Inspection on 24/07/07 for Old Barn Close (5)

This inspection was carried out on 24th July 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 (5) 29/08/06

Old Barn Close (5) 06/12/05

Old Barn Close (5) 20/07/05

Old Barn Close (5) 20/07/05

Old Barn Close (5) 11/03/05

Old Barn Close (5) 19/10/04

Old Barn Close (5) 16/09/03

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Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

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 (5) Gawcott Bucks MK18 4JH Lead Inspector Annette Miller Unannounced Inspection 24th July 2007 11.30 DS0000023076.V339215.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 DS0000023076.V339215.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. DS0000023076.V339215.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Old Barn Close (5) 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 824799 01280 824799 5oldbarn@nildram.co.uk Hightown Praetorian & Churches Housing Association Miss Fiona Hull Care Home 5 Category(ies) of Learning disability (0), Physical disability (0) registration, with number of places DS0000023076.V339215.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 5 residents with learning disabilities/physical handicap The home is able to continue to provide care and support to two Service Users who have been diagnosed with Early Onset Dementia. This variation applies to the two specific Service Users named in the Variation Application of June 7th 2006. 29th August 2006 Date of last inspection Brief Description of the Service: 5 Old Barn Close is a care home registered to provide care and accommodation for up to five adults aged 18 to 65 years with learning and physical disabilities. The home is a modern, single-storey building at the end of a quiet cul-de-sac in the village of Gawcott, close to Buckingham. The home is in a rural location with limited public transport. There are 5 single bedrooms, a lounge, kitchen/diner and small conservatory leading onto an enclosed garden at the back of the home. Bathroom facilities are adapted for people with physical disabilities and consist of a spacious bathroom and a separate shower room. Parking space is available at the front of the home. The home has its own transport and this is used to take residents out. Activities in the home are also provided. The standard fee is £1,445.29 per week. DS0000023076.V339215.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection conducted by the Commission for Social Care Inspection. It was undertaken by one inspector on a weekday between 11.30 am and 5.15 pm. The registered manager was on duty throughout the inspection. The inspector toured the home, spoke to one resident, the manager and 3 carers, and looked at a range of documents relevant to the work of the home. The inspection took into account detailed information provided in writing by the manager prior to the inspection and also comments received during the inspection. The inspector looked at how well the service was meeting the national minimum standards set by the government and has in this report made judgements about the standard of service provided by the home. Questionnaires were sent to the manager to be distributed to people involved with the home. This was to obtain feedback about how well the service is doing. No comments were received. What the service does well: What has improved since the last inspection? Additional training has been obtained that is particular to staff needs. Staff vacancies have been filled through two successful recruitment campaigns. The back garden has been developed to provide more attractive surroundings and residents interested in gardening have been supported to cultivate their own vegetables. DS0000023076.V339215.R01.S.doc Version 5.2 Page 6 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. DS0000023076.V339215.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000023076.V339215.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are assessed before admission to enable the manager to decide whether or not the home can provide the care that is needed. This ensures people are admitted appropriately. EVIDENCE: The manager confirmed she obtains a summary of the social services care management assessment and any health assessments that are necessary before agreeing to admit prospective residents. This is to ensure the home’s environment is right for people and also that staff have the necessary knowledge and skills to be able to provide the care that is needed. If necessary, the manager visits prospective residents to review their assessment and to decide whether the person is likely to settle well with the other residents. At the last inspection it was found that some of the required information had not been completed for one resident regarding the person’s skills and abilities. The manager said that the assessment procedure had been reviewed to ensure that in future all of the required information would be obtained before admission. As there have been no new admissions since the last inspection this could not be assessed. DS0000023076.V339215.R01.S.doc Version 5.2 Page 9 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): 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of care provided was found to be good. There was a good range of information in residents’ care records concerning all aspects of their care, although the residents did not have an individual care plan and this is needed to ensure all care needs have been identified. EVIDENCE: Each resident has three separate files containing relevant information about their care needs. The manager explained that one of the files was the day-today file, although the inspector found information about current care needs in the other files. It was unclear why information was spread across three files and it is recommended that this procedure is reviewed. The aim should be to have all information about a resident’s current care in one file so that it can be located quickly and easily. DS0000023076.V339215.R01.S.doc Version 5.2 Page 10 The manager considers these files to be the resident’s care plan. It is recommended that residents have an individual care plan (see standard 6) listing all of their care needs so that this information is contained in one place, rather than having to look for it in various files. Individual care plans should also state what action staff must take to ensure all aspects of the health, personal and social care needs of residents are met. The plan needs to be kept under review to take account of changing needs. The staff showed a good awareness of the residents’ right to make decisions, such as being able to choose when to get up and go to bed, and the importance of respecting residents’ right to privacy. The three carers spoken to each