Inspection on 24/04/06 for St Barnabas Residential Home

This inspection was carried out on 24th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 18/04/07

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 Southwold Suffolk IP18 6AJ Lead Inspector Jill Clarke Unannounced Inspection 24th April 2006 10:50 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.V289788.R01.S.doc Version 5.1 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.V289788.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service St Barnabas Residential Home Address The Common Southwold Suffolk IP18 6AJ 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) 01502 722264 The Trustees 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.V289788.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th December 2005 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.V289788.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a unannounced key inspection, undertaken over 7 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. During the visit, time was spent talking to 7 of the 13 residents to hear their views on the home. CSCI surveys were also used during the visit, to enable residents and staff to feedback their views, anonymously if they wished. Five of the residents, and 6 staff, completed the surveys during the visit; comments made 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 and toilet. 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: The home is in a desirable location, with uninterrupted views across the common to Walberswick, and within walking distance of the shops and sea front. On entering the home, you are made to feel welcomed by residents and staff. The environment is homely and comfortable, with many period features. Residents confirmed that the home is “always” kept clean and odour free. Lunchtime in the small dining room was relaxed, and unhurried, which promoted conversations between residents. All residents were asked if they would like more food, before the dinner plates were cleared away. Residents asked to comment on the food replied “always very good” “standard of food good”, “vegetables very good” and praised the Chef, who had time to discuss any of their individual food likes and dislikes with them. Residents liked the home and staff, their comments included “do what you like” “cheerful place all the helpers are helpful”, “are treated as individuals – treated very well”, “looked after very well” and that staff are “friendly”. CSCI St Barnabas Residential Home DS0000024494.V289788.R01.S.doc Version 5.1 Page 6 survey asked residents ‘if there was anything else that you would like to tell us? 1 resident had written ‘Yes I am happy here’, another wrote ‘I am often very impressed by the patient and cheerfulness of the staff, and feel very lucky to be here’. Resdients felt the home was well managed, staff approachable and caring. What has improved since the last inspection? 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. St Barnabas Residential Home DS0000024494.V289788.R01.S.doc Version 5.1 Page 7 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.V289788.R01.S.doc Version 5.1 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. (Home does not offer intermediate care) People wishing to move into the home, can expect to have their needs to be assessed, invited to visit the home, and given a trial period to decide if the home is right for them. The written information on the home could be more informative, to ensure people enquiring about the home are fully aware of the level of service the home is able to provide. EVIDENCE: Following the last inspection the home was asked to update their Statement of Purpose, and produce a more ‘user friendly’ Service User’s Guide. The new Statement of Purpose had been completed, however, the Manager said that they were still working on the Service User’s guide. It was agreed that the timescale would be extended to support the home at looking at different formats that could be used. This would also give time for staff to consult with residents to obtain feedback, and identify what information they would like to see added. Five residents, who had completed the CSCI survey, had all said that they had been given enough information on the home to support them in deciding if St Barnabas was right for them. St Barnabas Residential Home DS0000024494.V289788.R01.S.doc Version 5.1 Page 9 The Statement of Purpose is seen by the CSCI as a stand-alone document, giving the reader information on the home’s aims and objectives, facilities, services and who they are registered to look after. The Home’s Statement of Purpose, although informative in some areas, does not confirm who they can, and cannot look after. It does not give information on what would happen if the resident’s needs changed and the home was no longer able to, or registered to be able to care for them. For facilities, services and complaints the reader is directed to other information/policies to read in the home. Time spent talking to a new resident, confirmed that they had been able to look around the home before they moved in on a 4-weeks trial. The resident said that at the end of this time, it was their decision to stay, as they felt