Inspection on 18/04/07 for St Barnabas Residential Home

This inspection was carried out on 18th April 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

St Barnabas Residential Home 24/04/06

St Barnabas Residential Home 06/12/05

St Barnabas Residential Home 17/06/05

St Barnabas Residential Home 28/02/05

St Barnabas Residential Home 29/09/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE St Barnabas Residential Home The Common Godyll Road Southwold Suffolk IP18 6AJ Lead Inspector Jill Clarke Key Unannounced Inspection 18th April 2007 10:00 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 St Barnabas Residential Home DS0000024494.V336302.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. St Barnabas Residential Home DS0000024494.V336302.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Barnabas Residential Home Address The Common Godyll Road Southwold Suffolk IP18 6AJ 01502 722264 01502 726045 st-barnabas@tiscali.co.uk 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) St Barnabas Southwold Wendy June Clack Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (13) of places St Barnabas Residential Home DS0000024494.V336302.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th April 2006 Brief Description of the Service: St. Barnabas is set in the residential area of Southwold, a short walk from the town centre, with its range of amenities. These include beaches, shops, restaurants, coffee shops, banks and post office. Public transport links include a bus service from Southwold, which connects with the railway station at Halesworth. The large house, built on the site of an old windmill has 3 floors, which residents can access by a very small lift or stairs. Due to the limited space in the passenger lift, not all people who use a wheelchair can be accommodated on the first floor. All 13 bedrooms have their own wash hand basin, 3 also have en-suite toilets. Communal toilets and bathrooms are situated close to bedrooms, which are located on all 3 floors. Communal areas consist of a dining room, lounge (drawing room) and enclosed porch area at the front of the home. There is an enclosed courtyard, and gardens which face out to the Common and sea front. There is off road parking at the side of the home, with further public car parking available, a short walk away. The home is a no smoking home. Costs per week range from £350 to £395 depending on size of room, and if it has en-suite facilities. Fees cover accommodation, care, meals, hairdressing and chiropody. St Barnabas Residential Home DS0000024494.V336302.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a unannounced key inspection, undertaken over 6 ½ hours, which focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to, and during the inspection. Commission for Social Care Inspection (CSCI) feedback cards were sent to the home in March. This gave an opportunity for residents, relatives, visitors and staff, to give feedback on how they thought the service was run. There was a 100 response from the people using the service. Comments from the completed residents (13), relatives & advocates (9), and staff (12) feedback cards have been included in this report. Time was also spent with members of staff, which included the Registered Manager, Senior Care Assistant, Care Assistants and Chef. A tour of the building took in all the communal rooms, and a sample of 2 bedrooms, bathroom, sluice, toilet kitchen and new laundry. Records viewed included, care plans, staff recruitment and training records, Fire Risk Assessment, Statement of Purpose and medication records. Previous visits to the home identified that people living at St. Barnabas preferred to be known as residents, this report respects their wishes. What the service does well: St. Barnabas is a well managed home which offers a good standard of care, by trained and experienced staff. The people, and their relatives, who use the service best summon up the level of service provided at the home: “It feels like a real home and not like an institution”. “Residents are treated as individual and feel cared for and safe”, “Provides a very caring, secure and friendly home” “it feels like my mother’s home” “ nothing is too much trouble for staff” “individual needs are taken into account” “I am happy here. The staff here look after me very well, the food is good and the staff make it a happy home which to live – I feel safe here”. St Barnabas Residential Home DS0000024494.V336302.R01.S.doc Version 5.2 Page 6 Discussions with residents, relatives and staff during the inspection, backed up these comments, especially feeling “well looked after”, the “homely atmosphere”, and “friendliness of the staff”. Staff promote residents to maintain their independence, which 1 resident said they appreciated, as it kept them “going”. The home is well situated within walking distance of the Town and opposite the Common. The home is not purpose built, therefore most of the bedrooms do not have their own en-suite. However, 1 relative commented, “what it lacks in modern amenities is more than compensated for by the quality of staff”. What has improved since the last inspection? What they could do better: Have checking systems in place to ensure all medication has been written onto the resident’s medication records, when they move onto the next month’s sheets. There is a need to ensure that the storage cabinet and logbook used St Barnabas Residential Home DS0000024494.V336302.R01.S.doc Version 5.2 Page 7 for recording controlled drugs meets the required standards, to protect against loss or misuse. The home needs to ensure they obtain a full employment history, so the home can check the reason for any gaps, and identify the reason members of staff have left previous jobs with vulnerable people. Continue developing their activities programme, to ensure it meets all the residents’ needs. 