Care Home: Barchester Tower

What the care home does well There is a comprehensive Statement of Purpose and Service Users Guide that gives prospective residents the information required to enable them to make an informed choice about where they live. The menus evidence a well thought out balanced diet with a varied choice of food in line with resident`s preferences. Quality assurance systems are in place, which enables the management team to monitor and improve their service. There is an open-house policy, which welcomes visitors at all reasonable times. Satisfactory arrangements are in place to safeguard residents` finances. Staff provision is well maintained with a robust recruitment practice being followed and appropriate numbers of suitably qualified staff working in the home. All staff working in the home have achieved a National Vocational Qualification at either level 2 or 3 or both- 100%. The atmosphere of the home is pleasant and relaxed with good interaction seen between residents and staff. The Comments received from residents and families regarding the care received included: ` Staff kind and polite ` ` She receives excellent nursing care and care workers are kind, considerate and supportive of her every need` There is a robust recruitment process in place to protect the residents. Barchester Towers provides a clean, safe and well-maintained environment, which is appreciated by the residents and their relatives. What has improved since the last inspection? Quality monitoring systems have been introduced and the results have been audited by the management team and where appropriate acted on. Systems for promoting the safety of residents are in place and include regular temperature checks of water temperatures. The home notifies the CSCI of any accident or incident that affects the welfare of the residents. The Registered Manager has completed her National Vocational Qualification level 4 in care management. The requirements made in respect of the environmental health inspection have been met. What the care home could do better: As discussed during the inspection the care plans need to include guidance for the staff to follow that ensures that the needs of the residents are met in a consistent manner and in such a way that promotes their independence. Specific areas of risk management of individual residents needs to be developed to include their behavioural traits, communication needs and continence promotion.The activities in the home at this time do not encourage or promote mental stimulation. There are no planned activities apart from the weekly extend exercise class and a tip out on the mini bus. The residents living in the home would benefit from a planned activity programme based on their interests and preferences, either group or one to one sessions. CARE HOMES FOR OLDER PEOPLE Barchester Tower 31 De Cham Road St Leonards-on-sea East Sussex TN37 6JA Lead Inspector Debbie Calveley Unannounced Inspection 10:00 13th May 2008 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Barchester Tower DS0000021038.V363208.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Barchester Tower DS0000021038.V363208.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Barchester Tower Address 31 De Cham Road St Leonards-on-sea East Sussex TN37 6JA 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) 01424 435398 Mr Paul Hughes Mrs Indra Hughes Mrs Indra Hughes Care Home 22 Category(ies) of Dementia (22) registration, with number of places Barchester Tower DS0000021038.V363208.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is twenty two (22) Service users must be aged sixty-five (65) years or over on admission Service users with a dementia type of illness only to be accommodated Date of last inspection 21st May 2007 Brief Description of the Service: Barchester Tower is a large detached property situated in St Leonards-on-Sea approximately 1 mile from the sea front. The home is set within its own grounds, and is a close walk to local amenities including public transport links. The external grounds offer a large garden and parking area. An alarmed gate separates the property from the outside road. The home is not ideally suited for people with mobility needs who would have difficulty with the lack of level access in the home. Residents who can walk easily with the aid of a Zimmer frame or minimal support can be accommodated in the home. The home has a stair-lift, which some residents can safely access. The home is registered to provide care for up to twenty-two older people with dementia needs. Accommodation consists of fourteen single rooms and three shared rooms. Communal areas comprise of a large lounge and dining room. There are two bathrooms and additional toilets. The home also has smoking area for those service users who wish to smoke. This is subject to a risk assessment and safety considerations. Information on the range of fees charged was confirmed in the pre-inspection questionnaire prior to the last inspection with fees approximately ranging from around £423.86 to £450 [private rate] per week with extra changes for personal items. Copies of recent Inspection reports are kept in the reception area of the home as part of the Service User guide. Barchester Tower DS0000021038.V363208.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term ‘service user’ to describe those living in care home settings. For the purpose of this report those living at Barchester Towers will be referred to as ‘residents’. This was a key inspection that included an unannounced visit to the home and follow up contact with resident’s representatives and visiting health and social care professionals. This unannounced inspection was carried out over 6.5 hours on the 13 May 2008. There were sixteen residents living in the home on the day, of which three were case tracked and spoken with. During the tour of the premises six other residents both male and female were also spoken with. The purpose of the inspection was to check that the requirements of previous inspections had been met and inspect all other key standards. A tour of the premises was undertaken and a range of documentation was viewed including the Service Users Guide, Statement