the home could meet their needs, and they were happy with the standard of care and environment provided. The manager assesses all prospective residents, recording information on a pre-admission template, which covered a good range of information. However, on looking at the 2 completed admission forms, for residents who were paying privately, and had no Social Care Assessment, 1 was found to give limited information. The medication and medical history had not been completed. The manager said that it was sometimes more difficult to complete the preassessment fully, whilst residents are visiting/looking around the home. Although not fully completed, discussions with the resident concerned, confirmed that the home could clearly meet their needs, and the resident was able to give any required information themselves, which they had done on admission. In the files of the 2 residents whose admission was being tracked were copies of contracts (Terms and Conditions of Residency), signed by the resident (or advocate) and the home. From the 5 residents who had completed the CSCI survey, 2 had ticked ‘yes’ to having been given a contract, 1 had stated ‘sorry can’t remember’ and the other 2 had been left blank. Residents were heard to discuss the surveys before lunch; some remembered being given a contract, which “they had put in their drawer”, but general agreement amongst themselves, was that they must have received a contract, and they were aware of the fee increases. St Barnabas Residential Home DS0000024494.V289788.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the service can expect their wishes concerning their personal care to be written in a care plan, and monitored. Medication received into the home is not being recorded accurately, which could potentially put residents at risk, as staff are unable to fully check, if all medication has been given. EVIDENCE: Two residents care was ‘tracked’ during the inspection, which included talking to the residents (where able), reviewing their care records (care plans), and discussing with staff the level of care/support given to the resident. Care plans covered all aspects of the resident’s daily lives, by using a ‘daily needs assessment’. An action sheet gave staff guidance on areas of concern that they need to be aware of. For example to support a new resident to settle in, the action plan stated ‘to establish a routine which will suit [resident’s name]’. Information had been written on how the resident liked to spend their day, and their preferred meal times ‘likes breakfast upstairs’. There was a good write up about the person, and what action was taken to support them, as they had found it difficult to settle in at first. Staff and management spoken with, had a good insight into resident’s physical and mental health needs. Information in care plans was good, but needs to be St Barnabas Residential Home DS0000024494.V289788.R01.S.doc Version 5.1 Page 11 more informative on what residents can do/be encouraged to do for themselves, to maintain independence and support new staff, who will not know the resident. Information on daily personal care and visits from external health professionals, such as Nurses, Chiropodist, Optician and Dentist was kept on a separate file. The Malnutrition Universal Screening Tool (MUST), discussed at the last inspection, had not been instigated. Care plans had an area for ‘Nutrition monitoring’ but no weight had been written in for 1 of the new resident’s, whose care was tracked. One care plan showed that a resident had sore heals, and action taken by staff, to make the resident more comfortable. The manager confirmed that none of the residents was being treated for pressure sores. Staff write an informative daily record of residents’ wellbeing, and any concerns they may have. One resident’s care records showed that they had sustained a lot of falls during December (8) and January (6). There was no falls risk assessment or referral to a falls coordinator. The reason for the falls was documented, including accident reports. The manager confirmed that action would have been taken, if the falls had continued, which was more due to the resident trying to maintain their independence, and not request help. Records showed only 1 fall in February. Feedback to ensure the residents were given the level of support they wanted was also gained through completed surveys, open discussion with 6 residents after lunch, and with 1 resident in the privacy of their bedroom. Residents confirmed that they were given the level of physical and medical support they wanted. One resident said if they “need help” staff would always help, another also described staff as being “very helpful”. During the lunch staff were attentive and respectful however, 1 member of staff was heard by the inspector to speak about a resident they were helping in the ‘third person’, to other staff sitting at the table. The member of staff may also not have been aware that their voice carried across the dining room into the lounge area, which included every instruction and word of encouragement said to the resident. Residents were asked if they found staff polite and respectful, all replied “yes”, and raised no concerns over staff conduct. When asked if they were able to see their Doctor if they wanted? 