Inspection on 19/07/05 for The Barn House

This inspection was carried out on 19th July 2005.

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

The Barn House 09/09/08

The Barn House 12/09/07

The Barn House 19/04/06

The Barn House 22/11/05

The Barn House 09/12/04

The Barn House 24/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

1 Marten Road

St Joseph`s

Ridgemount

Wingham Court

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

CARE HOMES FOR OLDER PEOPLE The Barn House Quality Street Merstham Surrey RH1 3BB Lead Inspector Janet Daulton Announced 19 July 2005 11.00am 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 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. The Barn House H58H09 s13355 The Barn Hse V228840 190704 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Barn House Address Quality Street Merstham Surrey RH1 3BB 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) 01737 643273 01737 644551 Mr Permal Naidoo Gungaloo Mr Permal Naidoo Gungaloo CRH Care Home 30 Category(ies) of DE(E) Dementia over 65 - 12 registration, with number MD(E) Mental disorder over 65 - 12 of places OP Old Age - 30 The Barn House H58H09 s13355 The Barn Hse V228840 190704 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: The age/age range of the persons to be accommodated will be: OVER 65 YEARS Date implemented 14 May 2002 Of the 30 older persons up to 12 can be in category (DE(E)) and up to 12 can be in the category (MD(E)). Date implemented 20 August 2002 Date of last inspection 9 December 2004 Brief Description of the Service: The Barn House is a detached, adapted property, registered for 30 service users, some of which may require assistance with nursing care or support with mental health needs. The home is situated in a quiet cul-de-sac in the village of Merstham. There are 20 single occupancy rooms, and 5 twin bedded rooms. 23 of the rooms have en-suite facilities. The Garden is to the rear of the property, and is laid mainly to lawn. There is limited parking to the front of the property, and also on- road parking. Mr. and Mrs. Gungaloo are both registered nurses. The Barn House H58H09 s13355 The Barn Hse V228840 190704 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over 5.5 hours and was the first inspection carried out by the Commission for Social care Inspection for the year 2005-2006. The inspection was carried out by Janet Daulton, Lead Inspector for the service. The Registered Person and Registered Manager, Mr. Gungaloo was present throughout the inspection. A tour of the premises took place. Four care plans, the complaints log, staff recruitment files, and a sample of safety certificates were inspected. The inspector spoke to 10 service users, and observed lunch being served in the dining rooms. The inspector also spoke with some of the staff on duty at the time of the inspection. 10 comment cards had been completed by the service users, and 1 comment card was received from a relative. Overall the feedback on these questionnaires was positive. The inspector would like to thank the staff and service users for their time, assistance, and hospitality during the inspection. What the service does well: The service uses appeared well cared for and were dressed appropriately. When they were asked about the home, they said that they were happy there, and that the staff were kind to them. The service users were satisfied with their accommodation and enjoyed the food. The Registered Person/ Manager was involved in the running of the home on a daily basis, and it was apparent to the inspector that he was very knowledgeable about the needs of the service users. The Barn House H58H09 s13355 The Barn Hse V228840 190704 Stage 4.doc Version 1.40 Page 6 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. The Barn House H58H09 s13355 The Barn Hse V228840 190704 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection The Barn House H58H09 s13355 The Barn Hse V228840 190704 Stage 4.doc Version 1.40 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 standard(s) 3,6 Service users have their needs assessed before they move into the home to ensure that the home can provide for those needs EVIDENCE: All the care plans inspected had a pre- admission needs assessment completed by the Social Services Care Manager. The assessment covered all elements of physical, mental, and social needs. The registered person confirmed that he always assesses service users prior to admission to ensure that the home can meet the needs. The home does not offer intermediate care. The Barn House H58H09 s13355 The Barn Hse V228840 190704 Stage 4.doc Version 1.40 Page 9 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 standard(s) 7,8,9,10 The service users needs were set out in an individual plan with actions stated to meet the needs. There was written evidence that these were being met, and overall there was a regular review of whether the needs had changed. The administration of medication was in line with the homes medication policy. EVIDENCE: Care was observed to be carried out with attention to the service users privacy. Service users spoken with confirmed that personal care was given in private, and that they wore their own clothes and their dignity was respected. Care plans were sampled. Overall they gave a clear record of the service users needs and the actions that had to be taken to meet those needs. Risk assessments, such as moving and handling and pressure sore risk were completed where necessary, however some of these risk assessments need updating. A requirement was therefore made. Several care plans examined were not signed by the Service User, and a requirement was made. The manager stated that one service user had refused to sign the care plan. This should be documented. It was noted at inspection that a large number of falls were occurring to the service users. These were being appropriately recorded and action being The Barn House H58H09 s13355 The Barn Hse V228840 190704 Stage 4.doc Version 1.40 Page 10 taken. It was discussed with the Manager that a regular audit should be carried out to determine whether there was a pattern to the falls such as a certain time of day, or following medication. There was evidence that service users have access to specialist services such as chiropody, dentist, and optician, and service users were registered with the local GP. All service users were weighed regularly, and nutritional assessments completed as necessary. Medication records were sampled. Medication was being administered appropriately. It was recommended that when a nurse transfers the medication record to a new sheet that she signs this new sheet as well as the person who is checking. The Barn House H58H09 s13355 The Barn Hse V228840 190704 Stage 4.doc Version 1.40 Page 11 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 standard(s) 12,14,15 The home provided opportunities for the service users to choose their lifestyles within their limitations. The home offered a satisfactory choice of food at mealtimes. EVIDENCE: Service users stated that they were happy with the social activities provided. One service user commented on how much she enjoyed just sitting in the garden when the weather was good. There were no outside agencies providing entertainment, and the manager stated that the carers arranged activities. The social interests of service users were included