CARE HOME ADULTS 18-65
Old Barn Close (5) Gawcott Bucks MK18 4JH Lead Inspector
Sue Smith Unannounced Inspection 6th December 2005 09:30 Old Barn Close (5) DS0000023076.V271684.R02.S.doc Version 5.0 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 Old Barn Close (5) DS0000023076.V271684.R02.S.doc Version 5.0 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. Old Barn Close (5) DS0000023076.V271684.R02.S.doc Version 5.0 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 soldbarn@muldrom.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 Old Barn Close (5) DS0000023076.V271684.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 5 residents with learning disabilities/physical handicap Date of last inspection Brief Description of the Service: 5 Old Barn Close is a single storied residential Home for five people under the age of 65, with both Learning and Physical Disabilities. The Home is situated in the village of Gawcott, which is close to the town of Buckingham. Due to the size of the village the Service Users at 5 Old Barn Close access this town for shopping and G.P. services. The Home is managed by a suitably qualified and Registered Manager .The Home does not accept emergency admissions and doesnt supply intermediate care services. Public transport in the form of a village bus service is accessible the home, and a mobility van is also provided to meet the needs of Service Users with staff vehicles, covered by business insurance, also used for transporting service users when necessary. Old Barn Close (5) DS0000023076.V271684.R02.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is was an unannounced inspection of 5 Old Barn Close, which took place over a 2hr period. The Manager was on annual leave on the day of inspection therefore the inspection was conducted with the support of her most senior member of staff. During the inspection 18 of the National Minimum Standards for Younger Adults was assessed with all standards met. There were 2 recommendations to further support practice made. T here is no requirements made as a result of this inspection. The Inspector conducted a full environmental tour of the home and assessed a variety of documents, which included the recent pre-admission assessments for the new Service User residing at the home. The Inspector would like to thank the Service Users and Staff for their warm welcome and support in completing this inspection. What the service does well:
A thorough pre-admission procedure supports the home and prospective Service Users. Service Users are given ample opportunity to participate in the day-to-day running of the home. Menus are planned weekly to ensure they are varied and enjoyable to Service Users. There are robust medication procedures backed by a comprehensive medication policy to support staff and ensure Service Users remain protected. There is a comprehensive complaints procedure, which is accessible. There have been no complaints received at the home or directly to the Commission in the past 12 months. The Organisation provide regularly updated protection of vulnerable adults from abuse training which is supported by an Organisational policy.
Old Barn Close (5) DS0000023076.V271684.R02.S.doc Version 5.0 Page 6 The Home is a single storey house, which is pleasantly decorated (programmed for redecoration in January). Comfy furnishings and fittings are provided which create a homely and relaxing environment. All bedrooms provide single accommodation and have been fitted with adaptations and equipment to support the individual. These have been individually decorated and are reflective of the personalities of Service Users. The Staff team ensure the home is cleaned to a high standard, ensuring all infection control measures are in place and implemented. Ongoing training and support are offered to all staff to ensure their professional development. The staff are to be commended for their professionalism whilst ensuring a relaxing and friendly ethos is maintained for the Service Users. A programme of supervision is in place, which is offered to all staff to ensure they are able to discuss professional practice in a safe and productive environment. As far as they are able, staff ensure the views and opinions of Service Users is taken into consideration for all future planning. Policies and procedures are provided by the Organisation to support staff in their roles. Records are maintained within current guidance to ensure all information is current and applicable to the current care needs of the Service Users. What has improved since the last inspection?
