home was found to have staff who are trained and in sufficient numbers to meet the needs of the residents. EVIDENCE: Issues identified at the last inspection regarding the recruitment of staff have been addressed across the organisation and are now found to be satisfactory. Staff were aware of their own and others roles and responsibilities and presented as a competent team. The service manager undertakes regular monitoring visits. A written report of these visits is made and sent to the commission for information. The service manager was on site on the day of the inspection. Regular health and safety spot checks are made on the home and a dedicated person has been identified to be responsible for these issues. DS0000023095.V328763.R01.S.doc Version 5.2 Page 21 Staff files read evidenced that staff are being trained regularly and appropriately. Staff are being managed supervised and monitored appropriately with staff handover and staff meetings taking place regularly. DS0000023095.V328763.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. 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. The home was found to be well managed with sufficient policies and procedures to enable staff and management to know what is required of them. EVIDENCE: The manager is registered with the Commission and has one unit to finish before completing the Registered Manager’s Award. The manager was not on duty at the time of the inspection but the home appeared to be well run in her absence. DS0000023095.V328763.R01.S.doc Version 5.2 Page 23 Residents views are sought in a variety of ways to ensure that the home is meeting their needs. The home has undertaken a comprehensive Quality audit and are at present analysing its findings the inspector commends this initiative. The home has appropriate policies and procedures to ensure that rights and best interests of the residents are being met. The inspector viewed a range of core documentation that evidenced that the home is meeting the healthcare needs of residents are being protected and promoted. The inspector assessed the home as being competently run and managed in a professional manner DS0000023095.V328763.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 2 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 3 3 3 3 3 3 DS0000023095.V328763.R01.S.doc Version 5.2 Page 25 No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2. Refer to Standard YA12 YA24 Good Practice Recommendations The home should review the use of its transport to enable an equal usage of it for all residents It is strongly recommended that the organisation review the staff office / sleep-in room, with a view to an improvement of these facilities and the provision of secure storage for residents records. DS0000023095.V328763.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 DS0000023095.V328763.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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