Care Home: Barham House Nursing Home

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What the care home does well Feedback from the home`s own quality questionnaires was positive with `average` to `high` ratings in meeting needs, good attitudes and friendliness of staff. Observations made during this inspection were also reflective of respectful and polite staff who appear to be genuinely interested in their clients. A full time activities coordinator provides opportunities for individuals or small groups, as well as larger group activities. The `expert by experience` said, "...all the staff I saw interacted well with residents, spending a moment or two to talk to them; all were friendly and cheerful...". One resident said he was helped to be as independent as possible and another person said how much she loved her room. Examples were noted of the home trying to ensure that preferences regarding practicing religion are supported. What has improved since the last inspection? Terms and conditions of residence are given to all residents or their representatives. A letter is sent to prospective residents or their representatives confirming that the home feels it can meet their needs and explaining about when and how a placement would be made permanent. The manager has better IT equipment which supports the home`s administration. There is now a fire safety risk assessment in place and staff files seen for this inspection contained all that is necessary. CARE HOMES FOR OLDER PEOPLE Barham House Nursing Home The Street Barham Canterbury Kent CT4 6PA Lead Inspector Christine Lawrence Unannounced Inspection 5 August 2008 10:30 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 Barham House Nursing Home DS0000070163.V369008.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. Barham House Nursing Home DS0000070163.V369008.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Barham House Nursing Home Address The Street Barham Canterbury Kent CT4 6PA 01227 833400 01227 832920 barhamhouse@hotmail.co.uk 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) Care and Residential Homes Ltd Mrs Sheralyn Kelly Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places Barham House Nursing Home DS0000070163.V369008.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing only - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category (OP). The maximum number of service users to be accommodated is 23. Date of last inspection 26 November 2007 Brief Description of the Service: Barham House is registered to provide nursing care for up to 23 people. The home is a detached house, set in its own grounds. Parking is not available on site. The home is situated in the rural village of Barham. There two churches and a public house in the village. The A2 is half a mile away, providing links to Dover, Canterbury and Folkestone. Residents’ accommodation currently consists of 15 single bedrooms and 3 double bedrooms. Nine single bedrooms have en suite facilities. A 5-person passenger lift accesses bedrooms on the first floor. A wheelchair platform lift accesses three bedrooms on the mezzanine floor. Information about the home including inspection reports by the CSCI is available on request at the home. Current fees are £600 per week. Additional charges are payable for chiropody, hairdressing, barber, newspapers, toiletries, and trips to external venues. Barham House Nursing Home DS0000070163.V369008.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The inspection visit was unannounced and started at 10.30 and finished at 16.15. We, that is the commission for social care inspection (CSCI) looked at various records in the home and also used information sent to us by the manager through her completion of the Annual Quality Assurance Assessment (AQAA). Information from the previous inspection was also referred to. A tour of parts of the building was undertaken in the company of the manager. We observed staff interacting with residents and we spoke to staff on duty as well as the manager. We asked an ‘expert by experience’ to accompany us during this inspection. An ‘expert by experience’ is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. She chatted with residents and staff and made her own observations and her comments are also used for this report. What the service does well: What has improved since the last inspection? Terms and conditions of residence are given to all residents or their representatives. A letter is sent to prospective residents or their representatives confirming that the home feels it can meet their needs and explaining about when and how a placement would be made permanent. The manager has better IT equipment which supports the home’s administration. There is now a fire safety risk assessment in place and staff files seen for this inspection contained all that is necessary. Barham House Nursing Home DS0000070163.V369008.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Barham House Nursing Home DS0000070163.V369008.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Barham House Nursing Home DS0000070163.V369008.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents can be confident that the home judges that it can meet their needs because it assesses their needs before they move in. EVIDENCE: We looked at four individual records. They showed that an assessment is carried out prior to any admission. There is an admission information sheet which includes personal, basic information and also a patient assessment sheet which covers activities of daily living (see under standard 7). This initial assessment is followed by a re-assessment when the person has been in the home for a short period or if there are any changes noted. The records showed that information from placing authorities or healthcare professionals is also gathered where appropriate eg joint assessments, KCC social services care plans. The assessments are carried out by the manager or her deputy. Barham House Nursing Home DS0000070163.V369008.R01.S.doc Version 5.2 Page 9 The manager informed us that subsequent to requirements from the previous inspection terms and conditions of residence are given to all residents or their representatives. She also ensures that a letter is sent to representatives or residents confirming that the home feels it can meet their needs and explaining about when and how a placement would be made permanent. An example of this was seen during this inspection. Barham House Nursing Home DS0000070163.V369008.R01.S.doc Version 5.2 Page 10 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 the 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 having an individual plan of care which identifies how their health and care needs are to be met. They are protected by the home’s procedures for dealing with medication and they can be confident that they will be treated with respect. EVIDENCE: As noted previously we looked at four individual records for this inspection. There is a nursing care plan in place for each person. This is based on the preadmission assessment as well as ongoing monthly reviews of residents’ needs. These