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Inspection on 04/08/05 for The Barn

Also see our care home review for The Barn for more information

This inspection was carried out on 4th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The Barn is very good a providing their service in a manner which meets the personal requests of service users. 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. Food provision is of an excellent standard. Service users all stated that food provided was `good home cooking` cooked with fresh ingredients. When asked, `What is the best thing about being at The Barn?` all reported that food provision was excellent. Care staff were noted to be caring and committed to their work. Once again service users rated the staff team as one of the best things about being at The Barn. One said, `I have been coming here for 9 years, three times a year, I think that tells you what I think. The staff are the best, they are happy to do anything for you and nothing is too much trouble`.

What has improved since the last inspection?

Staff have received formal fire training since the last inspection, which addresses fully, a requirement, which has been made following the last two inspections. The Responsible Individual on behalf of the East Holton Charity providers now makes visits regularly. Reports have been written following these visits and some have been sent to the Commissions officer.

What the care home could do better:

Work should be undertaken to improve the quality of written information available to staff about the individual care to be provided to service users. A risk assessment approach should be used in assessing potential risks to service users. Of particular note at this and previous inspection is the lack of individual risk assessment in relation to service users who may self medicate. There are likely to be other areas, which may warrant a risk assessment approach although at this brief inspection these were not explored.

CARE HOME ADULTS 18-65 The Barn Holton Lee East Holton Holton Heath BH16 6JN Lead Inspector Susan Harvey Unannounced 04 August 2005 10:00 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 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 Stationary 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. The Barn D55 S26821 The Barn V275326 040805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Barn Address Holton Lee, Eat Holton, Holton Heath, Poole, Dorset, BH16 6JN Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01202 631063 01202 631063 holten@lds.co.uk East Holton Charity Ms Elizabeth Ann Jones PC Care Home only 4 Category(ies) of PD - 4 registration, with number of places The Barn D55 S26821 The Barn V275326 040805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: One or more Service Users, who will have a physical disability, may also be over the age of 65. Date of last inspection 11 February 2005 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. The Barn D55 S26821 The Barn V275326 040805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a brief unannounced inspection being the first of two statutory inspections for this year. The inspector arrived at 10am and left at 1pm. The inspection included discussions with three service users and the three staff members on duty. A review of care records was undertaken and a brief discussion with the registered manager. A cursory tour of the building also took place. What the service does well: What has improved since the last inspection? Staff have received formal fire training since the last inspection, which addresses fully, a requirement, which has been made following the last two inspections. The Responsible Individual on behalf of the East Holton Charity providers now makes visits regularly. Reports have been written following these visits and some have been sent to the Commissions officer. The Barn D55 S26821 The Barn V275326 040805 Stage 4.doc Version 1.40 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Barn D55 S26821 The Barn V275326 040805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection The Barn D55 S26821 The Barn V275326 040805 Stage 4.doc Version 1.40 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 standard(s) 2 Needs assessments are undertaken or provided with varied outcomes. Some service users needs are therefore well known whilst others may not be, which could result in care not being provided to meet need. EVIDENCE: Three care files were reviewed for the purpose of this inspection. Each held a copy of the funding authorities care needs assessment. One was very detailed and therefore gave clear guidance in respect of the service users needs; one however was very scant in detail. The Barn also uses a form, which is sent to service users prior to admission. This form seeks information about care needs from the service users perspective and this is commended as good practice. However, this document is only as useful as the information given and two were seen with scant detail. It is recommended therefore that on admission, time, is set aside to complete these forms in greater detail. Some records available in one care file were somewhat out of date, e.g. completed in 1999, with no indication as to whether this had been reviewed or updated. The Barn D55 S26821 The Barn V275326 040805 Stage 4.doc Version 1.40 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 standard(s) 6 Service users know their needs and are able to voice these well, however, these are not always clearly identified in a written plan of care, which could potentially result in care not being provided in the manner required. EVIDENCE: Three care files reviewed, held a variety of documentation. Some held a funding authority Needs Assessment and Care Plan, one of which was very detailed. Another however, held very limited information. The service has produced a format referred to a ‘Guest Requirement Form’. This document or similar was seen in two of the three files reviewed. One file had a copy of an out of dated plan of care from a previous residential resource. One had a ‘Management Handling Plan’, which was scant in detail. The Registered Manager showed the inspector a copy of a ‘Client Handling Form’, to be used in circumstances where support with movement is required. Although, this was the case with all three individuals reviewed, none had a completed handling plan. In the face of the evidence this is considered to be poor, however in all circumstances the service user was entirely happy with the care they received. It is clear that staff are heavily reliant on the verbal instruction from the service user, which affects positive outcomes. Whilst the inspector accepts that the output and delivery of care is good and meets service users needs, The Barn D55 S26821 The Barn V275326 040805 Stage 4.doc Version 1.40 Page 10 staff are left somewhat vulnerable without the backup of good documentation to refer to. A recommendation was made following the last inspection, which highlighted