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. St Barnabas Residential Home DS0000024494.V336302.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 St Barnabas Residential Home DS0000024494.V336302.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): 1, 2, 3, 4 and 5. (the home does not offer intermediate therefore standard 6 was not assessed). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are given information on the home and have their needs fully assessed before moving in. This enables people to identify if the home is what they are looking for, and if staff is able to provide the right level of care and support they are looking for. EVIDENCE: Since the last inspection the home has updated their Statement of Purpose and produced a more user friendly, informative Service Users Guide, a copy of which was given during the inspection. On reading the booklets, it was identified that the home needed to add/make some minor amendments, which will be dealt with through separate correspondence to the home. St Barnabas Residential Home DS0000024494.V336302.R01.S.doc Version 5.2 Page 10 All residents are provided with a written contract, which fully sets out their terms and conditions of residency. Discussions with the manager identified that this tends to be undertaken at the end of the 4-week trial period. This is to ensure that residents do not feel pressured to make their mind up, which they may do if they have to sign the contract before moving in. Although they have not been given a contract they have been given information on the fees payable, and what it includes. Records for the 2 newest residents showed that they had received contracts. The manager had visited one of the residents to carry out their preassessment, which was held on their file. Where the Manager had not been able to visit the second resident, who lived in another county, the care establishment that they were residing in at that time, had sent a copy of their care plan. The manager confirmed that they, or the Deputy Manager (who also holds a Registered Managers Award) undertake all the pre-admission assessments. This enables them to answer any questions, and check that they will be able to meet all the prospective persons care needs. Time spent talking with the newest residents confirmed that their families had looked around the home before they moved in, and had visited Southwold before. They said they had settled in very well, and already “felt at home”. Their relative also commented on how they “had been made to feel welcome” when they arrived. Feedback from the CSCI resident surveys confirmed that they had been given sufficient information on St Barnabas, to help them decide if it was the right care setting for them. Both the new residents spoken with felt the home was able to meet their needs, and it lived up to their expectations. This reflected information given in the CSCI resident and relative surveys, which included a positive observation from a relative who said since their mother had moved into St. Barnabas, she had ‘gained a stone’, is ‘incredibly healthy, ‘always has company’, feels settled in her ‘home’, and thinks of the staff as ‘family’. St Barnabas Residential Home DS0000024494.V336302.R01.S.doc Version 5.2 Page 11 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): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can expect to be fully consulted on how they wish to be cared for, which will be reflected in their individual care plan. The principles of respect, dignity and privacy are put into practice. EVIDENCE: Staff are continually developing the residents’ care plans so they become more individualised. Three residents care was ‘tracked’ during the inspection, which involved looking at their care plans, discussing their care with staff, and where possible, spending time with the residents to hear their views on the level of care and support they receive. Care plans showed that residents and relatives are being involved in their development and review. They gave staff clear guidelines on how much help the resident wanted with their personal care and mobility needs. Wording St Barnabas Residential Home DS0000024494.V336302.R01.S.doc Version 5.2 Page 12 used throughout showed that staff were encouraging residents to remain independent as possible. One resident spoken with, who wanted to ‘keep going’ and not lose any of