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Care Home: Barley Close

  • Axminster Road Musbury Axminster Devon EX13 8AQ
  • Tel: 01297552913
  • Fax: 01297553973
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Barley Close is registered to provide personal and supportive care for up to ten service users with a learning and or physical disability. The home is run by Voyage Ltd, which has a number of similar homes throughout the region. Barley Close is a large detached house situated just outside the village of Musbury, close to the town of Axminster. The home has extensive views of the countryside and hills and has large gardens and ample parking. The home is on two levels; the ground level has five en-suite bedrooms, a large conservatory, a lounge, dining room, kitchen, laundry room and sensory room. The second floor, which can only be accessed by people without mobility problems, has five en-suite bedrooms and two offices. Information received from the manager indicates that current fees range from £1500 to £2000. Additional charges are made for transport and personal items. The previous inspection report is kept within the office and is available at request.

  • Latitude: 50.75
    Longitude: -3.029000043869
  • Manager: Mrs Nicola Atkins
  • Price p/w: ~
  • UK
  • Total Capacity: 10
  • Type: Care home only
  • Provider: Voyage Ltd
  • Ownership: Private
  • Care Home ID: 2492
Residents Needs:
Learning disability, Physical disability

Latest Inspection

This is the latest available inspection report for this service, carried out on 21st October 2008. CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

For extracts, read the latest CQC inspection for Barley Close.

What the care home does well There is a friendly and relaxed atmosphere at the home. Our expert by experience noted, "All the residents get on well with each other and the staff". Visitors to the home, including relatives and professionals, told us that they were always welcome at the home and had developed good relationships with the home. One relative told us, "I am 110% happy with this home". Another commented, "They are very professional". There are good arrangements in place to ensure admissions to the home are successful. People are welcome to visit to ensure they like the home, and thorough assessments are completed to make sure the home can meet people`s needs. Parents and professionals described how well the home managed new admissions and made sure people felt welcomed and settled. Experienced, sensitive and skilled staff provide people with the assistance and the communication support they need to make daily choices. Relatives and other visitors` feel the home communicates well on the whole, keeping them informed of important events. People appear to enjoy the food and mealtimes appear relaxed and unhurried. People`s health needs are well monitored and they have access to a good variety of health professionals to ensure health needs are met. Health professionals were generally happy with the care provided. Relatives and outside professionals told us that the home deals with any concerns or queries in an appropriate way. Staff are well informed about their role and responsibility to safeguard people living at the home from abuse or harm. People`s finances are protected by the arrangements in place. The environment is bright, homely and clean. It is furnished and decorated to a good standard in most areas. People`s bedrooms are personalised and reflect the individual`s personality and interests. The staff team appear to enjoy their work and relatives and professionals spoke highly of staff. Staff were described as "Lovely", "Very professional", "Genuinely caring" and "Committed". A good range training has been provided for staff including induction training. The home is generally well managed with systems in place to promote people`s well-being. People are encouraged to share their views about the home and improvements have been made following suggests from people living here. The home follows good health and safety procedures. Staff have received training and updates on all health and safety topics. This helps to ensure that people are safe. What has improved since the last inspection? Care planning has improved and individual care plans provide good information about people`s needs and preferences to ensure needs can be met.Residents` meetings have been arranged giving people an opportunity to express their views and concerns about the service they receive. The level of activities has increased since the last inspection and people are now getting out and about more than before (see what they could do better). A plan of each person`s daily activities is being developed to assist with the planning of meaningful and fulfilling activities. New carpets and wooden flooring have been laid and parts of the home have been redecorated helping to keep people`s surroundings bright and homely. The staffing levels have improved since the last inspection enabling people to make some decisions about their lives, and choices about what they do or which leisure activities to get involved in. However staffing levels have not been consistent (See what they could do better). We saw that checks had been carried out on new staff before they started working at the home to ensure they are suitable to work there. What the care home could do better: CARE HOME ADULTS 18-65 Barley Close Axminster Road Musbury Axminster Devon EX13 8AQ Lead Inspector Dee McEvoy Unannounced Inspection 13 & 21st October 2008 09:15 th Barley Close DS0000063867.V373139.R01.S.doc Version 5.2 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 Barley Close DS0000063867.V373139.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 Adults 18-65. 