Preparation work necessary before the redecoration of the home in January 2006, has been undertaken. The Senior Team Leader has established herself in her role and was found to be knowledgeable and competent in her role. Old Barn Close (5) DS0000023076.V271684.R02.S.doc Version 5.0 Page 7 The Home continues to provide a professional and sensitively run service for Service Users with complex needs. 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. Old Barn Close (5) DS0000023076.V271684.R02.S.doc Version 5.0 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 Old Barn Close (5) DS0000023076.V271684.R02.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4. All Service Users are subject to a rigorous pre-admission assessment to ensure staff are able to fully meet their assessed needs. All Service Users are given the opportunity to visit the home prior to admission to ensure the placement is suitable to their needs. EVIDENCE: The Home has recently admitted a new Service User who is presently undergoing a three-month trial period. A review of service provision will take place in February 2006 to ensure the placement has been a positive initiative for the Service User. This admission has taken place following rigorous pre-admission assessments, which have included assessments from the previous placement, Care Manager reports, and observations and assessments undertaken by the Home. The Service User visited the Home on several occasions for Teatime stops, social and overnight visits to assess the personal care needs as well as compatibility with other Service Users in the Home. This has been a productive method of assessment with records held in the home supporting the admission. However the Inspector has asked for further information due to the assessment documents making reference to a classification of Dementia for this Service User. If the Service User has been medically diagnosed with Dementia further assessment of future needs will need to be made and an application for variation of the existing registration to support this admission
Old Barn Close (5) DS0000023076.V271684.R02.S.doc Version 5.0 Page 10 will need to be undertaken by the Organisation. At this time the Home is not registered to admit Service Users with Dementia. Discussion has taken place with the senior manager for the home and this information will be provided to the Commission as soon as it has been obtained, the Commission supports the admission to the Home due to the evidence found in the assessment documents and satisfaction expressed by the Service User. Old Barn Close (5) DS0000023076.V271684.R02.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 8 Service Users are supported to participate as far as they are able in all aspects of life in the home, ensuring they reach their full potential. EVIDENCE: The Service Users at 5 Old Barn Close have complex needs which classifies them as high in dependency, this naturally limits the amount of participation in the day-to-day maintenance of the home. However the Staff team ensure individual Service Users are supported to express their likes and dislikes in all aspects of life in the Home. Service Users are supported to maintain as much independence as possible with such things as personal care, welcoming visitors to the Home, assisting with daily chores and so on. In addition an independent Advocate facilitates residents meetings to support Service Users living in the Home. Old Barn Close (5) DS0000023076.V271684.R02.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17 Menus are planned weekly, thus ensuring meals offered are nutriously balanced, are varied and enjoyable for Service Users. EVIDENCE: The Inspector assessed menus for the past four weeks to gain a view of the meals offered at the Home. These were well planned with a variety of meals offered with alternatives held in the Home should a Service User request a change of meal. The Inspector did note there was a high number of meals that were Pasta based on three of the menus, this in itself is not an issue for concern as long as it is in keeping with the likes and dislikes of Service Users. A recommendation is made for the Manger or Senior staff to assess the menus to ensure there is a continuation of variety available within the menus that is based on the likes and dislikes of Service Users. Old Barn Close (5) DS0000023076.V271684.R02.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 Medication procedures in the home are robust and ensure Service Users are protected. EVIDENCE: The Home administers all medication due to the complex needs of Service Users. Medication systems in the home are backed by the Organisations policy and procedures and are in keeping with current legislation. There were no out of date medications held in the home and dates of opening were present on all creams, ointments and bottles. This system will be put in place for the new Service User once the first delivery of medication had taken place. Old Barn Close (5) DS0000023076.V271684.R02.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. The Home follows a thorough complaints procedure to ensure an open, and transparent practice is in place, which protects the Service Users. The Home follows the Organisations Protection of Vulnerable Adults Policy to ensure all Service Users are protected from abuse. EVIDENCE: Old Barn Close (5) DS0000023076.V271684.R02.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30. 5 Old Barn Close is a homely and pleasant environment, which has been furnished and adapted to ensure the needs of the Service Users can be met. The Home is maintained to a high standard ensuring Service Users live in a home that is clean and hygienic and maintains the health and safety of Service Users and Staff. EVIDENCE: The Home is due for redecoration with preparation work already carried out; this has been postponed from November 2005 to January 2006. The current facilities do not pose any risk to Service Users and the Commission agrees to this change of proposal as a positive initiative for Service Users. The Home provides single bedroom accommodation, which is individually decorated and furnished to meet the needs of Service Users. Adaptations and equipment to support the Service Users in the environment are provided, these are regularly serviced to ensure they are maintained to a high standard and are fit for purpose.
