CARE HOME ADULTS 18-65
Barn (The) Holton Lee East Holton Holton Heath Poole, Dorset BH16 6JN Lead Inspector
Sally Wernick Unannounced Inspection 13 March 2006 10:15
th DS0000026821.V285091.R01.S.doc Version 5.1 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 DS0000026821.V285091.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000026821.V285091.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Barn (The) Address Holton Lee East Holton Holton Heath Poole, Dorset BH16 6JN 01202 631063 01202 631063 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) East Holton Charity Ms Elizabeth Ann Jones Care Home 4 Category(ies) of Physical disability (4) registration, with number of places DS0000026821.V285091.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. One or more Service Users, who will have a physical disability, may also be over the age of 65. 4th August 2005 Date of last inspection Brief Description of the Service: The Barn at Holton Lee offers accommodation for holidays, activities, retreats and relaxation for up to 9 people with a physical disability, although at any one time only 4 will require personal care. Family members, friends or carers can accompany guests and accommodation is provided to support this. The Barn is a modern building set within 350 acres of varied landscape with views towards Poole Harbour. The building is fully wheelchair accessible and designed to meet the needs of people who have a physical disability. The house provides single or double room accommodation. Other facilites include adapted bathroom and toliet including overhead hoist in a shower room, mobile hoists, Apollo bath, alarm call systems and electrically operated beds. Communal areas consist of a resource room fitted with compuiters with internet access, lounge with TV, a sitting room and a large dining room. As well as the main kitchen where staff prepare the meals there is a guest kitchen for snacks and drinks. During the day service users can use power chairs and scooters to go around the grounds, for bird and deer watching. At extra cost guests can book additional services such as counselling, massage/aromatherapy, reflexology and carriage driving. The home is not particualrly close to community resources being in a rural area, however this is in keeping with the expectations of this service. Guests who wish to visit local towns can make taxi arrangements. DS0000026821.V285091.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection visit was unannounced and started at 10:15 am on Monday, 13 March 2006. It was conducted as part of the normal routine of inspecting twice during a twelve-month period. The registered manager Ms Jones and members of the staff team assisted the inspector in her work. Methodology used included a tour of the premises, review of records and discussions with guests and staff. Not all of the National Minimum Standards were assessed on this visit. Please note where a National Minimum was not assessed the score is shown as X. What the service does well:
The home provides excellent holiday respite for approximately 8 guests at any one time. During the inspection 6 guests were enjoying the facilities at The Barn four of whom had holidayed there many times before. Without exception those spoken to had high praise for the care, attention and support they received whilst enjoying their holiday/respite break. All said that they were free to ‘do as they please’, to have the freedom to rest, relax and enjoy their holiday as they wished. Guests at the Barn present with a range of abilities and all stated that they received the right amount of assistance for their particular emotional and physical needs. Guests reported “nothing is too much trouble for staff at The Barn” and care is taken to provide resources, which cater for individual likes and dislikes. There are good links with other healthcare providers within the community if guests require. There is a clear complaints policy in place however no complaints have been received within the last four-year period. Staffs receive training in adult protection and there is a policy in place to protect vulnerable service users. The Barn whilst safe, clean and comfortable is about to undergo a major change. New ten-bedroom accommodation all with en-suite facilities is due to be built adjacent to the current barn. This will significantly improve the environment and enhance the comfort for guests. The Barn staff benefit from a structured induction programme. All receive training in equal opportunities and training and development is linked to the charities overall aims as well as service users needs. There is a clear quality assurance system in place and guest views regularly inform decision-making. A range of training, policy and practice protects the Health, safety and welfare of service users and there are good links with the local fire department. DS0000026821.V285091.R01.S.doc Version 5.1 Page 6 Guests return year after year to The Barn and cannot speak highly enough of the service and care they receive. It is clear that Holton Lee benefits a wide range of individuals and provides a much, needed well valued community resource. 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. DS0000026821.V285091.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000026821.V285091.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Care plans are in place for guests at The Barn and provide information on physical and emotional needs. EVIDENCE: This standard was reviewed fully during the last inspection and will not be repeated here. Recommendations were made however, in relation to care plans, which were observed to be out of date and scant in detail. As a result and prior to guests arrival up-to-date care plans are now requested from care managers and guest information forms are completed in full. Risk assessment however, would benefit from greater detail as identified in standard 9. DS0000026821.V285091.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7&9 Staff provides guests with the assistance and information in order that they may make decisions about their own lives. Written risk assessments are not yet in place for minimising the risk of harm to both staff and guests. EVIDENCE: All of the holiday guests at The Barn live independently within the community. Prior to their arrival they indicate on a guest requirement form specific levels of assistance and support needed. All six guests spoken to had only the highest praise for the staff stating that the levels of assistance provided were dictated by individual choice and assessed need. The Barn offers a range of activities including motorised vehicles, which enable guests to access the 300 acres of Holton Lee. This is a great opportunity to enjoy the countryside and view the wildlife. Each guest receives a driving lesson and detailed instructions and where appropriate will be accompanied by a member of staff. These actions however are for example not recorded in a risk assessment and there is no written method for recording how to minimise the potential risk of accidents for guests and staff. In order to ensure the
