Inspection on 09/09/08 for The Barn House

This inspection was carried out on 9th September 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Barn House 12/09/07

The Barn House 19/04/06

The Barn House 22/11/05

The Barn House 19/07/05

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 13/11/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Barn House Quality Street Merstham Surrey RH1 3BB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Deborah Sullivan     Date: 0 9 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: The Barn House Quality Street Merstham Surrey RH1 3BB 01737 643273 01737 644551 nigelgungaloo@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Mr Permal Naidoo Gungaloo,Mrs Gungaloo Mr Permal Naidoo Gungaloo care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: Of the 30 older persons up to 12 can be in the catergory (DE(E)) and up to 12 can be in the catergory (MD(E)). The age/age range of the persons to be accommodated will be: OVER 65 YEARS The age/age range of the persons to be accommodated will be: OVER 65 YEARS 0 0 0 Over 65 12 12 30 Date of last inspection Brief description of the care home The Barn House is a detached, adapted property, registered for 30 Service Users, requiring support with mental health needs or assistance with nursing care. The home is situated in a quiet cul-de-sac in the village of Merstham. Care Homes for Older People Page 4 of 27 There are twenty single bedrooms rooms and five double rooms. Twenty three 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 there is also on road parking. Mr Gungaloo is the registered manager and together with his wife are joint registered providers; both are registered nurses. The weekly fees range from 450- 550 pounds per week. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection of The Barn House was completed on 12th September 2007. This unannounced key inspection took place over eight hours,during the visit time was spent with the registered provider and registered manager, service users, care and nursing staff and a visiting social care professional. A tour of the home took place and records and documents such as care plans,staff files,medication and training records were inspected. Information in the Annual Quality Assurance Assessment document (AQAA) completed by the provider has also been used as part of the inspection process and a small number of survey forms were returned by service users and health and social care professionals. Throughout the visit service users spoken with and staff were helpful in providing Care Homes for Older People Page 6 of 27 information. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line – 0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Up to date information about the home is available to potential service users and their representatives. Needs are fully assessed before a place is offered and service users are only admitted if their needs can be met. Evidence: The home has a statement of purpose and service users guide; both documents have been updated this year. Each potential service user is assessed by the provider before they are admitted and this follows an initial referral from a social services department. All the service users currently at the home were being sponsored by local authorities. Assessments can Care Homes for Older People Page 11 of 27 take place in a service users home, hospital or other setting such as another care home. A pre admission document is used alongside relevant health and social care assessments. If necessary a second visit from the provider takes place and potential service users are welcome to spend time at the home such as for a meal or a day before making a decision about moving in. Visits from relatives or other representatives are also welcomed.A service user spoken with said that their care manager had made the arrangements for them to move into the home and they felt it met their needs. Following admission there is a four week trial period. The home offers respite care; one respite service user was at the home to give their family a break. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans reflect the individual needs of service users; care plans have been improved to include more in depth information on service users needs and guidance for staff. Medication procedures are thorough and the privacy and dignity of service users is respected. Evidence: Each service user has a care plan that sets out their individual needs.Since the last inspection the care plans have been revised and now they include more detailed information about care and support needs, preferences and any risks possible. They give staff clear guidance on how to support each person. Service users or their representatives had signed the care plans inspected and the information is reviewed Care Homes for Older People Page 13 of 27 monthly. Risk assessment documentation is completed for each person and daily records are filled in thoroughly giving a good picture of each persons day, they include details about any health or personal care issues, support provided that day such as with bathing, and activities undertaken. The manager has put into place a record sheet for documenting medical appointments with brief details of the intervention so that information is easy for staff to find and a sheet is prepared for service users to take should they need to go to hospital. Contact is supported and maintained with outside health professionals; during the inspection a respiratory nurse visited a service user who had recently been in hospital and the provider escorted two service users to planned psychiatric appointments. Where service users have expressed a gender preference as regards staff providing personal care this is respected, on the day of the visit there was a good mix of male and female nursing and care staff. Any health concerns are referred on to appropriate health professionals, recording and discussion with the provider and manager showed that there is an in depth awareness of the mental and physical health needs of those living at the home. A visiting social care professional stated The home sees mental health needs as a priority and has a real understanding of mental health issues and a survey form from a health professional stated that the home provides a very personalised service to their residents. The needs of service users are diverse with some people being quite independent with personal care and others needing a lot of support, the home promotes individuality and diversity. The privacy and dignity of service users is respected, staff knock on bedroom doors before entering and within reasonable bounds of safety and hygiene service users can organise their rooms as they wish and spend time in them as well as with others. Medication policies and procedures are in place and medication storage and recording is good. Nursing staff administer medication and the manager audits medication recording sheets regularly. Care plans record the preferences of service users in the event of terminal illness or death if they have expressed these. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are offered activities provided by the home and are supported to pursue their own interests. Contact with friends and relatives is encouraged and service users are able to make choices about their lives. Meals are varied and nutritious with choice available. Evidence: Service users are able to follow their own interests and the home offers activities such as board games, exercises, music and reminiscence. There is a weekly activities planner which is used flexibly. The home encourages the pursuit of personal interests, activities and individuality. More independent service users access the local community independently or travel further afield on the bus or train. One service user Care Homes for Older People Page 15 of 27 said they had a bus pass and regularly travelled to Redhill and another that they went out for a walk every day. The manager said another service user had recently been to London on the train and spoke of needing to provide discreet support for another when they went out as due to their preferred mode of dress they could be a target for anti social behaviour from the community. A visiting social care professional said that the home provides a balance between keeping service users safe and allowing for eccentricities. During the visit some service users chose to spend time in the garden, others spent time in the lounge or their rooms and could move about the home as they wished, one plays the piano at the home every day. A monthly Church of England service is held at the home and a Roman Catholic priest visits. A hairdresser visits fortnightly. Relatives are welcome to visit and the manager said one comes nearly every day, the provider said that some relatives keep in touch with home even when their service user is no longer living there. Service users are offered choices in their daily lives and their preferences are recorded. Two service users spoken with said they choose their activities and meals and their daily routines. One was a later riser and was given breakfast in their room at 9 am, another liked to rise very early as they had always done so when working, and had breakfast at 6.30 am. Staff confirmed this was their preference. There is a four week menu and daily choice of meal. There is an upstairs and downstairs dining room and two lunch sittings.The upstairs room is used at the later sitting by those needing less support with their meal so that those at the first are not rushed. The main meal was mince or lamb chops with potatoes and vegetables followed by rice pudding. The menu is varied and service users can offer their views on meals at residents meetings. Special diets can be catered for and service users are given their favourite meal each week. Lunch was not rushed and service users were given support with eating and special utensils if needed. A service user said that they liked most of the meals and there was always choice. Hot drinks were served mid am and mid pm. One service user is very individual as regards their choice of food and eating habits, this is respected by the home and the provider and manager have liaised with other professionals to make sure that the service user is supported to follow their regime safely and it does not impact on others. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints procedure and service users are aware of who to go to with concerns. Safeguarding vulnerable adults procedures and policies are in place and staff are made aware of their role in protecting service users. Evidence: The home has complaints, whistleblowing and safeguarding vulnerable adults procedures. The home has a copy of the Surrey multi agency safeguarding procedures. The provider and manager have updated their safeguarding training. The Commission has received two complaints about the service since the last inspection that have been satisfactorily responded to by the provider. There had been one safeguarding matter that had been investigated by the local authority and was now closed. Staff attend POVA training and those spoken with were aware of their responsibilities should they suspect abuse. Staff meeting minutes show that they are reminded of safeguarding and whistle blowing procedures. Service users spoken with said they would go to the provider with any concerns and two service users who sent in surveys said they knew who to go to if they were not Care Homes for Older People Page 17 of 27 happy and how to complain. The home does not manage the monies of any service user and where there is expenditure on a service users behalf the home funds it and relatives or social services reimburse. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a well maintained, clean, homely and comfortable environment. Bedrooms are personalised and individuality of preferred décor and arrangement of rooms is respected. Equipment is available for service users who require it. Evidence: The home is well decorated and maintained and is in a pleasant quiet area of Mersham with local shops nearby. There is a large lounge/dining room, quiet room, second upstairs dining room, entrance hall that was being used by service users to sit in and sufficient bathrooms and toilets. The garden is large and attractive and there is garden furniture, it has lawn and a path, is accessible for service users and has secure gates at each side. The manager said it was well used in good weather. During the visit the lounge and dining room were occupied by a number of service users, some were spending time in their rooms as and when they wished. Bedrooms are personalised and reflect the personalities of service users. Some are en suite, double rooms are spacious with curtaining between the beds, all rooms have wash hand basins. Bedrooms are well decorated; the manager said that a small Care Homes for Older People Page 19 of 27 number need very frequent redecoration and one is painted quarterly due to the needs of the service user. One service user liked to rearrange the furniture and to avoid risks their wardrobe had been fitted to the wall and a TV mounted to the wall. Bedrooms contained personal items such as photos, paintings, furniture and TVs. One service user had chosen to have their bed moved within their room. There is a dedicated smoking room that was well ventilated although it did not have a sign on the door about its use; the manager took action to put up a sign shortly after the visit. One bedroom was prone to having an odour due to the needs of the occupant, the manager explained ways in which this was managed and advice had been sought from a continence specialist. Any area where an odour is noticed is thoroughly cleaned. The home was cleaned to a good standard throughout and two cleaners were on duty. There is a cleaning schedule and any maintenance work needed is recorded the provider said a maintenance worker is employed part time. Aids and equipment such as handrails, bath seats,a ripple bed for one service user and hoists are in place and there is a shaft lift. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported by staff who receive training appropriate to their roles and are well supervised. Staff are on duty in sufficient numbers to meet the needs of service users. Recruitment procedures are in place that protect service users whilst staff files must be checked to ensure that they include all the necessary documentation at all times. Evidence: The home had enough staff on duty to meet the needs of service users, as well as qualified nursing and care staff two cleaners and the cook were on duty. Both male and female care and nursing staff were in shift during the morning and afternoon, three waking staff are on duty at night. Staff receive core training, training is well documented and as well as core training courses are provided in topics specific to the service user group such as dementia and communication, nurses attend training appropriate to their roles and files for nursing staff contained current PIN numbers. Staff spoken with were aware of POVA and said they had done the training. NVQ training is promoted and a number of the care staff were working towards their NVQ Care Homes for Older People Page 21 of 27 in care. One fairly new member of staff confirmed that they had received induction and had worked with senior staff until they felt confident. A service user said they liked the staff and that the care is very good indeed. Regular staff meetings that are well documented are held and the recording showed that staff are reminded at the meetings of policies and procedures and safe working practices. Three staff files were inspected and they contained the necessary documentation relating to recruitment except for one that did not include evidence of an up to date satisfactory CRB declaration, the staff member was present and said they had needed to forward the original to another agency for verification it was returned and details would be added to the file without delay. The home updates CRB disclosures three yearly as good practice. Files of staff recruited who are from other countries include police checks from their country of origin. Staff observed during the visit were confident and competent. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and policies and procedures are in place to protect the health, safety and welfare of service users and staff. The views of service users are regularly sought and this needs to be extended so that relatives and health and social care professionals are surveyed at least annually. Records are well maintained and kept safely and securely. Evidence: The registered manager and provider have long experience of running the home and Care Homes for Older People Page 23 of 27 are both qualified nurses who hold the Registered Managers Award. The provider as well as the manager is at the home on a daily basis and both are readily available to service users staff with offices in the main part of the home. Service users were observed to be confident in approaching the provider or manager at times if they wished to ask about something during the day and both the provider and manager take an active part in supporting service users e.g. escorting them to medical appointments. Staff spoken with said that they felt well supported by the provider and manager. A visiting social care professional said that the home communicates well and always consults them about decisions that they need to be involved in. The home seeks the views of service users via regular residents meetings and annual quality assurance surveys. The residents meetings are well recorded. It is recommended that relatives and health and social care professionals be surveyed as well. Policies and procedures are in place and are updated as needed. The home does not manage the finances of any service user who is unable to take responsibility for their own affairs. The Annual Quality Assurance Document (AQAA) was received by the Commission within the timescale given for its return. Maintenance records are kept and fire equipment is regularly tested. Records are safely and securely stored and the standard of record keeping is good. . Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 19 The registered person shall 22/09/2008 not employ a person to work at the care home unless they have obtained a valid CRB disclosure for them. All staff must have a satisfactory CRB disclosure.One staff file did not contain evidence of a satisfactory disclosure. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 14 33 It is recommended that the views of relatives and health and social care professionals are sought annually. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!