their abilities, appreciated this. Staff are aware of the Malnutrition Universal Screening Tool (MUST), but have not yet instigated it as part of the care plan. Although records showed that they are closely monitoring residents weight on a monthly basis, the use of this tool should be considered, to support staff identifying any concerns, and what action they have taken. Nearly all the residents asked through completion of CSCI Surveys said they ‘always’ received the care and support they needed, with 2 saying they ‘usually’ did. One resident said they found the ‘experience varies with each carer’. Information in surveys also confirmed that residents were receiving medical support, with 1 person saying they felt sometimes there was a ‘long wait for an appointment’. This was fed back to the manager, who said that they had never any problems getting appointments. They also confirmed they have a good working relationship with the local Doctors, and visiting community nurses. Further discussion identified that the resident may have been referring to hospital appointments, which was out of the home’s control. Since the last inspection the home has been pro-active in addressing the requirements made in relation to the administration, and recording of medication (see Inspection report dated 24/04/06). This has included medication now being stored in a specialist lockable trolley, which is of a small size and can easily be moved around the home. However, it was noted that the trolley, when left was chained to the bookshelf in the office, rather than the more solid fixture of the wall. As the home comes under the Waveney PCT group area, the home has been able to take advantage of seeking advice from their accredited Pharmacist, who has visited the home to undertake a training session for staff and review the homes medication procedures. All medication received into, and out of the home is recorded on the Medication Administration Records (MAR), which is supplied by the Pharmacist every 28 days. Each resident has their own chart, which lists the prescribed medication they are taking, when it was received including quantity, and the dosage to be given. The MAR charts for the 3 people, whose care was being tracked was examined, and the medication held was checked against the records. This identified a administration error, where 1 medication held, was not listed on the MAR chart. Previous MAR charts for the person showed that the medication had been previously hand written onto the sheet. When the staff started the new sheets that weekend they had forgotten to transfer the information. St Barnabas Residential Home DS0000024494.V336302.R01.S.doc Version 5.2 Page 13 Discussion with the resident concerned, confirmed that they had been given all their medication, including the tablet that had been left off the MAR sheet. Staff took action to address the situation straight away, by updating the MAR charts. Other MAR charts looked at had been completed fully, and a check of ‘stand alone’ medication, not supplied in the ‘dossett’ box was correct, when stocks were checked against the home’s records. The home does not hold any controlled drugs at the moment, but has procedures in place to ensure safe systems, and checks are undertaken when they are dispensed. This includes completing a ‘controlled drug register’, which has been put together by the home. The book did not fully comply with regulations, as the pages were not numbered, and could be easily removed from the plastic, spiral binding used. It was also noted that the controlled drugs cupboard is domestic in nature, and not of a metal structure, which would be more secure, and meet the requirements of the Misuse of Drugs Regulations 1973. Throughout the inspection staff addressed some residents by their first name, others by Mr/Mrs and surname. Care plans showed that residents had been asked how they would like to be addressed, which staff were observing. One relative wrote in their CSCI survey, that their ‘mother is always treated with respect’, which reflected the feedback given by residents during the inspection. St Barnabas Residential Home DS0000024494.V336302.R01.S.doc Version 5.2 Page 14 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): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to be able to choose their life style, social activity and keep in contact with family and friends. However people cannot be assured that the social activities arranged by the home will offer the level of social stimulation they are looking for. Residents are offered a healthy, varied diet according to their assessed requirement and choice. EVIDENCE: Previous inspections have always included feedback from some residents/relatives who felt there were not always enough activities going on. Prior to this inspection residents surveyed, were asked if there was activities arranged by the home that they could take part in, 9 replies fell into the ‘always/usually’ category, 3 ‘sometimes’ and 1 saying they ‘chose not to join in’. The Manager felt staff had been working hard to arrange stimulating activities, and were always asking