of Purpose, care plans, medication records and recruitment files. Three members of care staff and the cook were spoken with in addition to discussion with the Manager. Telephone contact was made with visiting professionals following the visit and one relative was spoken with during the inspection visit. Seven service user surveys have been returned to the CSCI as part of the inspection process. The information received both verbally and written has been incorporated into this report. An Annual Quality Assurance Assessment was received from the Registered Manager completed in full prior to this key inspection. What the service does well: There is a comprehensive Statement of Purpose and Service Users Guide that gives prospective residents the information required to enable them to make an informed choice about where they live. The menus evidence a well thought out balanced diet with a varied choice of food in line with resident’s preferences. Quality assurance systems are in place, which enables the management team to monitor and improve their service. There is an open-house policy, which welcomes visitors at all reasonable times. Barchester Tower DS0000021038.V363208.R01.S.doc Version 5.2 Page 6 Satisfactory arrangements are in place to safeguard residents’ finances. Staff provision is well maintained with a robust recruitment practice being followed and appropriate numbers of suitably qualified staff working in the home. All staff working in the home have achieved a National Vocational Qualification at either level 2 or 3 or both- 100 . The atmosphere of the home is pleasant and relaxed with good interaction seen between residents and staff. The Comments received from residents and families regarding the care received included: ‘ Staff kind and polite ’ ‘ She receives excellent nursing care and care workers are kind, considerate and supportive of her every need’ There is a robust recruitment process in place to protect the residents. Barchester Towers provides a clean, safe and well-maintained environment, which is appreciated by the residents and their relatives. What has improved since the last inspection? What they could do better: As discussed during the inspection the care plans need to include guidance for the staff to follow that ensures that the needs of the residents are met in a consistent manner and in such a way that promotes their independence. Specific areas of risk management of individual residents needs to be developed to include their behavioural traits, communication needs and continence promotion. Barchester Tower DS0000021038.V363208.R01.S.doc Version 5.2 Page 7 The activities in the home at this time do not encourage or promote mental stimulation. There are no planned activities apart from the weekly extend exercise class and a tip out on the mini bus. The residents living in the home would benefit from a planned activity programme based on their interests and preferences, either group or one to one sessions. 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 summary of this inspection report can be made available in other formats on request. Barchester Tower DS0000021038.V363208.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Barchester Tower DS0000021038.V363208.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides prospective residents and relatives with a good level of information about the home, its facilities, services and the costs involved. The admission procedures allow for the needs of prospective residents to be assessed by a competent person before admission. EVIDENCE: There is a comprehensive Statement of Purpose and Service Users Guide, which contain clear information about the home and the services it provides. They are presented in a brochure, which is bright and colourful and contains photographs of the home and grounds. Copies of these are available in the front entrance along with inspection reports. Areas previously identified as in need of updating have been updated. There is a copy of the terms and conditions of residency included in the brochure. Barchester Tower DS0000021038.V363208.R01.S.doc Version 5.2 Page 10 A review of the care documentation confirmed that pre-admission assessments are completed by the manager. The format of the pre-admission document was seen to be thorough and relevant. Three assessments seen were completed in full and contained all the information required to ensure that new admissions to the home were suitable and that the home have the staff and environment to meet the care needs of their needs. The prospective residents’ are seen either in their home or hospital before admission and the manager confirmed that wherever possible the family or representatives are involved. A recommendation of good practice is that the venue and all the people involved in the assessment are documented. The manager was able to verbally demonstrate her knowledge and awareness of the different specialities required in the home and ensures that the carers employed have attended relevant courses to deal with the needs of the elderly and also specialised courses for certain diseases. Trial visits to the home can be arranged. The manager confirmed that all residents are invited to a trial period to ensure suitability of the home; this is clearly stated in the Statement of Purpose and in the statement of terms and conditions. Barchester Tower DS0000021038.V363208.