the need to review and update, plans. This recommendation is adapted but brought forward to this report. The Barn D55 S26821 The Barn V275326 040805 Stage 4.doc Version 1.40 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 standard(s) 12, 13, 15, 16 & 17 Service users are provided with activities to meet their needs and wishes ensuring that social inclusion, education and leisure is appropriate to need. Daily routines are flexible, which ensures that service users rights and responsibilities are recognised. Service users receive a healthy and nutritious diet provided by high quality meals, thereby promoting service users wellbeing. EVIDENCE: Service users who come to The Barn are often on a holiday, retreat or receiving care to allow permanent carers to take a break. This means that the provision of education and occupation is not foremost in care provided. However, the service includes access to leisure and education to fit with this holiday function of this service. Examples include, art, sculpting, weaving classes, therapeutic activities and support with hobbies. Where requested service users are supported in accessing community activities. The Barn D55 S26821 The Barn V275326 040805 Stage 4.doc Version 1.40 Page 12 Service users are able to bring with them partners, or friends to either care for them or to enjoy a holiday alongside them. The Barn offers open access to visiting family and friends although this is not usual to those on holiday. Daily routines although regular, are not strictly adhered to. All service users spoken to said that they could chose how to spend their day and that although they chose to go to bed and get up at regular times and take communal meals that this was not expected. All said that their right to privacy, choice and independence were safeguarded. Meals are generally a communal event are taken in the dining room in pleasant surroundings. Lunch was being prepared and laid towards the inspection and looked very appetising. Service users gave high praise to the quality of meals provided saying that it was ‘good home cooking’. Care plans have space to identify when or if a service user has any special dietary requirements. One service user confirmed that their special dietary needs were well catered for with ‘no fuss’. The Barn D55 S26821 The Barn V275326 040805 Stage 4.doc Version 1.40 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 & 20 Service users receive care based on their personal wishes ensuring that they central to the care provided. Where possible service users maintain administer and control, their own medication ensuring that their independence is promoted at all times. EVIDENCE: Based on the views of three service users spoken to during this inspection, The Barn excels in providing sensitive, flexible personal care. Service users were unanimous in their view that they could not wish for better care. One service user said, ‘I am never made to feel a burden, I am never made to feel awkward and nothing is ever too much trouble for the staff.’ Another said, ‘I can go where I want, when I want, do what I want, how I want. The freedom to just be yourself is superb.’ All service users receiving care during this inspection were independent in maintaining, administering and controlling their own medication. None of the files reviewed held evidence of a risk assessment approach as recommended in the last inspection report. Whilst all of these service users are likely to be in control of their own medication at home the risks are likely to be minimal. However, some consideration should be given to ensuring that this is the case in all circumstances, hence the repeated recommendation for the home to consider a risk assessment approach. The Barn D55 S26821 The Barn V275326 040805 Stage 4.doc Version 1.40 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Not inspected on this occasion. EVIDENCE: The Barn D55 S26821 The Barn V275326 040805 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Not inspected on this occasion. EVIDENCE: The Barn D55 S26821 The Barn V275326 040805 Stage 4.doc Version 1.40 Page 16 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Not inspected on this occasion. EVIDENCE: The Barn D55 S26821 The Barn V275326 040805 Stage 4.doc Version 1.40 Page 17 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) The inspector did not review all aspects of standard 42 and is therefore unable to make a clear judgement. The standard was however, partially reviewed in respect of a previous requirement. EVIDENCE: Fire records were reviewed which evidence that care is taken to upkeep in house fire safety checks and specialist servicing of equipment. Regular fire drills ensure that staff and service users are aware of what action to taken in the event of a fire. A fire drill had taken place early in the morning (6.30am) prior to the start of the inspection. In response to a requirement made following the last inspection staff received fire training in March of this year. It is noted that all staff will require an update shortly. The Barn D55 S26821 The Barn V275326 040805 Stage 4.doc Version 1.40 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 2 x x x Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 3 Standard No 31 32 33 34 35 36 Score x x x x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Barn Score 3 x 3 x Standard No 37 38 39 40 41 42 43 Score x x x 3 x x 2 D55 S26821 The Barn V275326 040805 Stage 4.doc Version 1.40 Page 19 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 2 Good Practice Recommendations Greater care should be taken to ensure that sufficent information is made available in respect of each service users needs. This maybe adding to a Care Needs Assessment that has already been provided by a funding authority or completing in more detail the homes own assessment. Attention should be paid to improve the quantity and quality of information available within care plans ensuring that plans are updated and reviewed to reflect the changing needs of service users. Where service users self medicate this should be considered in a risk assesment format. This should include a commitment from service users to keep medication stored safely. 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 alchol and substances by service users, visitors or staff. Reports made by the person visiting the home on behalf of D55 S26821 The Barn V275326 040805 Stage 4.doc Version 1.40 Page 20 2. 6 3. 20 4. 40 5. The Barn 43 the Register Provider must be made available to the Commission. Greater care should therefore be taken to ensure that all such reports are made available. The Barn D55 S26821 The Barn V275326 040805 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Unit 4, New Fields Busines Park Stinsford Road Poole BH17 0NF 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 The Barn D55 S26821 The Barn V275326 040805 Stage 4.doc Version 1.40 Page 22 - 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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