gave a good account of how these important aspects of care are promoted within the home. Risk is assessed and recorded. For example, a wheelchair user uses a lap strap to minimise the risk of falling from the chair. This has been discussed with a physiotherapist and an occupational therapist to ensure that the action taken is appropriate to safeguard the resident. The manager confirmed that all relevant discussions are recorded in the person’s care records. None of the residents are able to express an opinion about their care as they all have difficulty in communicating verbally. However, the inspector observed staff to be good at interpreting residents’ requests from their facial expressions and body language. The inspector saw that residents were treated kindly and with respect. Residents looked happy and relaxed with their carers indicating they felt safe with them. None of the residents are able to look after their own money. The home has good procedures to do this on their behalf when needed. Accounts of income and expenditure are kept and are regularly audited. DS0000023076.V339215.R01.S.doc Version 5.2 Page 11 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): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Links with the community have improved since the last inspection. These need to be maintained to support and enrich social and recreational opportunities available to residents. EVIDENCE: None of the residents are mentally able to undertake employment, but have involvement with the local community when taken out by staff in the home’s transport. During the inspection one resident was taken to the local church coffee morning where she met up with a resident from another home. Another resident was taken out to lunch. In-house activities consist mostly of artwork, examples of which were displayed to good effect around the home. The lounge has a TV and a range of videos, which staff said residents enjoy watching. DS0000023076.V339215.R01.S.doc Version 5.2 Page 12 There were no visitors during the inspection. The manager said visiting hours are flexible so that visitors can visit whenever they wish. Care records showed that one resident had regular visits from two family members, including the family dog. Lunch was served at 12.30 and consisted of a cold meal of Tortilla wraps filled with a chicken and mayonnaise spread, which residents appeared to enjoy. Crisps and fresh fruit were also provided, as well as cold and hot drinks. A hot meal is provided in the evening. On the day of inspection the meal planned was sausage and onion casserole with mashed potato and cauliflower. Residents are weighed monthly to ensure weight loss/gain is carefully monitored and that nutritional concerns are referred promptly to a dietician. One weight chart was examined and this showed the resident’s weight was steady. The last environmental health inspection in January 2006 found kitchen standards to be “well kept”. From the evidence seen by the inspector and comments received, the inspector considers that this home would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. DS0000023076.V339215.R01.S.doc Version 5.2 Page 13 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): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are given good support with their personal and health care needs and are protected by the home’s policies and procedures regarding the administration of medication. EVIDENCE: Personal care is given in private in the resident’s bedroom, or in the home’s bathroom or shower room. Carers encourage residents to be independent but are available to give assistance when needed. All of the residents need some help to wash and dress. Bathing facilities are good and residents can choose to have a bath or shower, or to wash at a sink. There is evidence in the care records of health care treatment and intervention. Currently, district nurses are visiting one of the residents to provide wound care. Nurses assess residents’ skin for signs of pressure damage and arrange for pressure relieving mattresses and cushions to be supplied when needed. Residents are registered with a local doctor and are given support to access healthcare specialists, such as opticians and dentists. DS0000023076.V339215.R01.S.doc Version 5.2 Page 14 The home has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. Medication records are fully completed, contain required entries, and are signed by appropriate staff. Medication is securely stored and training is provided for all staff involved in administering medication. This ensures residents’ safety. None of the residents are able to self-medicate. DS0000023076.V339215.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a clear complaints policy in use within the home. Residents are protected from abuse, neglect and harm through the home’s policies and procedures and also relevant training. EVIDENCE: The home has a clear complaints procedure that ensures complaints are responded to within 28 days. However, it is unlikely that residents would be able to initiate a complaint and the prompt involvement of a relative or advocate would need to be arranged if staff suspected a resident was unhappy about any aspect of care or life in the home. The manager gave assurance that this would be done. The manager gave written information to CSCI saying no complaints had been received since the last inspection. Also, no complainant has contacted CSCI with any concerns since the last inspection. The home has satisfactory adult protection policies and procedures and staff receive training to ensure any suspicion of abuse is reported promptly to the manager. The manager confirmed that training regarding adult protection is provided during induction and that annual updates are arranged. No safeguarding referrals to the local authority’s adult protection team have been made since the last inspection. DS0000023076.V339215.