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. Barley Close DS0000063867.V373139.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Barley Close Address Axminster Road Musbury Axminster Devon EX13 8AQ 01297 552913 01297 553973 barleyclose1@tiscali.co.uk Voyagecare.com Voyage Limited 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) Manager post vacant Care Home 10 Category(ies) of Learning disability (10), Physical disability (10) registration, with number of places Barley Close DS0000063867.V373139.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Learning disability, aged between 16 to 45 years on admission- Code LD 2. Physical disability, aged between 16 to 45 years on admission- Code PD The maximum number of service users who can be accommodated is 10. 18th October 2007 Date of last inspection Brief Description of the Service: Barley Close is registered to provide personal and supportive care for up to ten service users with a learning and or physical disability. The home is run by Voyage Ltd, which has a number of similar homes throughout the region. Barley Close is a large detached house situated just outside the village of Musbury, close to the town of Axminster. The home has extensive views of the countryside and hills and has large gardens and ample parking. The home is on two levels; the ground level has five en-suite bedrooms, a large conservatory, a lounge, dining room, kitchen, laundry room and sensory room. The second floor, which can only be accessed by people without mobility problems, has five en-suite bedrooms and two offices. Information received from the manager indicates that current fees range from £1500 to £2000. Additional charges are made for transport and personal items. The previous inspection report is kept within the office and is available at request. Barley Close DS0000063867.V373139.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 using this service experience good quality outcomes. This unannounced inspection was undertaken over two days. Prior to the inspection the appointed manager completed an Annual Quality Assurance Assessment (AQAA), which contained general information about the service and the people using it. We sent surveys to 8 people living at the home. All were returned but only two were completed; we were told that the majority of people did not have the ability to respond. The staff surveys sent to the home did not arrive. There were eight people living at the home and we were told that six people could not communicate verbally so they were unable to give their views in detail. On the first day of the inspection we looked closely at the care planned and delivered to three people. We spoke with two people living at the home, staff and visitors and spent a considerable amount of time observing the care and support provided to people. To help us understand the experiences of people living at this home, on the second day of the inspection we were accompanied by an ‘expert by experience’. These people have experience of using services, and they join some inspectors to help us get a good picture of the service from the viewpoint of the people who use it. Experts by experience can provide a unique contribution to the assessment of quality. On this occasion the expert by experience met with most of the people living at the home to get an idea of what life was like. He also spoke with staff, looked around the home and looked at some records. His observations and findings are contained within this report. During our visit we met and spoke with three relatives, two health professionals and nine members of staff including the appointed home manager and operations manager. A tour of the premises was made and we looked at a number of records including assessments and care plans and records relating to medication, recruitment and health and safety. On the second day of our visit the outcome of the inspection was discussed with the appointed manager and the operations manager. What the service does well: There is a friendly and relaxed atmosphere at the home. Our expert by experience noted, “All the residents get on well with each other and the staff”. Barley Close DS0000063867.V373139.R01.S.doc Version 5.2 Page 6 Visitors to the home, including relatives and professionals, told us that they were always welcome at the home and had developed good relationships with the home. One relative told us, “I am 110 happy with this home”. Another commented, “They are very professional”. There are good arrangements in place to ensure admissions to the home are successful. People are welcome to visit to ensure they like the home, and thorough assessments are completed to make sure the home can meet people’s needs. Parents and professionals described how well the home managed new admissions and made sure people felt welcomed and settled. Experienced, sensitive and skilled staff provide people with the assistance and the communication support they need to make daily choices. Relatives and other visitors’ feel the home communicates well on the whole, keeping them informed of important events. People appear to enjoy the food and mealtimes appear relaxed and unhurried. People’s health needs are well monitored and they have access to a good variety of health professionals to ensure health needs are met. Health professionals were generally happy with the care provided. Relatives and outside professionals told us that the home deals with any concerns or queries in an appropriate way. Staff are well informed about their role and responsibility to safeguard people living at the home from abuse or harm. People’s finances are protected by the arrangements in place. The environment is bright, homely and clean. It is furnished and decorated to a good standard in most areas. People’s bedrooms are personalised and