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Whilst the care plans provide a good framework for the delivery of care, they need to provide clear guidance for care staff to provide a consistent approach in meeting their needs. The home was found to be meeting resident’s health and general needs with accessed additional specialist support when needed. Procedures and practices in the home allow for the safe administration of medicines and care is delivered in such a way that promotes and protects the residents’ privacy, dignity and individuality. EVIDENCE: The care documentation pertaining to three residents were reviewed as part of the inspection process. These were found to include plans of care, personal histories and risk assessments. On the whole the care documentation demonstrated that the care was reviewed and evaluated, however it was noted that not all the plans of care highlighted all the needs of residents. For example one resident who has communication problems did not have any Barchester Tower DS0000021038.V363208.R01.S.doc Version 5.2 Page 12 guidance in the documentation to facilitate this vital need, the staff though were observed communicating very well with the resident. Others did not provide guidance for staff to deal with the known behavioural traits; again the staff were knowledgeable and discussed this in detail during the inspection. The staff were seen encouraging residents to maintain their mobility and promoting their independence in continence management, however this is not included in residents care plans. These shortfalls however do not impact on the positive outcomes of the residents due to the long serving and stable care team and the knowledge they have on individual residents. It does however highlight that staff need to improve their documentation in certain areas and this was discussed in full with the manager who was to review and address the identified shortfalls in care planning. Following the site visit the manager has already commenced work on developing a new care plan system suitable for the staff and residents in the home, therefore a requirement has not been made at this time, but this will be reviewed at the next key inspection. Risk assessments for health needs are included in the care planning format used by the home, and all risk assessments were found to be completed, but not all followed through with an appropriate plan of action when identified as required. It is acknowledged that work has been undertaken by the staff to improve the records and documentation and that staff have received training in care planning, however it was discussed that a more personalised approach with clear guidance for staff would benefit both staff and residents. Staff spoken with confirmed that they received a full report on each resident daily and read the care documentation that is kept in the office. They felt that their views were taken into account when planning resident’s care. The documentation recorded community health care professionals input into care when contacted and daily records are maintained and provide a record of resident’s activity, wellbeing and medical condition. Assessments completed included nutritional screening and risk assessments associated with pressure sore development, falls and the assessment of safe moving and handling. Surveys conducted by the home and completed by residents and family indicated a good level of appreciation of the services and care provided by the home. Medication administration practices were observed and midday medications were dispensed from a lockable medication trolley appropriately and safely. The trolley is stored when not in use in a lockable cupboard. Further lockable cupboards are used for storing topical and liquid medications and these are kept clean and well organised. Barchester Tower DS0000021038.V363208.R01.S.doc Version 5.2 Page 13 There are policies and procedures in place for staff to refer to regarding the safe administration, storage, disposal and recording of medication. The systems for ordering and checking medications were found to be thorough. There are no controlled medications being used at this time, but there are suitable storage and recording systems in place if necessary. Medication Administration Charts were viewed and found to be competently completed. The comparison signatures of staff able to administer medication were available and provide a clear audit trail. Staff were seen to be respectful and considerate to all residents and visitors, whilst attending to their needs. Each of the residents were addressed by their preferred term and dressed appropriately in well-laundered clothing. Barchester Tower DS0000021038.V363208.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The lifestyle experienced by residents at this time does not always match their expectations, choice or preferences. Meals remain good in respect of both quality and variety that meets the majority of residents’ tastes and choice. EVIDENCE: Care plans evidence some residents past histories and social preferences, but they are not yet linked constructively to a formal activity programme. There are plans to employ an activity co-ordinator that will work between both homes. At present the staff decide daily with the residents what to do. Residents were seen knitting, reading and watching the television. It was confirmed by staff that the residents are enabled to attend facilities away from the home; these include shopping trips, church services and visits to local areas of interest, however not all residents go on these trips and it was not clear from the documentation whether this occurs weekly. Another popular activity enjoyed by the residents is the weekly extend exercise class. Barchester Tower DS0000021038.V363208.R01.S.doc Version 5.2 Page 15 The interaction seen between the residents and staff was positive, but the residents would benefit from more mental stimulation and a programme of activities. Residents are facilitated to maintain their independence for as long as they are able. There are no restrictions on visiting times as long as consideration is shown to all the residents. There are communal areas throughout the home that are available to residents and their visitors for private meetings if required. Many of the residents have individualised their bedroom with items from home and a relative spoken with confirmed that they are encouraged to make it homely. It was observed during the inspection that the routines at the home are flexible. The home has an advocacy policy in place and the information regarding this is available to all residents and relatives. The cook has worked in the home for many years and works full time as head cook and also as a carer. She has devised a 4 weekly rotating menu that reflects the residents’ preferences. The meals provided for residents were seen to be nutritious and attractively presented, including the soft meal; it was confirmed that fresh fruit and vegetables are readily available. There is only one main