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment within this home is good providing residents with an attractive and homely place to live. EVIDENCE: The home’s interior is well-maintained providing pleasant living and sleeping accommodation. All bedrooms are single occupancy giving residents their own personal space and privacy. A resident showed the inspector her bedroom, which looked comfortable, clean and well decorated. The resident appeared happy with her accommodation and showed the inspector her possessions with enthusiasm. The communal lounge is spacious and homely. It has comfortable armchairs, a TV, a good range of videos and a music centre. The back garden is accessed through the dining room and small conservatory and residents can wander in and out freely. The garden is pleasant with flower tubs and bird feeders, as well as garden furniture. DS0000023076.V339215.R01.S.doc Version 5.2 Page 17 The manager said that the back garden had been tidied as a result of a recommendation made at the last inspection and residents are now involved in cultivating their own vegetables, which they enjoy. The front garden is not enclosed and therefore not safe for residents to use unless they are accompanied. The inspector considered the front garden would benefit from being tidied to make the entrance to the home more attractive. The home does not employ a gardener and care staff are responsible for keeping the gardens in good order (see comments under staffing). There is an on-site laundry in an area of the home not generally used by residents, although they have access to it. The manager said it is the home’s policy to keep the door locked, but this was not the situation during the inspection. When the inspector pointed this out the manager immediately locked it. Hazardous substances are stored in the laundry in a lockable cupboard, but the lock was broken. The manager said she would arrange for the lock to be mended as soon as possible. She pointed out that she had never known a resident attempt to enter the laundry, but acknowledged that the door must be kept locked for safety. DS0000023076.V339215.R01.S.doc Version 5.2 Page 18 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): 32, 33, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are sufficient to meet the present needs of residents, but need to be kept under review to ensure residents’ care is not compromised when staff are involved in other duties. EVIDENCE: The manager said staff vacancies have now been filled following two successful recruitment campaigns. On the day of inspection the manager and two carers were on duty to care for 5 residents. A third carer was scheduled to work from 9 am to 4 pm but was sick and the manager covered this absence instead of undertaking management duties as planned. There were 2 carers from 4 to 10 pm and 1 carer overnight, including an on-call carer who sleeps in the home. The number of staff on duty on the day of inspection appeared sufficient to meet the care needs of residents, but staff are also involved in cooking, cleaning, laundry and gardening duties, as well as organising entertainment for residents. The manager needs to monitor the time taken to complete this additional work to ensure residents’ care is not compromised. DS0000023076.V339215.R01.S.doc Version 5.2 Page 19 Two staff files were examined and most of the necessary information and checks to safeguard residents had been completed. Two references were obtained and criminal record bureau checks were completed before employment was confirmed. The manager confirmed that health screening was obtained, but was kept at the company’s head office. The manager should arrange for written confirmation of this to be on file. One file did not have proof of identify and this must be obtained for all employees. One person had not given a full employment history and the manager should ensure this is obtained from candidates so that any gaps in employment can be checked. Two members of staff have achieved NVQ level 2 in care and one person is currently on this training. The company has established its own NVQ assessment centre to assist more staff to achieve the qualification and also for staff to proceed beyond level 2. However, for standard 32 to be assessed as fully met 50 of the care staff need to have achieved NVQ level 2 in care. The company provides good training opportunities and training records showed staff attendance was good. Recent training has included diabetes, glucose monitoring, continence and dementia. There is a structured induction programme following appointment. A new member of staff said she shadowed experienced staff for two weeks before being included on the staff rota. This gave her the time she needed to settle into her role and to learn her responsibilities. She said she has received good support from the manager since her appointment. DS0000023076.V339215.R01.S.doc Version 5.2 Page 20 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): 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager provides clear leadership throughout the home with all staff demonstrating an awareness of their roles and responsibilities. EVIDENCE: The manager is experienced and is committed to ensuring the staff team give a good standard of care. She is actively involved in the day-to-day running of the home and in providing hands on care and support to care staff. Staff spoken to considered the home was well run. A carer said there was good support within the staff team and she was very happy working at the home. The manager has achieved NVQ level 4 in management [the Registered Managers Award], but not the NVQ level 4 in care. This is needed for Standard 37 to be assessed as fully met. DS0000023076.V339215.R01.S.doc Version 5.2 Page 21 The manager obtains information from a variety of sources to assist in the future development of the service. This is through regular care reviews involving the resident, relatives, health and social care professionals. The residents are unable to voice their opinions, but by using pictures and symbols can give some feedback. Information provided by the manager showed that maintenance checks are regularly undertaken ensuring residents and people visiting the home are safeguarded. Training records provided evidence of regular mandatory training for staff. This ensures they are appropriately trained for the work they do. DS0000023076.V339215.R01.S.doc Version 5.2 Page 22 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 X 2 3 3 X 4 X 5 X 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 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 3 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 3 X DS0000023076.V339215.R01.S.doc Version 5.2 Page 23 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 3 4 5 6 Refer to Standard YA6 YA6 YA30 YA30 YA33 YA34 Good Practice Recommendations Reorganise care files so that all current information about residents’ care needs is in one file to ensure this important information is easy to find. All residents to have an individual plan of care to ensure all care needs are clearly identified. Keep the laundry room door locked for residents’ safety. Replace the lock on the cupboard used to store hazardous cleaning fluids to ensure residents are not exposed to risk. Keep staffing levels under review to ensure that any extra duties do not affect residents’ care. Obtain a full employment history so that gaps in employment can be checked to ensure employees are suitable to work with vulnerable adults. DS0000023076.V339215.R01.S.doc Version 5.2 Page 24 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. 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