1 resident replied, that on moving into the home they had been able to remain with the same surgery and when they “wanted to see the Doctor they would come”. They said is was “not always easy to get an appointment”, which was not the home’s or the Doctor’s fault – more due to the Doctor’s work load. From the residents who were surveyed, 2 had said that they always received the medical support they needed, and 3 had replied ‘usually’. Care plans viewed showed that staff had monitored resident’s physical and mental health, and Doctors had visited when contacted. There was also regular input from the community nursing team for 1 of the St Barnabas Residential Home DS0000024494.V289788.R01.S.doc Version 5.1 Page 12 resident’s whose care was tracked, which included renewing their dressings and taking bloods. During the last inspection (see report dated 6 December 2005) major shortfalls were identified in how the home stored, recorded and transported medication around the home, which was seen as unsafe. A review of the home’s current system showed work undertaken to address the concerns. They had liaised with their Pharmacist, who now sent up printed Medication Administration Records (MAR) with the sealed dossett boxes. A relative has purchased a, specialist medication trolley, to be used with dossett boxes, which the home is waiting to be delivered. Until the arrival of the trolley, which had been delayed, liquid medicines are still being carried around the home, ready dispensed into named containers with lids on. The manager confirmed that liquid medications were not made up in advance, but poured out by the person giving out the medication at the time. MAR charts showed that staff were signing to confirm medication had been given, and recording on a weekly basis, the amount of medication delivered in the dossett boxes. The home kept a separate book for all medication received, which has not been delivered in the dossett box. Although the date and the name of the medication received had been recorded, staff had not entered the quality received. This raised concerns over not being able to track and monitor medication being given out to ensure the right amount had been given. This was also identified at the last inspection, when they were asked to take immediate action to address the situation. A sample audit of 1 resident’s medication not held in a dossett box, against records held, was unable to be carried out. This was due to the bottle of Methotrexate stating 7 tablets had been dispensed by the pharmacist, however on counting the contents of the bottle it was found to hold 10. Records did not show how many had been brought into the home. Since the last inspection, staff had given the medication cupboard a good ‘spring clean’, which included getting rid of out of date medication. It was noted that this had included getting rid of all the ‘homely’ medications, which meant that staff were reliant on being able to get a prescription for minor ailments. The manager confirmed that staff had not undertaken training in medication “for some time”. A look at 1 member of staff’s training record showed that medication training had been given 6 years ago. The home’s medication policy did not give clear guidelines on what action to take if medication was given in error. The manager was shown (obtainable from the CSCI website) a copy of the new (19 April 2006) CSCI guide lines, which gave professional advice on the ‘Administration of medicines in care homes’, ‘Training care workers to safely administer medicines in care homes’, and the completion of MAR sheets. St Barnabas Residential Home DS0000024494.V289788.R01.S.doc Version 5.1 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Meals are well presented, tasty, varied, and nutritious. People using the service feel in control of their lives, and feel comfortable to voice their opinions and preferences. Although the home has continued to develop their range of ‘inhouse’ activities and social outings, not all residents felt it met their needs. EVIDENCE: One resident spoken with felt there were enough activities going on in the home. They went on to say that they preferred to spend a lot of time in their bedroom, when asked about going out, they said that they “did not wish to go out”, but if they wanted to, they could. Feedback from other residents through the survey and discussion group was mixed. When asked (CSCI survey) ‘are there activities arranged by the home that you can take part in?’ 3 out of the 5 residents had stated ‘sometimes’ and 2 had ticked ‘always’. One resident had written that it ‘would be nice to get out more in wheelchairs, when staff are available’. The staffing rotas showed that this would need to be in the morning, due to only 2 staff on in the afternoon, unless the Manager was in the building to give the additional cover. One resident said they enjoyed the crossword activity, which 1 of the staff had just started doing, and that the home was planning some outings in the summer. Discussions with staff showed that they were looking to increase the activities. This was reflected in the home’s April Newsletter, which asked