Old Barn Close (5) DS0000023076.V271684.R02.S.doc Version 5.0 Page 16 The Home is cleaned by staff on a daily basis to ensure it is hygienic for Service Users. All items of C.O.S.H.H. are kept in lockable facilities with no such items found to be left around the home on the day of inspection. Laundry facilities are provided with staff ensuring all soiled items are cleaned on the provided sluice cycle. Drying facilities were out of action in the day of inspection with the use of the dryer at 4 Old Barn Close implemented in the interim. Towards the end of the inspection the repair service arrived at the home and satisfactorily fixed the problem. The kitchen was found to be clean and tidy with all recommendations and guidance from the Environmental Health Inspector implemented. Old Barn Close (5) DS0000023076.V271684.R02.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35, 36. The Home has a skilled staff team who ensure the Service Users needs are met in a safe and professional manner. Staff are supported to carry out their roles through a supervision programme, which enables staff to discuss issues of practice in an open and transparent manner. EVIDENCE: Staff receive ongoing training and support to ensure their professional development. The staff team are competent in their roles and are knowledgeable of the individual needs of Service Users. The Inspector noted an open dialogue with Service Users with an inclusive and relaxed ethos evident. The Staff are to be commended for their positive and professional approach to providing a holistic method of care delivery. A programme of supervision is in place; this is realistically taking place every 6 weeks and is reported as a supportive method of discussing individual practice issues as well as future plans for Service Users. Old Barn Close (5) DS0000023076.V271684.R02.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39, 41. Service Users views and opinions on the day-to-day operation of the Home are sought through a variety of systems to ensure the Home is operating in the best interest of the Service User group. The Organisation provides policies and procedures, which enable Staff to provide a professional service. EVIDENCE: As previously mentioned in this report the Service Users at 5 Old Barn Close are classified as high dependency with complex needs. The Staff Team ensure as far as is practicable the Service Users views and opinions are sought when planning the day-to-day activities of the Home. Individual support is offered to Service Users with communication difficulties to gain their views. In addition, (as previously mentioned) an independent Advocate is attached to the Home. Her main duties are to facilitate the residents meetings with minutes of these meetings held in the home. The Advocate also offers additional support with individual issues that may arise.
Old Barn Close (5) DS0000023076.V271684.R02.S.doc Version 5.0 Page 19 Policies and procedures are provided by the Organisation to ensure staff are working within current legislation and the Organisations philosophy for care delivery. In addition the home has established its own procedural guidelines to ensure all staff are working in a consistent manner and in the best interest of Service Users. Records held were found to be up-to-date and completed within current guidelines, ensuring all information held in relation to Service Users is stored appropriately in line with the Data Protection Act 1998. The Inspector did note that some information held on file reflected only the first name of staff and in some instances signatures were missing. Staff are reminded to ensure full first and surnames are included on all documentation with signatures put in place as required. Old Barn Close (5) DS0000023076.V271684.R02.S.doc Version 5.0 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X 3 3 X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X 3 X X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X X X 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Old Barn Close (5) Score X X 3 X Standard No 37 38 39 40 41 42 43 Score X X 3 X 3 X X DS0000023076.V271684.R02.S.doc Version 5.0 Page 21 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 YA17 YA23 Good Practice Recommendations Menus are reviewed by senior staff to ensure there is a continuation of variety that is led by Service Uses likes and dislikes. The home obtains a copy of the Buckinghamshire InterAgency Protection of Vulnerable Adults policy to further support practice. Old Barn Close (5) DS0000023076.V271684.R02.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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