are based on activities of daily living covering personal safety and comfort, breathing, circulation, communication, mental orientation, mobility, hygiene/dressing, eating and drinking, elimination, resting/sleeping, skin condition, spiritual needs and sexuality. The nursing care plan sets out goals to be achieved and provides caring instructions for staff. Staff spoken to were confident that they knew people’s needs and how to respond. The home tries to ensure continuity of care by having staff work with small groups of Barham House Nursing Home DS0000070163.V369008.R01.S.doc Version 5.2 Page 11 residents, therefore having time to get to know them well. One staff member said that the team leaders (nurses) support them to work with clients and get to know them as individuals. The care plans contain risk assessments including those relating to falls, skin, bed safety rails, nutrition and depression. We noted that assessments and plans were updated when a person was readmitted to the home after a stay in hospital. Generally the nursing care plans are reviewed monthly. Staff maintain daily notes and these are used as part of the review of the plans and assessments. One resident told us that he felt he was ‘well looked after, couldn’t ask for better!’. Records are maintained of health care professionals’ involvement with residents and this included GP, hospital appointments, optician checks, community psychiatric nurses and speech and language therapists. One of the nurses who works at the home has a mental health qualification and is therefore involved in providing support to other staff. The staff records seen showed that some staff have received training with respect to more specialist care needs such as stoma care, diabetes and the care of gastrostomy tubes. The home uses a monitored dosage system for administering medication and the administration records and storage were satisfactory, with hand washing facilities and monitoring of temperatures. There is a large poster on display in the staff work station reflecting the Department of Health’s Dignity Challenge. Staff spoken to said that privacy and dignity were an important part of caring for people – ‘…sometimes you have to encourage people because they don’t always think about things…it’s up to you to remind them and help them…’. Residents’ preference for how they wish to be addressed is known and recorded. We observed staff to be polite and respectful in their interactions with residents. The ‘expert by experience’ made the following comment - All staff that I saw interacted well with the residents spending a moment or two to talk to them; all were friendly and cheerful and gave the home a homely atmosphere. Barham House Nursing Home DS0000070163.V369008.R01.S.doc Version 5.2 Page 12 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 the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents can be confident that their preferences will be identified and responded to and that they will be enabled to maintain contact with friends and family. Residents will be enabled and encouraged to make choices and they will benefit from healthy, well-presented food at a time and place to suit them. EVIDENCE: The ‘expert by experience’ spent time with the activities coordinator, spoke to and observed residents and made the following comments – ‘The Activities Coordinator has an information file on each resident identified by a photograph on the font. The file is very informative stating age, infirmity, level of mobility etc. A great deal is taken up with the background to that resident, including home life previous to Barham House, and a list of activities which that person enjoys doing as well as those they are not interested in. A great deal of work had gone into this folder. There was a complete file for 13 of the residents, 2 being new people where she was getting to know them because they were new to the home in the last two months. The Activity Co-ordinator wears a red tee shirt which makes her stand out to the residents whose eyesight is not so good Barham House Nursing Home DS0000070163.V369008.R01.S.doc Version 5.2 Page 13 and they appreciate her doing this. She visits all the residents every day, stopping to read a newspaper to one resident who although watching television likes to discuss what is going on in the world.’ Other examples of the activities coordinator being involved with residents includes going to the pub, attending a service in Canterbury Cathedral and organizing particular outings as requested eg to the county show and to an open farm setting. There are sometimes soft ball games which residents can join in if they wish, as well as bingo sessions. The ‘expert by experience’ noted that the activities coordinator had a good understanding of the residents’ needs and wishes. One resident confirmed that she went out on trips and there were a variety of things she could do if she wished. The manager gave examples of residents being supported to maintain hobbies such as watching sport, gardening, following a favourite programme on television, painting and knitting. The ‘expert by experience said “…the variety of activities had been well thought out and were individualised and gave the overall impression of a caring environment…”. There are no restrictions on visitors at the home and there is a quiet room which can be used if people wish. A newsletter called the Barham House Howler is used to keep relatives informed about things at the home. The manager informed us that relatives are invited to join in social events and residents’ meetings. There were examples of residents making choices about what to wear, getting up and going to bed, joining in activities, what to eat and where to eat as well as spending time in their rooms or the lounge. People were supported to be able to vote by post if they wished. The ‘expert by experience’ observed people having lunch and made the following comments – ‘Lunches are served individually, mostly in the residents’ rooms but some in the lounge, all meals looked a good size, one resident having egg and chips, whilst others had other dishes including shepherds pie. Some residents had their food cut up but most wanted to eat them with no assistance which looked acceptable according to their needs, whilst others were assisted.’ The manager informed us that there is a menu planned for a four week period. The menu was on display and clearly had two choices. In reality there are sometimes more choices made. Fruit and vegetables are purchased form a local farm shop and cakes are home made. The cook confirmed that special diets can be catered for and if somebody needed their food soft, it was still important to present this well. Barham House Nursing Home DS0000070163.V369008.R01.S.doc Version 5.2 Page 14 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 the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Complaints would be handled objectively and in keeping with the home’s appropriate procedures and residents/their representatives can be confident that any concerns will be listened to, taken seriously and responded to. Staff are aware of adult protection issues and there are systems in place which create an atmosphere for protecting residents from abuse. EVIDENCE: The service user guide now has information about how to make a complaint. The manager provided examples of how complaints were dealt with. The policy/procedure regarding the disclosure of abuse or bad practice (whistle blowing) is on display for all to access. Staff have received training with regard to adult protection procedures and awareness of abuse and some update training is being planned. This was seen in the staff records looked at for this inspection. Two residents spoken to confirmed that they knew who to talk to if they had any concerns. One person said that ‘Sheralyn (the manager) was approachable, you can talk to her’. Staff spoken to were clear about their responsibilities regarding the protection of the residents in their care. Barham House Nursing Home DS0000070163.V369008.R01.S.doc Version 5.2 Page 15 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 and 26 People who use the 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 living in a safe, well-maintained home which is homely, clean, comfortable, pleasant and hygienic. EVIDENCE: We toured parts of the building with the manager. The house has had quite a bit of redecoration and refurbishment over the past year and more is planned. The manager has a plan of what needs to be done and will progress this through the coming twelve months. The home is homelike and comfortable, with different areas where residents can sit if they don’t wish to stay in their own rooms. There are attractive and maintained gardens for residents to use in good weather. As required from the previous inspection there is now an appropriate risk assessment in place regarding fire safety. Some doors have been fitted with automatic closers and the rest will have them as part of the planned improvements. Barham House Nursing Home DS0000070163.V369008.R01.S.doc Version 5.2 Page 16 The home was seen to be clean and fresh throughout on the day of this inspection. Records showed that almost all staff have received training with regard to the control of infection. The manager informed us that she uses the Department of Health’s Essential Steps to Safe, Clean Care to monitor cleanliness. All catering staff have received training in safe food handling and most of the care staff have also. Hand washing facilities are appropriate. Laundry and sluice facilities are satisfactory. There are policies and procedures in place regarding infection control and the disposal of clinical waste. Barham House Nursing Home DS0000070163.V369008.R01.S.doc Version 5.2 Page 17 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 the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ needs are met by sufficient staff who are competent and trained. Residents are supported and protected by the home’s recruitment procedures. EVIDENCE: The rota and other information seen about staff showed that there are sufficient nursing, care and ancillary staff. The manager told us that if necessary she will use agency staff to ensure that levels are sufficient. Over 50 of care staff have achieved their national vocational qualification (NVQ) in care at either level 2 or three and two members of staff are currently undertaking their NVQ. We looked at three staff records for this inspection, as well as training records and found that the recruitment procedures are robust and include the use of application forms, references, interviews, written terms and conditions of employment, a health declaration form and a criminal record bureau check. The manager informed us that there is a programme for training both for mandatory and basic things as well as more specialised input when needed eg optical awareness, stoma care, care of gastrostomy tube etc. The home provides placements for student nurses and there are registered nurses on the staff team who can provide a mentoring role. The home now uses an induction format in keeping with the common induction standards. Barham House Nursing Home DS0000070163.V369008.R01.S.doc Version 5.2 Page 18 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, 33, 35 and 38 People who use the 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 the home being managed by someone who is competent, experienced and knowledgeable. Residents’ financial interests are safeguarded and their views are sought. Staff and residents have their health and safety promoted and protected. EVIDENCE: The manager is experienced and qualified including level 4 national vocational qualification in management, as well as a Diploma in Management for Nursing Home Care. She keeps up to date with current practice and is currently involved with a pilot project regarding inappropriate hospital admissions, with the local primary care trust. She has appointed a registered nurse as a ‘flexi’ member of staff to ensure that there is as much cover as possible when other Barham House Nursing Home DS0000070163.V369008.R01.S.doc Version 5.2 Page 19 nurse staff are on holiday or off sick, ensuring that she still has time for the management role. She intends to build on this by employing another flexible member of staff. The owning company visit weekly and have done so since they took over the home in June 2007, and a report is written monthly to conform to Regulation 26 of the Care Home Regulations. The manager sends out surveys to residents, relatives and others to ascertain their opinions of the service and she completes the annual quality assurance assessment when asked to by the commission, using this to identify areas for improvement or change. She informed us that she plans to more formally feedback information from the questionnaires. The home is not currently involved in any residents’ finances but they are looking at ways they can support people with their personal allowance if required. The manager is also working with the quality assurance nurse advisor from the local PCT to improve standards and identify any training needs. As noted previously there is a programme for staff training and this covers health and safety subjects such as first aid, fire safety, moving and handling, the control of substances hazardous to health, food safety and infection control. Accidents to staff and visitors, and residents where relevant are properly recorded with regard to data protection. A spot check on service and maintenance contracts showed them to be up to date and appropriate. Barham House Nursing Home DS0000070163.V369008.R01.S.doc Version 5.2 Page 20 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 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 X 3 X X 3 Barham House Nursing Home DS0000070163.V369008.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Barham House Nursing Home DS0000070163.V369008.R01.S.doc Version 5.2 Page 22 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 Barham House Nursing Home DS0000070163.V369008.R01.S.doc Version 5.2 Page 23 - 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. 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