residents for St Barnabas Residential Home DS0000024494.V289788.R01.S.doc Version 5.1 Page 14 suggestions. One resident said they would like to have more outings, and activities going on, as they felt otherwise people tended to fall asleep in the afternoon. Another resident said they were “lucky”, as they were taken out a lot by their friends. This led to discussions that some residents were reliant on being taken out by family and friends, and would like to be able to go out more with staff. Care plans held information on resident’s social and religious interests, and gave information how they were supported to attend services, and Holy Communion at the local Church, or at the home. The residents information board showed that weekly, Thursday Afternoon activities were undertaken, recent entertainment provided (Irish folk songs). There was no separate social calendar kept in residents care plans, to be able to monitor what activities people were invited to, or take part in, and any social contact or outings undertaken. To be able to focus on the lunchtime routines, the inspector spent the hour sitting in the lounge area of the lounge/dinning room, so they could observe, but not be intrusive. The atmosphere was friendly, with residents meeting up, and using lunch as a social time to converse with each other. Some residents spoke about the morning events, including the inspection, and surveys they were completing. Dining tables were well presented with place mats, napkins, matching crockery, cutlery, glasses and water jugs. Residents were also offered a choice of cordials and Cranberry juice. Staff did not rush the meal service, making it relaxed, with the residents, not staff leading the timings. They served each resident with a plated meal (Lamb Stew & Dumplings, Bircher potatoes, Swede and Cauliflower), offering more gravy if they wished. One resident had ordered a vegetarian meal. Once all the residents had been served, staff joined the residents at 1 of the tables for lunch, where they could also assist a resident with their meal. The inspector later asked a resident if they would have preferred to be able to serve their own vegetables from dishes at the table, rather than have their meals ready plated. They said they preferred staff doing this for them. Plates were not cleared away until all the residents had finished, and each resident had been asked if they would like some more to eat, and confirming that they had finished. The dessert, Apple Meringue (served with cream or ice cream) was brought round on a trolley by staff, to allow residents to see and choose for themselves. There was also fresh fruit and mandarins as an alternative. Staff asked each resident in turn, what they would like, and if they were not sure, staff were seen showing the residents the selection of desserts on offer. St Barnabas Residential Home DS0000024494.V289788.R01.S.doc Version 5.1 Page 15 Residents asked if this was the normal routine, replied “yes”, although a resident commented that it was “not always relaxed – but pretty relaxed”. One resident felt it was more relaxed when the “boss was in the building”, but they confirmed they were always offered, “seconds for main course”. Residents spoken with described the standard of food as “good”, especially the roast, saying, “it was a better roast than your mother could make”. All agreed there was plenty of choice, if they did not like the main course they would just speak to the Chef. The resident who was vegetarian, felt well catered for, saying they discussed on a daily basis with the Chef what they would be having for lunch. However, 1 resident had written (CSCI survey) that they found the ‘meat and sausage often too tough’. A resident said they enjoyed having their breakfast in their bedroom in the morning. When asked about the evening meal, they said staff would ask each day what they would like for supper. The menu on the day of the visit was Soup and Toast, Mackerel Salad, followed by Fruit Cocktail and Evaporated Milk. Residents praised the Chef, and said that they would always cook something different if they did not like what was on the menu. Discussions with the Chef during previous inspections, identified in such a small home, they were able to get to know all the residents’ likes and dislikes. When they knew that the resident might not like the main choice, they would approach them first with an alternative. The menus looked at, for the week beginning 24 April 2006, showed a good variety of home cooked meals. Staff confirmed that they could access snacks and drinks for residents at any time of day or night. Residents spoken with felt able to do as they wished, and make their own decisions and choices. However 1 resident had written in the additional comments box (CSCI survey) that they ‘would like someone to come earlier in the morning to help me get up’. This was fed back to the manager, who confirmed that they always try to accommodate residents individual wishes, however, although sometimes a resident may ask to receive help earlier, when arranged, they sometimes found that they had changed their mind and decided to get up later. Staff confirmed that they worked flexibly to ensure residents chose when they