meal choice, but the cook visits all residents during the morning to discuss the meal and any resident that is not happy with the meal will be able to choose something else. The residents choose either sandwiches or a light cooked meal in the evenings. The kitchen has recently been inspected by the Environmental Health Team and the requirements made have been actioned. The kitchen was clean and well organised and the food storage areas were appropriate and cool. The cook works with the ‘safer food and better business’ book and this is completed daily and includes the cleaning schedules and the temperatures of the fridges and freezers. The residents comments included, ‘the food is very good’, ‘its really very good’. At present there is no daily record kept of resident’s food consumption and this was discussed and is to be introduced as a useful tool, as it is not always possible to ensure the weights are consistently recorded. This will enable the staff to identify appetite traits early and seek advice. Barchester Tower DS0000021038.V363208.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a formal complaints system with evidence that residents feel that their views are listened to and acted upon. Staff receive training to protect residents from abuse. EVIDENCE: The complaint policy and procedure is clear and uncomplicated and a copy of this is readily available in the home and the Service Users Guide. A system of recording complaints was demonstrated to the inspector during her visit to the home. The home has not received any complaints since the last inspection. Relatives and residents spoken with confirmed that they were confident that any complaints or concerns that they had would be listened to and responded to effectively. The home has relevant guidelines on the safeguarding of vulnerable adults and staff have received appropriate training. The management team has a clear understanding of adult protection guidelines and are aware of how to initiate an investigation if required. Robust recruitment processes are in place to protect the residents. Barchester Tower DS0000021038.V363208.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Barchester Towers provides a comfortable, clean and safe environment for those living there and visiting. Residents and their families are enabled and encouraged to personalise their room, and rooms are homely and reflect the resident’s personalities and interests EVIDENCE: The home continues to follow an improvement programme that benefits the residents and visitors to the home and provides a welcoming and comfortable environment. These plans include the exterior of the home as well as the interior. The tour of the home evidenced that a considerable amount of work has been undertaken. The entrance area is attractive and welcoming. The lounge and dining room area are pleasantly decorated and comfortably furnished. The furniture in the home is being replaced on a rolling programme over a period Barchester Tower DS0000021038.V363208.R01.S.doc Version 5.2 Page 18 of time; this will include new chairs and sofas in the lounge areas. The general maintenance of the home was in the main good, but as discussed there were some bedrooms that needed some minor maintenance work, it was confirmed that this was scheduled to be attended to. The layout of the home is not particularly easy for those who are restricted by poor mobility as there are differing levels with steps and they do not have a shaft lift. This needs to be considered regularly alongside the individual risk assessments for residents’ mobility and personal safety. Residents who expressed an opinion spoke positively about the home, many have decorated their rooms with their own possessions, pictures and ornaments. The gardens are secure, accessible and attractive. There are adequate communal bathrooms and shower rooms in the home with specialist equipment, which enables frail residents and those with a physical disability to enjoy the facilities available. There is a new shower room and split level bath which will allow more choice for residents. Specialised equipment to encourage independence is provided e.g. handrails in bathrooms, hoists, wheelchairs and a stair lift to the first floor. Call bells are provided in all areas. The lighting in the home is of domestic quality and there are above bed lights as well as the main ceiling lights. Water temperatures are controlled and monitored monthly and a record kept. Random temperatures were taken and were of the recommended level. There are systems in place for monitoring safety issues such as fire checks, fire drills, PAT testing, electrical tests and gas and boiler checks and all the rooms are routinely checked for safety and maintenance issues. The records in the home confirmed they were up to date. The tour of the home confirmed that staff are aware of the fire safety policies, no doors were found inappropriately wedged open. Polices and procedures for infection control are in place and are updated regularly. The home was clean and free from offensive odours on the day of the inspection. There was an odd odour in two bedrooms, which is being investigated. Good practice by staff was observed during the day and there were gloves and aprons freely available in the home. Sluice and laundry areas were found clean and safe. The home provides a good laundry service. Barchester Tower DS0000021038.V363208.