in the assessment and care plans. Several service users went out on their own, and were encouraged by the home to do this if they were able. Meals were provided in two sittings and in two dining rooms. The service users who required assistance with their meals were served first, and staff were seen to be available to assist the service users. The menus indicated that a choice was offered. The service users stated that they enjoyed their food, and the food served on the day of the inspection appeared satisfactory in presentation and quantity. The Barn House H58H09 s13355 The Barn Hse V228840 190704 Stage 4.doc Version 1.40 Page 12 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 standard(s) 16,18 The home had a complaints procedure that was available for all service users. Care staff demonstrated that they had the necessary knowledge about the procedure for dealing with allegations of abuse, however the Manager had not followed the procedure for reporting to the CSCI a recent incident. EVIDENCE: The complaints procedure was available for service users, however most of the service users spoken to were not aware of the process or how to use it; this was largely due to their mental frailty. The service users who were spoken to by the inspector during the inspection had no complaints about their care. The Home had adopted the Surreys Multi -Agency procedure for vulnerable adults. However it was of concern that in a recent vulnerable adults incident the manager had failed to follow the procedure, and had not reported the incident to the CSCI under Regulation 37. An immediate requirement was made. This incident was being investigated in line with Surrey’s procedure. Staff have received training in vulnerable adults protection. It was recommended that staff receive training in how to deal with aggression by service users, as several of the service users exhibit challenging behaviour at times. The Barn House H58H09 s13355 The Barn Hse V228840 190704 Stage 4.doc Version 1.40 Page 13 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 standard(s) 19, 24, 26 The layout of the home was suitable for its purpose. Maintenance and renewal of the fabric and decoration of the premises took place. The grounds were well maintained to provide a pleasant area for service users. EVIDENCE: The home was observed to be maintained in a satisfactory condition. The grounds were accessible to the service users. Several of the service users rooms were observed to be rather sparse in the decoration of the rooms with the service users personal effects, such as pictures and ornaments. The service users spoken with were satisfied with their rooms, however the registered person may wish to consider encouraging service users to personalise their rooms more to appear more homely. Overall the standard of cleanliness was satisfactory. One room had an offensive odour, and a requirement was made that all rooms are to be kept free from offensive odours. The Barn House H58H09 s13355 The Barn Hse V228840 190704 Stage 4.doc Version 1.40 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 The numbers of staff on duty during the inspection were sufficient to meet the needs of the service users. The recruitment process was not being followed satisfactorily to ensure that only suitable staff were being employed. EVIDENCE: The staff rota inspected demonstrated that the staffing numbers and skill mix were appropriate to meet the assessed needs of the service users living in the home. Staff files of 5 members of staff were examined at inspection. 3 of these did not contain the necessary checks and references as required by Regulation, and a requirement was made that all information as stated in the Regulations must be obtained on all members of staff before employment. Two staff had obtained their NVQ Level 2 qualifications, and several other members of staff were completing it. The Manager stated that it was the expectation that 50 of the care staff will have obtained level 2 NVQ by the end of 2005. The Barn House H58H09 s13355 The Barn Hse V228840 190704 Stage 4.doc Version 1.40 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 36, 38 The quality assurance process needs further development. Health and safety Policies and procedures were in place to ensure, as far as is reasonably practicable, the health safety, and welfare of service users. EVIDENCE: The home had recently obtained the views of service users about the care provided, in the form of a questionnaire. The registered person has not yet produced a report which is available to service users and other interested parties. A requirement is made that a report is produced. The registered person has implemented supervision since the last inspection. During the inspection the fire log, servicing certificates, and accident book were inspected and found to be in order and up to date. Staff were observed to be following appropriate health and safety practices as they went about their work. The Barn House H58H09 s13355 The Barn Hse V228840 190704 Stage 4.doc Version 1.40 Page 16 One window restrictor was noted to be broken on the first floor. An immediate requirement was made to repair it. The Barn House H58H09 s13355 The Barn Hse V228840 190704 Stage 4.doc Version 1.40 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x x x 3 x 2 STAFFING Standard No Score 27 x 28 2 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 x x 2 x x x x 2 The Barn House H58H09 s13355 The Barn Hse V228840 190704 Stage 4.doc Version 1.40 Page 18 yes 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. 2. Standard 7 7 Regulation 15(2) 15(1) Requirement Risk assessments in the care plans must be kept up to date. Unless it is impracticable, the care plan must be signed by the service user as evidence thyat the service user has been consulted about the care plsn. The registered person must inform the CSCI of any allegation of misconduct by any person working in the home. All rooms must be kept free from offensive odours. Timescale for action With immediate effect. With immediate effect. With immediate effect. with immediate effect With Immediate effect. 3. 18 12(1) 37 4. 5. 26 29 16(2)(k) 19(1) 6. 33 7. 38 The Registered person must ensure that all staff have the checks and documentation as required by Regulation before commencing employment in the home. This is an outstanding requirement from the last inspection. 24(1)(2) The results of the service user survey must be presented in a report which is available to service sers and other interested parties. 13(4)(a)(c The broken window restrictor identified at inspection must be repaired H58H09 s13355 The Barn Hse V228840 190704 Stage 4.doc August 31st 2005 With immediate efect. Page 19 The Barn House Version 1.40 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 9 8.8 18.5 Good Practice Recommendations As good practice the new medication record should be signed by the nurse transfering the information as well as the person checking the transfer. As good preventative practice, an audit of falls should be carried out to determine whether there was a pattern to the incidents. Training is organised for staff in dealing with aggression. The Barn House H58H09 s13355 The Barn Hse V228840 190704 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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. 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