wanted to get up or retire, which was reflected in a resident’s comment that they “could do what” they “liked”. St Barnabas Residential Home DS0000024494.V289788.R01.S.doc Version 5.1 Page 16 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. The home has a robust complaints procedure, however until all staff are trained in the home’s abuse policy, people using the service cannot be assured that staff will always take appropriate action when concerns are raised. EVIDENCE: The home’s complaint procedure is displayed in the entrance hall, which informs residents and visitors how they can make a complaint. Residents surveyed, and discussions with residents during the visit, all confirmed that they knew whom to complain to. CSCI and the home’s records showed that no complaints had been received. 50 of the staff surveyed had received training in the home’s abuse policy. The manager confirmed that this was being addressed as they had attended the Vulnerable Adult Protection Committee’s (VAPC) ‘Train the Trainer’, which now enables them to carry out their own ‘in-House’ Adult Protection Training. The manager said that they now planned to arrange training for all the staff at the home. Since the last inspection the home has obtained the latest copy of the VAPC (Suffolk) Inter-Agency Policy Operational Procedures and Staff Guidance, which was easily accessible for staff in the office. However, discussions with staff, identified that the home as part of their training may want to include every day scenarios, to make it more relevant to their role. St Barnabas Residential Home DS0000024494.V289788.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26. The home is clean, fresh and has comfortably furnished communal rooms, which promotes a homely atmosphere. Residents are encouraged to personalise their bedrooms as they wish. The hot water supplied to hand basins, is too hot, and could cause discomfort or risk of scolding when used. EVIDENCE: Time was spent talking to a resident in their bedroom. The room was large, airy, comfortably furnished, and overlooked the common. Asked if they felt warm enough they said staff monitored the situation, as the room could get cold at times, and would put the extra fire on, which was set in the fireplace, in keeping with the room. The resident, who had lived at the home for sometime, had moved to a ground floor room, to assist them with their mobility needs. The passenger lift is small, and can just take a wheelchair. Staff said that when they need to use a hoist they have to take it apart and reassemble. This could mean that when a resident falls, taking up to 20 minutes to be able to move them. The manager showed a pump up style, mobility aid, which uses cushions of air to aid a resident getting up from the floor. They felt this would St Barnabas Residential Home DS0000024494.V289788.R01.S.doc Version 5.1 Page 18 be more suitable to be used in bedrooms, where they have problems getting the hoist to. The member of staff spoken with confirm that they had enough mobility aids to support all the current residents individual needs. This was also reflected in the CSCI surveys completed by staff. The home was clean and odour free, discussions with residents, and completed survey’s confirmed that the home was always kept to this standard. The 2 bedrooms looked at were well maintained and decorated, however some corridors, doors, and bathrooms were showing signs of wear and tear. There was no on-going maintenance plan to identify when redecoration would take place. All communal rooms looked at had a homely, welcoming, comfortable atmosphere. During lunch, the dining room, although comfortably furnished, was not big enough to accommodate all the residents comfortably, and enable them to keep walking frames to hand, or move freely around the tables. However the Trustees, have written to the CSCI, and shown plans of extending the dining room, which will address the situation. Planning consent has been given, and funds are being raised to pay for the works. The temperature of the hot water supply to a communal bathroom was recorded as 42°C (bath) and 52°C (hand basin). The water to the hand basin was found to be too hot, and uncomfortable to use. The home was asked to take immediate action to reduce the temperature of the hot water, which comes from a central boiler, closer to 43°C. The bath was fitted with an individual temperature control, however, regular checks were not being undertaken to ensure the system was working correctly. Disposal gloves, liquid soap and paper towels were seen around the home, for use by staff, as part of their infection control procedures. The laundry system was not looked at during this inspection, and no concerns were raised by residents, or staff, over the laundry systems currently in use. Residents spoken with liked their bedrooms, which they had personalised, and were of different sizes, and outlooks. Lighting throughout the home was domestic in nature, some in keeping with the period property. Residents have easy access to the Common, overlooking Walberswick and within walking distance of the Southwold shops, beach and pier. St Barnabas Residential Home DS0000024494.V289788.