DS0000026821.V285091.R01.S.doc Version 5.1 Page 10 safety for all users the registered manager will be implementing written risk assessments for activities within The Barn, which will be reviewed during the next inspection period. DS0000026821.V285091.R01.S.doc Version 5.1 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not assessed on this occasion. EVIDENCE: DS0000026821.V285091.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 Guest’s physical and emotional needs are recognised and there are procedures in place to ensure that these are met. EVIDENCE: Many of the guests at The Barn have visited on a number of previous occasions. As a result over time their physical and emotional needs are known, recorded and well met. New and old guests complete their own requirement form, which provides relevant information to enable staff to support physical and emotional health. Care plans from managers are in place and there are good links with health care practitioners locally if additional care is needed. Guests report that “nothing is too much trouble for staff and every effort is made to accommodate all physical and emotional health needs. DS0000026821.V285091.R01.S.doc Version 5.1 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 A system is in place to deal with any complaints that might be made about The Barn to ensure that concerns will be listened to and investigated. There are systems in place to protect guests from harm and abuse. EVIDENCE: A suitable policy and complaints procedure is in place at The Barn and each guest receives a copy with their welcome pack. There is a formal record of complaints, which is maintained by the registered manager. No complaints have been received since 2002. The Barn has an adult protection policy and procedure and a high proportion of the staff have received training in the protection of vulnerable adults. There is a clear whistle-blowing policy and The Barn supports the “No secrets” local policy. Guests spoken to during this inspection commented on the high levels of respect afforded to them by staff of their sensitivity and high levels of individual care. DS0000026821.V285091.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 The Barn provides a safe, homely and comfortable environment well suited to the needs of the current guests. The Barn is clean and hygienic and promotes safe working practices. EVIDENCE: The accommodation arrangements at The Barn are well suited to the needs of the guests although vast improvements are underway. The charity is currently in the process of building a new 10 bedded fully en-suite facility adjacent to the current accommodation. Tenders are currently underway and the new building is expected to by completed by the end of 2006. The current accommodation continues to offer a well-maintained safe interesting environment with a resource room, which enables access to the, Internet, and a range of information services. The communal sitting room and dining area, provides lovely views of local bird life as well as the surrounding shrub land. There is a good range of up-to–date reading material, games and videos and the premises are accessible to all guests. The Barn is bright and airy and meets the requirements of both the local fire service and environmental health department.
DS0000026821.V285091.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 Guests are supported by a sufficient number of staff that is suitably trained and qualified offering consistency of care within the unit. However the target of 50 staff with NVQ qualification by 2005 is almost but not yet met. EVIDENCE: Staff at The Barn has a wide range of qualifications and experience, which makes them well placed to work with all guests. There is a structured induction in place, which provides training in a range of Health and Safety topics and all staff receive equal opportunities training. Training and development are linked to the Barn’s aims and to service users needs. Almost 50 of staff is trained to NVQ level this standard will almost certainly be achieved by the end of 2006. DS0000026821.V285091.R01.S.doc Version 5.1 Page 16 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 & 42 Guests are asked to make their views known and to have regular input into policy and practice. The Health Safety and welfare of guests and staff are protected by current policy, procedure and practice. EVIDENCE: Following their stay all guests are asked to complete an evaluation form, which is reviewed both by the registered manager and the director. Any areas of concern are followed up as a result of this by letter and results are incorporated into the charity’s strategic yearly review. Family members also complete evaluations although at the current time care managers and other stakeholders are not included in the quality assurance programme. There is a five-year management plan in place and the views of guests strongly influence, decision making. For example the decision to undertake the new build has been made following comments from guests who benefit from the current provision and who has expressed a preference for en-suite facilities. DS0000026821.V285091.R01.S.doc Version 5.1 Page 17 The manager stated that all staff has received training in moving and handling, fire safety, first aid, food hygiene and infection control. There is clear evidence that all electrical and gas systems are well maintained and that regular servicing of the lift, and hoists takes place. The Barn has a particularly good relationship with the local fire station who regularly take part in staged evacuations with guests and staff and who provide advice on maintaining equipment. It is clear that investment in the quality and provision of service continues to be of paramount importance to the manager and registered providers. DS0000026821.V285091.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 3 X 2 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 X X X X 3 3 X 3 2 DS0000026821.V285091.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement 50 of care staff must be qualified to at least NVQ level 2 and qualifications gained by the extended date of 2006. Timescale for action 31/12/06 1 OP32 18 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 YA9 Good Practice Recommendations An individual risk assessment approach should be used in assessing potential risks to service users across the range of activities and arrangements in place at The Barn. A full range of polices should be available as indicated by Appendix 3 of the NMS for Younger Adults. This should include for example policies on gifts to staff, sexuality and relationships and the use of alcohol and substances by service users, visitors or staff. (Not reviewed at this inspection). Reports made by the person visiting the home on behalf of the Registered Provider must be made available to the Commission. Greater care should therefore be taken to ensure that all such reports are made available. (Not reviewed at this inspection). 2. YA40 3. YA43 DS0000026821.V285091.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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