residents what they would like to see arranged. St Barnabas Residential Home DS0000024494.V336302.R01.S.doc Version 5.2 Page 15 One relative said that the ‘recently started craft sessions, outings etc have provided a much needed relief from boredom’, and went on to say that they ‘would be pleased to see more opportunities like this – perhaps more trips out in their mini-bus’. The manager confirmed that they did not have their own mini bus, but had the use of one, which they only had to pay for the mileage used. Two other relatives had also commented that they would like to see more ‘stimulating activities’ and ‘outings’. The activities list placed on the notice board, showed that limited stimulating activities was taking place. However, discussion with the Manager and records held in the care plans, identified that a lot more social interaction was happening in the home – than was being advertised, therefore relatives may not be fully aware. This included spending 1 to 1 time taking residents to the local shops, which seemed to be happening daily. One resident said “whenever staff had time, they would take someone to the shops in the wheelchair”. They went on to say that the shops were very wheelchair friendly as “they could easily get through the doors”, and the shop staff were “very friendly”. They felt the location of the home helped them feel part of the community. The monthly resident newsletter contained information on the Easter activities, which included making Easter bonnets. During the inspection, 1 resident enjoyed sitting out on the bench at the front of the home, where they said they could watch the world go by, and found many “people stopped to talk”. The activity of the workman was also giving a point of interest and discussion. Another resident preferred to sit in the enclosed porch way, which had views of the Common. Five residents, during the afternoon were helping staff complete a newspaper’s crossword, nourished by homemade cakes and a cup of tea. One care plan showed support given to a resident to follow their faith; a committee member took them to attend the church service. The Service Users Guide informs the reader that there are ‘Churches of four denominations close by’. The Statement of Purpose states the home’s commitment ‘to ensure that each resident’s wishes are known and understood in relation to the practice of their chosen religion’. They also state they will support residents to access religious services, leaders, ministers or priests in private. Relatives/advocates surveyed were asked if they felt the care service met the different needs of people, taking into account resident’s age, disability, gender and faith. Six had ticked ‘always’, 2 ‘usually’ and 1 relative had not ticked a box, instead wrote ‘no issue has risen relating to this – but I am sure they would do’. Residents confirmed that their visitors could see them at any time. Relatives were seen visiting throughout the day, and seeing the notice that the inspector was in the building, were happy to meet them and share their views on the home. Relative CSCI surveys confirmed that the home keep relatives or their advocate up to date with any important issues affecting the residents. St Barnabas Residential Home DS0000024494.V336302.R01.S.doc Version 5.2 Page 16 One relative said that they had been ‘called immediately’, when their next of kin had been admitted to hospital. During the last inspection the, inspector had focused on the lunch time routines, which was noted to be ‘relaxed’ and have a ‘friendly atmosphere’ with residents and staff dining together and catching up on news. This visit found the same positive atmosphere, with staff regarding the lunchtime as an important part of the resident’s day, and not to be hurried. Plates were not cleared away, until all the residents had finished, and each resident asked if they would like more to eat. Nine out of the 13 residents surveyed said that they ‘always’ liked the meals in the home, with the remainder stating ‘usually’. Discussions with the Chef confirmed that they had a good insight into individual residents likes and dislikes. They were also aware of any dietary needs linked to people’s individual faith. One advocate wrote that their friend’s vegetarian needs were ‘always dealt with in a sympathetic way’. Although the menu only gives 1 main course option, previous inspections identified that the Chef will confirm individually with residents if they are happy with the choice, and if not offer a second option, taking into account their preferences. A sample of 2 menus were looked at which showed the range of lunches provided over a 2-week period included: Lamb Stew and Dumplings, sauté potatoes Salmon Hollandaise and new potatoes Roast Turkey, roast potatoes Shepherds pie, mashed potatoes All served with fresh vegetables For supper residents are offered a choice from 2 options, for example smoked haddock or poached eggs, followed by a Banana split. The weekly menus inform the reader that Cheese & Biscuits, and fresh fruit are available on request at every meal. St Barnabas Residential Home DS0000024494.V336302.R01.S.doc