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service can be expect to be cared for by staff who are well supported, and have had their training needs assessed, to ensure that they have the skills and knowledge to carry out their job. EVIDENCE: At the time of the visit the staffing levels were 1 senior and 2 care assistants, for 12 residents (1 resident was in hospital), this gave a ratio of 1 staff to 4 residents from 8am to 3pm. In the afternoon/evening between 3pm and 8 pm there is 2 staff on duty, which increases the ratio to 1 staff to 6 residents. During the evening, there is also a Supper Assistant on duty. Over night there is 1 waking member of staff, and a second sleeping in on call. Residents spoken with felt that there was enough staff on duty, although they did identify that with only 2 staff on in the afternoon, they would be unable to go out with a member of staff, unless the manager who works extra to the rota is in the building. Three of the 5 resident surveyed, when asked ‘are the staff available when you need them?’, said ‘yes’ and 2 had stated ‘ usually’. Feedback from residents confirmed that they received the level of care and support they required, but felt at times staff were too busy to be able to sit and talk with them. This was also reflected in another resident’s comments, who “wished they could see more of the staff”. Since the last inspection the manager has updated training records, which now gave clear information on what training staff have attended, and what needed updating. Staff had also completed training questions, and information gained St Barnabas Residential Home DS0000024494.V289788.R01.S.doc Version 5.1 Page 20 was being used to organise future training. Although records showed that some staff’s training was out of date, for example First Aid, the manager since taking over their post, has been focusing on organising and accessing training for staff. A file showed the different agencies they had been in contact with to arrange and cost out any training. In a positive move forward, new care staff are now being booked onto external induction training course, which will ensure that they have the training and skills to support them in their role. The home also has their own induction booklet, which covers emergency procedures and administration. Seven of the 11 care staff have already obtained their NVQ level 2 or above, with a further member of staff currently undertaking their NVQ 2. During a little impromptu meeting with 6 residents, they were asked if they felt the staff had the skills and knowledge to look after them, which they felt they had. To check that the home is following safe recruitment practises, the records of 3 new staff, taken on since the last inspection were looked at. Two of the completed application forms did not give a full employment history. The application form only asked applicants to give their employment history for the last 10 years. All contained 2 written references, paperwork to validate their identity, and proof that Criminal Records Bureau checks had been undertaken, prior to the staff starting work at the home. Staff complete ‘risk assessment for carers’, which asks questions such as ‘are you in good health’, and covers any back injuries, but no mental health questions. St Barnabas Residential Home DS0000024494.V289788.R01.S.doc Version 5.1 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, and 38. 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. The home is not always following safe procedures for the storage and labelling of chemicals hazardous to health, which could potentiality place people at risk. EVIDENCE: Mrs Wendy Clack was promoted to Manager, from Deputy Manager in June 2005, following the retirement of the previous manager. Since this time, Mrs Clack has applied and been registered with the CSCI. Part of the registration process included Mrs Clack attending the CSCI office for a ‘fit person’ interview. During the interview, Mrs Clack showed a commitment to ensuring residents receives a high level of care, within a homely environment is both provided and maintained. Mrs Clack was aware following both the June and December 2005 inspections, that they had a great deal of work to undertake, St Barnabas Residential Home DS0000024494.V289788.R01.S.doc Version 5.1 Page 22 to ensure all policies, procedures and practices carried out at the home, meet the National Minimum Requirements for Older People. Mrs Clack was also realistic that they would need to prioritise, and it would take time to get through the required work. Discussions during the Fit Person’s interview, and this visit, showed the hard work undertaken, in systematically reviewing and updating records, whilst at times being required to work hands on to cover staff shortages. Mrs Clack was aware that they had not been able to get all the work completed within the timescales, which led to discussions of extending timescales, which were not related to Health & Safety. Residents asked about the management of the home, described Mrs Clack as “helpful – if need help – will help”. They felt the manager was approachable, and had no concerns over the change of managers, with 1 resident stating that although there had been changes in