reflect the individual’s personality and interests. The staff team appear to enjoy their work and relatives and professionals spoke highly of staff. Staff were described as “Lovely”, “Very professional”, “Genuinely caring” and “Committed”. A good range training has been provided for staff including induction training. The home is generally well managed with systems in place to promote people’s well-being. People are encouraged to share their views about the home and improvements have been made following suggests from people living here. The home follows good health and safety procedures. Staff have received training and updates on all health and safety topics. This helps to ensure that people are safe. What has improved since the last inspection? Care planning has improved and individual care plans provide good information about people’s needs and preferences to ensure needs can be met. Barley Close DS0000063867.V373139.R01.S.doc Version 5.2 Page 7 Residents’ meetings have been arranged giving people an opportunity to express their views and concerns about the service they receive. The level of activities has increased since the last inspection and people are now getting out and about more than before (see what they could do better). A plan of each person’s daily activities is being developed to assist with the planning of meaningful and fulfilling activities. New carpets and wooden flooring have been laid and parts of the home have been redecorated helping to keep people’s surroundings bright and homely. The staffing levels have improved since the last inspection enabling people to make some decisions about their lives, and choices about what they do or which leisure activities to get involved in. However staffing levels have not been consistent (See what they could do better). We saw that checks had been carried out on new staff before they started working at the home to ensure they are suitable to work there. What they could do better: The number of staff on duty is not always sufficient to ensure that peoples’ needs, goals and preferences are met. Staff do not always have sufficient time to fulfil people’s goals, spend one to one time with people, or undertake other responsibilities such as cooking, cleaning and laundry. One relative told us they would like to see staffing levels increased so that people could “get out more”. This is a repeated requirement. The manager should keep the Commission for Social Care Inspection informed if staffing levels have the potential to affect the well being of people at the home. The organisation needs to investigate this issue further. In order to ensure that people’s rights are protected, the home should ensure that Service Users Guide includes information about transport costs. Terms and conditions of people’s stay at the home should be specific to them and include the room they are to occupy. In order to protect people’s rights, the home has been asked to ensure that multidisciplinary decision-making is in place regarding the use of monitoring devices, or covert medication or when other decisions are made on behalf of people who cannot consent or give their opinion. We looked at people’s lifestyle at the home – choice and opportunities for social activities could be improved for some people. We have asked the home to continue to develop opportunities for people to take part in meaningful activities both in the home and the community, including during the evenings and at weekends. The home should continue with its refurbishment plan to ensure it remains homely and pleasant. Some carpets are dirty and stained and some areas, such as corridors, need to be re-painted. Barley Close DS0000063867.V373139.R01.S.doc Version 5.2 Page 8 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. Barley Close DS0000063867.V373139.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Barley Close DS0000063867.V373139.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4, & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has good admissions procedures in place to ensure that individual needs can be met. EVIDENCE: The home has a Statement of Purpose and Service Users Guide, which tells people about the home, the staff and the services they can expect. Both are available in a format with pictures, which helps people to understand. The Service Users Guide needs to be up-dated with details of the new manager and include information about transport costs so that people have accurate information. The service takes care to ensure that admissions to the home are managed well. Information is gathered from referring professionals, from parents, and health care professionals. The manager and other senior staff will visit people to get to know them, tell them about the home and complete their own assessment. People also have opportunities to visit the home, including overnight stays if possible, to get to know it before they decide to move in. We looked at the assessment for the most recently admitted person. Good information was available to help staff understand individual needs and plan the care required. Following admission the placement is reviewed and reassessed to ensure that the home can continue offering appropriate support. Barley Close DS0000063867.V373139.R01.S.doc Version 5.2 Page 11 We spoke with three parents and one care manager about the admissions process; all were happy with how admissions are managed. One parent told us, “They visited us several times. They were very helpful organising the move. They even arranged for the furniture and other personal items to be moved. The bedroom was all set up and familiar to him when he arrived”. This parent said, “They did marvellously – an excellent job of settling him into a new home.” Another parent told us they had “popped in” unannounced