Version 5.2 Page 17 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): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a robust complaints procedure in place. People living at the home, can expect any concerns they have to be listened to, and acted on in an appropriate manner. EVIDENCE: The home’s complaint procedure is displayed in the entrance hall, and a copy is given to all new residents on arrival, in their information pack. The Statement of Purpose makes reference to the home’s complaints procedure, and where the full policy can be located. Therefore anyone reading the document off the premises would not be fully aware of the policy, which informs them who to complain to, and when they would hear an outcome to their concerns. Completed CSCI surveys showed that residents and relatives knew how to make a complaint. One relative wrote ‘I have a good relationship with the manager and would mention any concern directly to her’. This was also reflected in resident’s comments during the inspection who said that they felt comfortable to raise any issues directly with the manager or their staff. Staff are made aware of the home’s complaint policy during their induction. The manager has systems in place to record any complaints made, and what St Barnabas Residential Home DS0000024494.V336302.R01.S.doc Version 5.2 Page 18 action they have taken. The home had made the CSCI aware of 1 complaint they were dealing with, and action taken by them to safeguard a resident’s welfare, which included making a vulnerable adult referral. Discussions with staff, and looking at training records, confirmed staff receive training in safeguarding residents welfare. They were aware of the different types of abuse, and what action they should take if they witnessed or had concerns that this may be happening. St Barnabas Residential Home DS0000024494.V336302.R01.S.doc Version 5.2 Page 19 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): 19, 23, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service can expect a comfortable, homely environment to live in, which suits their needs – but shows signs of wear and tear. EVIDENCE: A walk around the home, showed paint work marked by wear and tear, and carpets, which were clean and serviceable, but had become stained and faded over the years. However, this is being addressed by the home’s on-going maintenance programme. The first stage, which has recently been completed, was the refurbishment of the kitchen, and relocation of the laundry, which previously could only be accessed by staff taking soiled laundry through the dining room (when not in St Barnabas Residential Home DS0000024494.V336302.R01.S.doc Version 5.2 Page 20 use). Staff were pleased with the layout of the new laundry accessed from the corridor, and the kitchen, which is “easy to keep clean”. Since the kitchen refurbishment they have received a visit from the environmental health officer who wrote on their report ‘ a good standard of structure and cleanliness (16/3/07)’. Builders were on site during the inspection, working on the next stage, which includes an additional downstairs toilet, and enlarging the dining room, which will incorporate a conservatory. Weekly news bulletins from the architect during the early building work, kept residents and visitors fully updated on what was happening each week, and any disruptions they needed to be aware of. At the time of the inspection, one area of the home’s toilets was out of action for a small part of the day, but staff had ensured everyone had been informed. The builders completed the essential plumbing work linked in with the new build, and normal service was resumed, quicker than expected. The residents said that they enjoy watching the work being undertaken, and their honorary role as ‘foremen’. They were looking forward to the completion of the dining room and getting their view back of the green (which currently is home to the portacabin). They also said they would miss the thoughtful workman. Work is due to be completed by the summer. The manager said that they had also been given a £7,000 grant to purchase new carpets throughout the communal areas. Following all the building work, and the carpets being laid, the communal areas will also be re-decorated. This was seen as very positive, and will really ‘spruce’ up the home. One relative raised concerns that the cleanliness of their next-of-kin’s bedroom, commenting that it ‘has not been as good as it used to be’ that the ‘carpet is dirty and dusting is not done regularly’. A sample of 3 bedrooms were looked at, and 1 was found to have a stained carpet, which staff said had been cleaned, but they had been unable to remove the stains. They would like to renew the carpet, but due to the amount of personal belongings, and that the resident liked to spend a great deal of time in their room, staff said they would need to negotiate when this could be done. Shelves had been dusted, however, one shelf evidenced that the photograph holders had not been moved, as there was still dust behind. Staff confirmed that they would ensure the shelf was given another