managers over the years “they have all been good”. On 1 resident’s survey, in the additional comments they had written that the manager ‘stays mostly in the office, hardly ever comes to our rooms’. This was not evidenced during discussions with residents on the day, who spoke warmly of the manager, who they saw often. The manager confirmed that they always go round and visit all the residents each day. All the staff (6) that had completed the CSCI surveys felt that the home was well managed. No formal quality assurance surveys has been undertaken by the home, although feedback has been obtained through residents meetings, and on a 1 to 1 basis with ‘key workers’ and management. The manager said that they are looking to undertake a resident survey with the Chef focusing on meals to update their menus. A copy of the CSCI’s ‘Highlight of the day?, Improving meals for older people in care homes’ (March 2006), was looked at by the Chef, and discussed during the inspection. The Trustees running the home are required to nominate a ‘Responsible Individual’ who will be the link between the CSCI and the Trustees. An nomination has been made, and application has just been received (28/4/06). A person designated by the Trustees is also required to visit the home unannounced at least once a month, and write a report, which is forwarded to the members of the Trustees, Registered Manager and CSCI. Although some have been received, which have been informative, these were not happening regularly on a monthly basis. Information gained is used as part of the ‘arms length’ on-going monitoring of the home. The manager showed the programme they had developed, to monitor and ensure all staff now receives regular supervision. This showed that all staff had received supervision during February or March, and the manager would continue to ensure one to one supervision would be carried out every 2 months. Staff files looked at (3) showed completed supervision records, St Barnabas Residential Home DS0000024494.V289788.R01.S.doc Version 5.1 Page 23 employees self-appraisal and training needs identification form. CSCI staff surveys, also confirmed that staff now receive regular supervision. Food Hygiene refresher training had been arranged for all staff in May, and records showed that staff had undertaken Fire training in March 2006. New staff will now receive Manual Handling training as part of their induction course. Training record for 1 member of staff looked at, showed that they had undertaken training in Infection Control, Fire Safety and Manual Handling during the last 12 months. Records showed that the fire call points and emergency lighting were being checked as per fire risk assessment. Although it was noticed that monthly checks of emergency lighting had been changed from monthly to 3 monthly. This they said was on the advice of the person carrying out the checks. The manager is currently updating the fire risk assessment to ensure it meets all the required guidelines and is up to date. This will include the location of any inflammable fluids that the Fire service would need to be made aware of. In the sluice room, although there was a lockable cupboard, some cleaning fluids had been placed in an unlocked cupboard. The manufacturer’s label on 1 bottle of cleaning fluid that had been decanted from a larger container was unreadable. The safety data sheets for the chemicals, which had been decanted, were hanging outside the cupboard, but there was no safety data sheets seen for the other bleach-based cream cleaner. The manager confirmed that the cupboard should have been locked, and would bring this to the staffs attention. The manager was aware of their responsibility in ensuring, for the safety of residents that staff knowledge and practices are kept updated. Staff undertook Fire Safety training in March, and Food Hygiene training has been arranged for the 22 May 2006. New staff who are now booked on external induction courses will undertake First Aid, as part of their induction. A member of staff on duty confirmed they had undertaken First Aid training. The accounting and storage systems used for looking after residents money held for ‘safe keeping’ was not reviewed during this inspection. However, the manager was contacted (2/5/06) and verbally went through their system, which included each resident being issued with a ‘Residents personal monies and Property book’. This gave a record of all deposits and withdrawals, kept in a plastic ‘pocket’ with the resident’s money. The manager confirmed that following discussions during the June 2005 inspection, the signature of both resident and staff (or resident unable to sign – 2 staff signatures) are obtained for each transaction, as part of their safe guarding measures. All monies are held in a lockable drawer, with restricted key access. A check audit of the monies held, against the homes records will be checked at a future inspection. St Barnabas Residential Home DS0000024494.V289788.R01.S.doc Version 5.1 Page 24 St Barnabas Residential Home DS0000024494.V289788.R01.S.doc Version 5.1 Page 25 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 1 3 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 