when looking for a home. We were told, “I was immediately invited in. Everyone looked very happy, there was a lovely welcome”. A care manager told us about a recent admission, “The home fully engaged with what we needed. They listened and acted quickly to help us place someone. There was a good transition period and my client has settled well here”. We looked at the contracts of care; these are large and complex documents and not currently available in an easy read format. We saw that contracts cover people’s rights and responsibilities, and include transport costs but do not specify the room to be occupied, which offers further protection. The cost of the transport is covered by a standard monthly charge levied on everyone living at the home irrespective of how often they use the transport. It would be fairer if a more equitable system of charging were introduced which reflected the extent to which those charged used the facility. The manager told us she would monitor this situation to ensure the system in place was fair. Barley Close DS0000063867.V373139.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments provide staff with the information they need to meet peoples’ needs. Decisions made on people’s behalf are generally in their best interest, however not all decisions which restrict people’s choice or privacy have been discussed with relevant professionals and representatives. EVIDENCE: We looked at three care plans and spoke with staff about the care they deliver. Overall care plans contained good information; they set out individual needs, preferences, goals and associated risks, which help to ensure staff deliver the appropriate care. Care plans have specific headings to address health, personal and social care needs. Information is available about people’s abilities, how they communicate, and their emotional and psychological needs. We saw that staff Barley Close DS0000063867.V373139.R01.S.doc Version 5.2 Page 13 delivered the care described in care plans in a number a ways. For example a speech and language therapist gave clear instructions about how one person was to be supported when eating and drinking. Staff were observed to consistently follow these instructions to ensure the person was safe. Monthly reports/reviews are written, which detail care concerns, changes in behaviour and outcomes relating to health, lifestyle and medication. The reviews did not always relate to the information in the care plans, for example some care plans identify individual goals to work towards, such as making new friends or developing more independent living skills. We saw that in one case the care plan had not been reviewed for some time to assess whether these goals had been achieved. However the monthly summaries did provide information on how people were progressing generally. Not all of the care plans we looked at had been signed or dated to indicate who was involved in the development of them. Most of the people living here would not be able to contribute. One parent told us they had been fully involved in the care planning process; another was not aware of the care plan but said, “I just know they look after him”. Care plans have pictures to indicate specific needs but our expert said, “Care plans should be made more accessible so the residents can understand their plan. They need more pictures and not so many words”. The home’s AQAA also identifies this as area for improvement for the future. The home operates a key worker system, which means that individual staff are responsible for designated people. Key workers spoken with had a good understanding of individual personalities, communication methods, and likes and dislikes. One parent told us, “Staff treat people with great respect”. Staff spoken with felt that they had enough information to deliver the care people needed. One told us care plans had “sufficient information” and added, “We build relationships with people here and get to know them”. Another member of staff told us, “Everything is written down clearly”. Two people returning our surveys told us they could make decisions about how they spend their time, including weekends and evenings. One person spoken with told us that staff listen and act on what they say. Another person told us people “never” listen to what they say. This person’s request was not within the home’s control but staff were advocating on this person’s behalf and understood the frustration felt. Staff’s attitude was sensitive and compassionate towards this person’s problem. We spoke with staff about how they enable people to make decisions, as many of the people living at Barley Close would not be able to verbalise their choices. Staff know the individuals well and described how non verbal clues, such as noises, facial expressions, gestures etc helped them to understand individual Barley Close DS0000063867.V373139.R01.S.doc Version 5.2 Page 14 preferences. Staff described how they use ‘objects of reference’ to offer choices to people. This information is also contained in care plans for staff to refer to. We saw that staff offered simple choices to people, such as what they ate and drank, and the activities they took part in. The expert by experience wrote in his report, “One of the residents said “I went to the beach”. They went in the morning. When asked they said, “I wanted to go to the beach”. The resident also likes to go shopping and helps to choose the shopping”. We also saw that several people could move freely around the home choosing where they spent their time. Staff were very keen to support people, and promote choice and individual decisions but we were told this could be affected by staffing levels at times. For example, when staffing levels fall to four or below per daytime shift, people’s choice about how they spend