clean. Twelve out of the 13 residents asked, said they ‘always’ found the home to be fresh and clean, with 1 resident saying ‘usually’, which reflected the findings during the inspection. One resident also commented that the ‘laundry service is excellent’. Time spent with new residents confirmed that they found their bedrooms comfortable, and had personalised them with their own possessions. St Barnabas Residential Home DS0000024494.V336302.R01.S.doc Version 5.2 Page 21 The management had addressed concerns raised at the last inspection (see report dated 24/04/06) over the hot water supply to one hand basin being very hot, by putting in regular checks to ensure all hot water is supplied at a comfortable, safe temperature. A sample check of 2 resident’s hand basins, found the water to be a comfortable temperature to wash with. St Barnabas Residential Home DS0000024494.V336302.R01.S.doc Version 5.2 Page 22 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): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to fill the aims of the home and meet the changing needs of the current residents. EVIDENCE: The current staffing levels gives a ratio of 1 carer to every 3 to 4 residents during the morning, and 1 carer to every 6 to 7 residents in the afternoon and evening. On paper this is a good ratio, however taking into account it is a small home of 13 residents, without the presence of the manager, whose hours are not included in the care rota, it would restrict staff being able to take residents out in the afternoon. Discussions with the residents, manager and staff, showed that they make best use of their staffing resources, by planning their ‘in-house’ activities in the afternoons, therefore trips out to the local shops can be undertaken in the morning, when there are more staff on. Previous conversations with the manager confirmed that they would increase staffing levels for planned group outings, and if a resident required 1 to 1 care during a crisis. The charity controlling the home are aware, that an increase in staffing levels could affect the viability of the home, if it was not met with an increase in residency, which currently the building would not accommodate. St Barnabas Residential Home DS0000024494.V336302.R01.S.doc Version 5.2 Page 23 With a 100 response to the CSCI resident surveys, this ensured good feedback to identify if the current staffing levels were meeting residents assessed needs. Residents asked if they felt staff was available when they needed them, 9 replied ‘always’ and 4 ‘usually’. Comments made included ‘very helpful staff’ and ‘when only two carers on duty, it can be difficult for them to be in all places at once’. CSCI resident surveys also evidence that there was no concerns that the home was not able to meet resident’s individual care and support needs (see Health and Personal section of this report). This reflected the information given on the staff surveys, which also confirmed in their view, that the staffing levels were sufficient. During the night there is 1 waking member of staff on duty, and another carer who sleeps in on-call. Discussions with staff confirmed that they are not often called, and start at 6am to help with any residents who would like to get up early. The Chef, Kitchen Assistant, Housekeeper, Domestic and Supper Assistant make up the rest of the complement of staff. The Charities Committee also takes an active part in supporting the administration of the home. Staff records show that the home maintains a fairly consistent work force, with only 3 changes in the last 12 months. The manager confirmed that all care staff undertakes the Skills for Care induction programme and receive on-going training. Staff said the home had a good training and development programme to support them in their role. One carer remarked that they “had a lot of training lately” and had just “finished their National Vocational Award level 3”. Records supplied by the home showed that 50 of their staff held an NVQ level 2 or equivalent, with a further 3 staff currently undertaking the award. Staff’s individual records showed what training they had attended, which included ‘Stoma and Catheter care’, and ‘supporting individual with dementia’. The manager keeps a yearly training calendar, which gives information on training to be undertaken. The recruitment records for 2 of the newest members of staff were looked at, which showed that the home was following safe recruitment procedures. This was being undertaken by ensuring 2 written references, Criminal Bureau Record (CRB) clearance, and paperwork to validate identify had been obtained prior to staff starting work in the home. The manager confirmed that they also contact the previous employer to verbally validate the reason why the applicant left their employment. A shortfall (which had previously been raised with the home) was identified on both application forms, where the applicant had not given their full employment history, and reasons why they had left. St Barnabas Residential Home DS0000024494.V336302.R01.S.doc Version 5.2 Page 24 The application form template did not help the