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 2 2 3 X 3 3 3 2 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 3 2 X 3 3 2 2 St Barnabas Residential Home DS0000024494.V289788.R01.S.doc Version 5.1 Page 26 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 4, 5 Schedule 1 Requirement The home must complete their Statement of Purpose (meeting all the requirements of Schedule 1) and Residents Guide, and make copies available to residents, and their representative. A copy should also be sent to the CSCI. This is a repeat standard (06/12/05), which had not been fully met. Timescale for action 01/06/06 2. OP3 Regulation The home must ensure people 14 (1) trained to do so, prior to writing to the prospective resident to confirm that the home is able to meet their needs, have undertaken a full preassessment. Regulation Staff must not, even if it is the 13 (2) same medication, move tablets from one prescribed pharmacist container to another. 13 (2) The home must have safe systems in place to record all medication coming into, and out of the home. DS0000024494.V289788.R01.S.doc 05/05/06 3. OP9 05/05/06 4. OP9 24/04/06 St Barnabas Residential Home Version 5.1 Page 27 5. OP9 13 (2) This is a repeat standard (06/12/05) which had not been fully met. The home must have policies and procedures in place to ensure residents can access treatments for minor ailments outside Doctor’s Surgery hours, to ensure they are not left in discomfort. The home must make arrangements to ensure all staff involved in the administration of medicines have received training/refresher training in current safe practices. The home must review their medication policies to ensure it clearly states what action to be taken if medication is given in error. 01/06/06 6. OP9 13 (2) 18 (1) (a) 01/07/06 7. OP9 13 (2) (4) 01/07/06 8. OP18 13 (6) The home must organise training 01/08/06 to ensure all staff are aware of the different types of abuse which can occur, and what action they should take in reporting any concerns, in line with the home’s abuse police and local protocols. To prevent the risk of scalding, the hot water supplied to hand basins, which can be accessed by residents, must be reduced to an acceptable temperature (between 41 to 43°C). To ensure the safety of residents, cleaning fluids must be locked away. Where chemicals have been decanted (according to manufactures instructions) and become unreadable, they must contact the manufacture to obtain new labels. DS0000024494.V289788.R01.S.doc 9. OP25 13 (4) 24/04/06 10. OP38 13 (4) 01/06/06 St Barnabas Residential Home Version 5.1 Page 28 11. OP29 19 Schedule 2 (6) 26 The home must ensure that they obtain a full employment history on all new staff. A regulation 26 visit must be undertaken at least once a month, and a report completed. On completion a copy should be forwarded to the other Trustees, Registered manager and the CSCI. 05/05/06 12. OP33 01/06/06 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 OP3 Good Practice Recommendations Where staff are unable to obtain all the required information from prospective residents, during their trial visit, then they should take action to visit the person in their own home, or make further contact with them, their family or Docotr (if applicable and with their permission), to ensure they have all the required information. The home should look at introducing a nutrition monitoring tool, such as MUST, to support them in monitoring and taking appropriate action when required, relating to residents nutritional needs. (this is a repeat recommendation from the 5/12/05) Care plans, to encourage independence, should reflect what residents are able to undertake from themselves, and any goals, that have been set. To be able to quickly identifying individual residents social contact, the home should consider using a separate social calendar as part of the residents care plan, which documents over the month what social activities they/outings and contact they have had. 2. OP8 3. OP8 4. OP12 St Barnabas Residential Home DS0000024494.V289788.R01.S.doc Version 5.1 Page 29 5. OP22 The home should consider purchasing a hoist/aid to support residents getting up off the floor, which can be easily be transported around the home, which does not require to be dismantled to fit in the lift. To get an over view of the planned work being undertaken, it is recommended that the home keeps a maintenance plan, which gives details of all planned and on going maintenance work, including redecoration and any planned replacement of worn items. (this is a repeat recommendation from the 5/12/05) To support the home in taking a view that staff are both physically and mentally fit, the home should review their ‘staff risk assessment’ to give more detailed information. The home should include in their Fire risk assessment, what action they have taken, following the recommendations made by the contractor who undertook their fire risk assessment. 6. OP19 7. OP29 8. OP38 St Barnabas Residential Home DS0000024494.V289788.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Barnabas Residential Home DS0000024494.V289788.R01.S.doc Version 5.1 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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