their day can be limited. We were told that with only three or four staff on duty outings and other outside activities have to be postponed at times (refer to standard 33). Staff appeared to communicate well with people and staff ably helped us to communicate with several people at the home. Many staff have received Total Communication training from an outside professional, which helps to improve knowledge and skills. Some people have communication books, however a visiting professional and three staff told us communication books needed to be up-dated and expanded. The home has a Total Communication Co-ordinator but we were told that inconsistent staffing levels (refer to standard 33) meant that this area of care could not be developed fully. Our expert by experience said, “It is not acceptable that people do not have communication books. It is a basic human right to communicate”. On the whole decisions made on behalf of people are discussed with relatives, representatives and other community professionals. Listening devices are used to monitor some people with health needs that require close monitoring, particularly at night. We were told that a good practice committee had approved the use of most monitors but that the use of a couple had not been discussed with other professionals. Some medication is given covertly in food (refer to standard 20). The manager said this was to be addressed with other professionals and relatives to ensure these decisions were in the best interests of the individual. Hazards within the home or risks to individuals are assessed and any action needed to reduce potential risks to people is recorded. This ensures staff have the information they require to keep people safe; staff also had a good awareness of individual risks. Barley Close DS0000063867.V373139.R01.S.doc Version 5.2 Page 15 Individual daily records are maintained but some personal information is also recorded in a general ‘communication book’. This practice does not take into account the Data Protection Act. Anyone wishing to see their records would also have access to personal information held about other individuals. This was discussed with the deputy manager and by the second day of our visit individual ‘communication’ books had been put in place to ensure confidentiality. Our expert by experience noted, “In the lounge I saw a couple of residents care plans left on the floor. After the plans have been looked at they should be put away in the office not left about”. Barley Close DS0000063867.V373139.R01.S.doc Version 5.2 Page 16 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Opportunities for people to enjoy a variety of activities have improved. People are supported to make some choices about their lifestyles and the home works hard to help people maintain relationships with families and friends. People are offered a balanced diet with their needs and preferences being taken into consideration. EVIDENCE: Although not consistent, there have been improvements to staffing levels, which has meant people are enjoying more regular activities inside and outside of the home since the last inspection. Our expert spent time with several people and found that some enjoy a variety of activities when staffing levels allow. He told us one person likes to “…read books, they also go to the cinema, play tabletop and board games, goes on Barley Close DS0000063867.V373139.R01.S.doc Version 5.2 Page 17 holiday with the other residents. The resident goes for meals out at weekends up to 8:30pm”. Staff informed the expert by experience, “The manager is looking to increase the cover to 10pm”. This will improve people’s opportunities. The expert by experience also found that “…during the week on different days people do various activities with an organisation called Link-up, e.g. skittles and swimming. At weekends the residents have trips out. The places the residents have been to include a Donkey Sanctuary, Weymouth and Cricket St Thomas”. The home has its own transport, which means that people can more easily access the local community and facilities. During our visit several people went to do different things, for example, Yoga, hydrotherapy, shopping etc. Records show that some people regularly enjoy aromatherapy and reflexology. However, the expert by experience noted, “While I was there I did not see much activity going on. The manager should arrange more activities for the residents who are not out during the day”. One visiting professional said they would also like to see “more structured activities between outings” and felt that some activities provided within the home could be “childish”. The expert by experience noted, “None of the residents goes to college or work. The manager is talking to the colleges to see if any of the residents could go”. The expert suggested, “The manager must make sure that residents can choose if they want to go and find out if the residents like the course they are on”. The range and frequency of activities does depend on staffing levels as two people need 1:1 support at all times and 2:1 support when out in the community. We were told that when staffing levels fall to 4 or below, as they have done according to the staff rota, activities and trips do not happen. One staff member told us, “Staffing is not consistent…sometimes functioning with 4 staff. Then we don’t have time to stimulate people and build relationships”. Another staff member told us, “The guys are getting out more now but when we are short of staff they can’t get out as often”. One parent told us they would like their relative to be able to go out more and enjoy one of their favourite things. The home works hard to ensure good relationships are maintained with families. People can be supported to maintain valued social and family