situation, as it only asked for the last 10 years of employment history. St Barnabas Residential Home DS0000024494.V336302.R01.S.doc Version 5.2 Page 25 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): 31, 32, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service can expect to be looked after by caring, approachable staff, who are well managed, and committed to running the home in the best interests of the residents. EVIDENCE: The Registered Manager Mrs Wendy Clack demonstrated throughout the inspection her commitment to running the home in the best interest of the residents. Mrs Clack said they had a “very happy” and “good team” at the moment, which reflects on the positive atmosphere of the home. One relative described the atmosphere as being one of ‘peace and calm’, another wrote in St Barnabas Residential Home DS0000024494.V336302.R01.S.doc Version 5.2 Page 26 reply to what do you feel the home does well, that it ‘provides a very caring, secure, and friendly home with individual needs taken into account’. Staff surveyed, all agreed that the home is ‘well run’, a view shared by residents and relatives whose comments included ‘Wendy Clack and her helpers are angels – I see them display kindness, patience, friendship and competence’. ‘staff continually have been very good and the management caring’. Time spent talking and observing staff practice, showed that they had a clear understanding of their role, and worked well as a team. All the staff spent time chatting to residents, and where 1 resident was seen to look anxious, staff spent time sitting holding their hand whilst giving reassurance. Being a small home, the manager comes in contact with all the residents as part of her daily routine, which includes joining them for lunch. They feel this is a positive way of gaining informal feedback from residents. More formal feedback is obtained through monthly committee meetings, where the manager gives an update of the home, including any concerns. The home also sends out annual quality assurance surveys, which focus on resident’s views of the catering. The feedback from their latest survey which has recently been completed, was still to be analysed and the results shared with the residents. Staff also update residents and visitors through a monthly newsletter. Records show that staff are receiving regular supervision, which gives both staff and management a chance to feedback any issues. People spoken with, also confirmed that manager had an open door policy, which enabled them to discuss any issues direct. St. Barnabas has produced set policies and procedures for staff to work to, including Health and Safety, which are regularly reviewed and updated as required. The home benefits from having 2 manual handling trainers, which enable staff to receive training as soon as they start their employment, and not wait for a course to come up. As part of their induction staff receive training in Food Hygiene, Infection control and Fire safety. Records also showed that some staff had received First Aid and training in administering medication. There is a fire risk assessment in place, and the home ensures fire safety systems are regularly serviced and checked to ensure they are in safe working order. Whilst walking around the home, it was identified that 1 resident had ‘parked’ their shopping trolley in the corridor close to their bedroom door. However, the trolley was in front of the fire extinguisher, and would hinder the exit of any people using a wheelchair. The manager said they had discussed this with the resident concerned, and would do so again – whilst offering a safer parking spot in their new storage area. St Barnabas Residential Home DS0000024494.V336302.R01.S.doc Version 5.2 Page 27 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 X X X 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 3 X 3 X X 3 St Barnabas Residential Home DS0000024494.V336302.R01.S.doc Version 5.2 Page 28 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 OP1 Regulation 13 (2) Requirement Medication Administration Records must list all medication that the person is taking which will ensure residents are given the correct medication. The home must ensure that they obtain a full employment history on all new staff, which will ensure that checks on staff are robust to protect residents. Repeat requirement Timescale for action 18/04/07 2. OP3 19 Schedule 2 (6) 18/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP8 Good Practice Recommendations The control drugs register and storage cabinet should meet the requirements of the Misuse of Drugs (Safe Custody) Regulations 1973. As part of the home’s quality assurance activity, they should look at how they can gain more individualised DS0000024494.V336302.R01.S.doc Version 5.2 Page 29 2. OP19 St Barnabas Residential Home feedback on what activities/social stimulation residents would like to see happening in the home. St Barnabas Residential Home DS0000024494.V336302.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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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