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit from a stable mature staff team and the staff training provided ensures they are aware of their roles and are able to provide the support and care each resident needs. EVIDENCE: The staffing rota was viewed and the staffing levels were seen to be sufficient to meet the needs of the residents at this time. It was confirmed by the manager that there is flexibility of the staffing levels and they are adjusted according to the changing needs of the residents. Care staff spoken with said that the levels of staff on duty were sufficient to give the care required. A selection of staff recruitment files were viewed and demonstrate that a robust recruitment process has been maintained to protect residents and contained all the relevant information required. There was evidence of health questionnaires, Criminal Record Bureau checks, two references, a resume of previous employment and work permits where necessary. All the paperwork is kept within a locked room. As there is a low turn over of staff, only one new member of staff has been recruited recently. The induction programme is in place but as there have been no new staff employed it has not yet been used, it was confirmed that the home follows the Skills for Care training specifications for the provision of social care. Barchester Tower DS0000021038.V363208.R01.S.doc Version 5.2 Page 20 Staff spoken with said that training opportunities at the home are good and they are well supported by the senior staff and the manager. Staff and the training list seen confirmed that compulsory training such as manual handling, adult protection, first aid and fire safety are being undertaken regularly. 100 of staff have a National Vocational qualification in Care at level 2 & 3 with further staff undertaking the level 4. Barchester Tower DS0000021038.V363208.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 38. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The overall management of this home is good with effective systems in place to protect residents. EVIDENCE: The registered manager is a first level RGN and RMN who has many years of experience in working with people who suffer from a dementia type illness and poor physical health. She has managed the care home for approximately twenty- five years. The manager has recently completed the NVQ in Management level 4. Barchester Tower DS0000021038.V363208.R01.S.doc Version 5.2 Page 22 Feedback from the staff was positive in respect of the support given by the management team and felt that they were able to contribute to the running off the home. The quality assurance systems in the home include questionnaires sent out to residents and relatives following admission to the home. The introduction of this formal quality assurance and quality monitoring systems has enabled the management to objectively evaluate the service and ensure it is run in the residents best interests. The quality assurance results have recently been audited and action taken to address any suggestions of improvement. Comments taken from the surveys include: ‘ very good, never smells’ ‘very pleasant and homely’ and comments from a regular health care professional ‘feel that the staff provide a fantastic level of care to their patients, they always notify us promptly of any concerns- they go the extra mile for their residents’. There are no residents at present who are responsible for their own finances; relatives and solicitors support the majority, while the home does not handle the financial affairs of residents. Staff supervision was discussed and staff supervision for all staff takes place regularly and is formally documented. Staff spoken with confirmed that they receive supervision and found it helpful. The training records were viewed and there is evidence of a rolling plan of training that ensures staff receive the necessary training to perform their role competently and safely. From direct observation during the inspection, some handling techniques were used that are now considered unsafe and as discussed a handling belt should be used at all times in these instances to protect the residents and staff safety. The accident book was found completed but needs the managers signature to ensure that the incident that occurred has been investigated and appropriate action taken re the prevention of a similar incident. Overall good practice was observed throughout the inspection in respect of promoting the safety and well being of the residents, fire safety guidelines were followed, no doors were inappropriately wedged open, fire exits were clear and doors were alarmed. Staff demonstrated an awareness of resident’s individual needs in respect of mobilisation and were seen guiding and helping residents throughout the inspection visit. Barchester Tower DS0000021038.V363208.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 3 3 3 X 2 Barchester Tower DS0000021038.V363208.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 14 (1) (a) (b) Requirement Timescale for action 31/07/08 2. OP12 16m&n That the Registered Person ensures that all service users are individually risk-assessed with a plan of action in place for staff to follow in respect of. • Access to call bells. • Use of mattresses and bumpers. • Baths. • Mobility- moving and handling. • Continence promotion. That the Registered Person must 31/07/08 ensure that Residents are regularly and fully consulted as to their activity interests and any diverse cultural or other needs such as hobbies they wish to continue. That a regular programme of stimulating activities is made available either group, or individually based, as appropriate. That participation is recorded to assess that such a programme continues to meets needs. That the Registered Person ensures that all residents are DS0000021038.V363208.R01.S.doc 3. OP38 13 (4) (b) 5 31/07/08 Page 25 Barchester Tower Version 5.2 assisted appropriately when being handled by staff and that the accompanying moving and handling risk assessments reflect how the staff are to assist individual residents. That all recorded accidents and incidents are audited by the manager and reflected in the individual’s plan of care to prevent a re-occurrence. 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 OP3 OP7 OP14 Good Practice Recommendations That the homes confirms in writing the agreement of the care to be provided before admission to the home. That as discussed the care plan system is reviewed and will include clear guidance for staff to follow. That the home explores a Reorientation board to communicate the day of the week, activities, and menu for the day and other information. Barchester Tower DS0000021038.V363208.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 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 © 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 Barchester Tower DS0000021038.V363208.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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