relationships so that they are not isolated. Arrangements are made for one person to keep in touch with family members via the Internet. The home also organises regular visits for one person to meet up with family members some distance from the home. This is commended. Relatives we spoke with told us the home “always” made them feel welcome, one said, “I feel welcome and involved”. Another told us “We don’t feel like visitors, it’s like a family”. Relatives told us that the home involved them and kept them informed of any changes. One parent told us, “I always feel as if I Barley Close DS0000063867.V373139.R01.S.doc Version 5.2 Page 18 can phone. And they contact me too”. Visitors told us they were always offered refreshments. People can see their visitors in the privacy of their own room or in one of the communal areas. The expert by experience noted, “The residents have good family contact”. Relatives we spoke with were very happy with the care and support provided. One told us, “Staff genuinely care”. Another said, “I can’t find any fault”. The daily routine appeared to suit most people’s needs and takes into account the activities planned for the day. We saw that people are assisted to get up when they want to and one person said they could “usually” go to bed when they choose to. Care plans contain information about peoples’ preferred routine and staff told us, where possible, people’s preferences are met. During our visit we observed breakfast, lunch and supper. Staff prepare and cook all meals. Mealtimes appeared relaxed and sociable occasions. The expert by experience noted, “The staff had lunch with the residents. The residents were assisted to eat”. Assistance with meals is provided in a discreet way, with staff sitting with people and going at their pace. To aid independence when eating some people have special crockery and cutlery. Staff were heard to encourage people and offer choices. The home offers a good range of meals. The AQAA shows that menus have been revised as a result of listening to people. Care plans have good details about people’s dietary needs and likes and dislikes. We saw that where people had been prescribed supplement drinks etc between meals these were given to people. One person told the food was “good”; another person said they “sometimes” like the food. Most people living at the home were unable to comment on the food but seemed to enjoy the meals prepared during our visit, we saw empty plates and people were offered a second helping if they wanted it. The expert by experienced observed, “In the dining room there is a board on the wall with the date on it and pictures to show what is happening that day including the day’s menu. This is a very good way for the residents to understand what is happening that day”. We saw that people could indicate when they wanted something to eat or drink and staff responded. The expert by experience noted, “The residents are allowed in the kitchen to make drinks with a member of staff present”. Barley Close DS0000063867.V373139.R01.S.doc Version 5.2 Page 19 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s health needs are well met and supported by appropriate professionals and medication is generally well managed. Overall people’s dignity and privacy is respected, although staff are unsure of how to support people to express their sexuality. EVIDENCE: Care plans described how individuals like to be supported to maintain their personal care. We observed that attention to person care was very good. People were appropriately dressed and staff were attentive to people’s care needs, for example if clothes became soiled or wet after meals people were assisted to change. One visitor told us, “My relative is always nicely dressed and clean”. During our visit staff attended to people’s personal care needs in a sensitive way, ensuring that privacy was maintained. However, we read in the communication that due to staffing levels one person did not receive the assistance they needed in time and this resulted in them being “very distressed” (refer to standard 33). Barley Close DS0000063867.V373139.R01.S.doc Version 5.2 Page 20 Throughout the inspection staff interacted with people in a respectful, caring and friendly way. One visiting professional commented, “Staff are genuinely fond of residents and they have an underlying concern and empathy for them”. Information about people’s needs relating to how they mobilise, and how staff support and transfer them is recorded, promoting good practice and safety. We spoke with staff about how they enable people to express their sexuality as we heard staff, on several occasion, telling one person to stop engaging in certain behaviour. Staff did not attempt to encourage this person to go to a more private place to maintain their dignity. Two staff told us they were “unsure” about the support people need and would like more training and guidance to help them enable people to explore and express their sexuality. Care plans clearly described individuals’ health care needs and one showed that changing needs were monitored and action taken to deal with any changes, such as difficulties with eating and weight loss. Specialist health professionals have been consulted where necessary, such as psychiatrist, epilepsy specialists, speech and language therapist, dietician and dentist. One visiting health professional told us that staff “always” followed their advice or instructions and that referrals made to them were appropriate. Another visiting professional described the improvements to one person’s general health since moving to the home, and added, “There have been so many improvements, and we are very pleased with the progress”. We also heard that staff have received a range of training on health issues relevant to the people they care for, such as epilepsy. One visiting professionals told us, “They have managed epilepsy well, including monitoring the condition and the administration of medication to control or elevate seizures”. Staff responsible for administering medication have been trained to do so. Medication is supplied in monitored dosage systems, and medications, including control drugs, were stored safely. Medication Administration Records (MAR) were generally satisfactory; there were no gaps, and codes are used to indicate why medication is not been given. Where handwritten entries had been made they were signed by two people to ensure accuracy and accountability. Comprehensive guidelines and protocols written by specialists are provided for complex health care procedures such as the administration of medication for seizures. All staff have received training in order to administer medicines to reduce the effects of seizures. Although some medication is provided in liquid form, the majority is in tablet form. Some people cannot take medication in tablet form and in these cases Barley Close DS0000063867.V373139.R01.S.doc Version 5.2 Page 21 medication is given with food to make it easier to swallow. This was recorded in one person’s care plan and had been discussed with relatives. However, there were no clear guidelines in other care plans about how medication should be given and no consideration about whether mixing medication with food or drink would affect medicines. Also, disguising mediaction in the absence of consent may be regarded as deception, as the person may be led to believe that they are not receiving medication when in fact they are. The manager recognised that this was an area for improvement and agreed to consult with other health professionals and ensure decisions were clearly recorded. Barley Close DS0000063867.V373139.R01.S.doc Version 5.2 Page 22 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good systems are in place to make sure people and their relatives will have their complaints dealt with appropriately. People living at the home are protected from abuse by clear procedures and appropriately trained staff. EVIDENCE: Two people told us, via surveys, that they knew who to speak with if they were unhappy about something. Some people have limited communication skills and they would be unable to tell people if they wanted to complain about something. We talked to some of the staff about how they spot the signals that might indicate that a person was unhappy. Staff appear to have a good understanding of the different ways in which individuals express themselves and described some ways people may show signs of unhappiness or discomfort. Care plans also give staff clues about how some people may respond if they are not happy about something. Relatives told us they were confident that any concern or complaint would be acted upon, one told us, “Any suggestions I make are acted on straight away”. Another relative told us, “If you mention a concern it is dealt with”. No complaints were raised with us during our visit. No complaints have been received by the home or CSCI since the last inspection. Barley Close DS0000063867.V373139.R01.S.doc Version 5.2 Page 23 The expert by experience commented, “If any resident wanted to complain about something bad they would see the manager or let their keyworker or family know”. All staff spoken with and training records looked at confirmed that they had attended adult protection training to help them understand the issues of abuse and what to do should they have any concerns. Staff were very clear about their responsibility to report any concerns they may have, and all were aware of the outside agencies to contact. The home has safe procedures in place for handling people’s finances. The expert by experience notes, “They have their own money it’s kept in the bank. They can have it when they want to. To help them understand how to budget they do money skills with the staff”. We looked at the accounts of two people. We found that the monies were stored securely and records were clear, regularly checked, and accurate. This helps to protect people from financial abuse. Barley Close DS0000063867.V373139.R01.S.doc Version 5.2 Page 24 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Barley Close offers people a safe, homely and clean environment with equipment and facilities to meet their needs. EVIDENCE: The home is provides accommodation over two floors and consists of a large lounge with a sensory room, a large dining room and a large conservatory. The lounge and conservatory have a TV and music system; the furniture is of good quality and generally in good condition. People with bedrooms on the first floor must be mobile as there is no passenger lift or stair lift for access. One relative told us, “The physical environment is good”. Other relatives said they were also happy with the surroundings. There have been several improvements to the environment since the last inspection; some parts of the home have been redecorated and new carpets and wooden floors have been laid on the ground floor. However, some carpets in the corridors are dirty and heavily stained. Our expert by experience noted, Barley Close DS0000063867.V373139.R01.S.doc Version 5.2 Page 25 “…most of the home needs new carpets and furnishings and curtains and blinds (in communal areas). The home also needs repainting. I was told by the manager the capital budget for 2009 will be used to pay for the work”. The AQAA shows that the home wants to improve the environment over the coming months by decorating interior walls and ceilings and replacing carpets. Bedrooms are single occupancy. The expert by experience notes, “The bedrooms are done to reflect each resident’s lifestyle. All the bedrooms have en suite bathrooms some with baths and some showers”. The expert added, “All the doors to the outside had keypads and all the bedrooms did as well. There were only a couple of residents who could use the keypads. The other residents had to ask the staff. When inside the bedrooms the residents could open the door to exit”. We saw that some bedroom doors were not closed and people could access their rooms freely. There is a large paved area outside and ramps to all entrances of the home and gardens to enable people who use wheelchairs or those with poor mobility easy access. The expert experience commented, “There is a small enclosed garden with a patio. The garden furniture needs to be re-varnished or new furniture bought”. The AQAA shows that the home plans to improve the garden by developing a “sensory gardens” over the next 12 months for people to enjoy. Some people have “assistive technology” devices in their rooms, such as pressure mats, to alert staff to people’s movements at night, especially those people who are at risk of seizures at night. There is sufficient equipment in the home to assist people, such as tracking hoists. Care staff at the home are responsible for the cleaning and laundry, to their credit the home was generally clean and free from offensive odours, the expert by experience told us, “As regards the home there were no bad smells”. One relative felt that a housekeeper should be employed to do the cleaning and laundry so that care staff would have more time with people (refer to standard 33). She also pointed out that one bedroom was “rather dusty” although she said this was not a concern or criticism. There is a separate laundry room, which was clean and well organised. Staff told us they had received training about good infection practices and described how they maintain infection control by using the appropriate equipment such as gloves and aprons. Dissolvable laundry bags are used for any soiled washing, which is good practice. Barley Close DS0000063867.V373139.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The numbers of staff on duty are not always meeting the diverse needs and aspirations of the people living at this home. Good recruitment procedures ensure that people are protected from unsuitable care workers. Staff have received a good range of training in order to give people the support they need. EVIDENCE: Two people living at the home, three relatives and two visiting professionals spoke highly about staff’s commitment, ability and kindness. One person living at the home told us, “I like them. They are nice to me”. Another person indicated that they liked most staff. One relative said, “Staff genuinely care…they interact positively with people and meet needs”. Another relative told us, “Staff are lovely, every one of them”. One professional described the deputy manager and senior staff as “excellent” and said of the staff team, “There is good will and a feeling that they want to get things right”. Barley Close DS0000063867.V373139.R01.S.doc Version 5.2 Page 27 The home has experienced staff recruitment and retention problems, and sickness has also affected staffing levels. Although staff and relatives told us things had improved since the last inspection, staffing remains an issue and is not consistent. Several staff described how unreliable the staffing levels were and the affect this had on the service. We were told that some activities did not happen if there were 4 or less staff on duty; we saw that staffing levels were reduced to 3 one afternoon, which led to one person not receiving the care, and assistance they needed in a timely way. This resulted in distress for the person and staff. The AQAA shows that people have significant needs and require support and assistance with all aspects of daily living. Three people need two or three staff to help with their care. Two people require 1:1 care at all times and 2:1 care when outside the home. Staff told us they struggled at times to meet people’s individual needs, one told us, “When there are only 4 staff on we get the basics done, get them up, prepare food and do the laundry”. The staff rota showed that the number of staff on duty could vary from 7 to 4 staff on an early shift and from 6 to 4 staff in the late afternoon and early evening. We looked at the three week’s rotas and found that staffing levels reduced to 4 staff at various times of the day between 5 and 2 times per week. There are two waking and one sleeping night staff on duty. Care staff are responsible for the cleaning, cooking, shopping and laundry within the home. One parent told us they would prefer to see staff spend more time with people rather than “housekeeping”. This relative felt a housekeeper would reduce the burden on the care staff and allow them to organise more activities. There have been problems finding cover for some night shifts. The home uses bank staff but not agency staff to cover unexpected absences or holidays etc. Several staff told us they were “not allowed” to use agency staff any more “because of the cost”. Staff told us they try to cover shifts between themselves but this has been difficult at times. We saw that on a number of occasions, staff that had worked a 12-hour day shift were asked to work a waking night as well. This is far from ideal. Some staff were feeling tired and put upon. Although morale seemed low among the staff several commented on the good teamwork at the home, one said, “We pull together as a team”. Another one told us, “We have a brilliant staff team”. There are 5 and further interviewed informed of inspection. staff vacancies at the moment, which have been advertised locally a field. The manager told us that two potential staff were being later in the week. We are going to ask the manager to keep us staffing levels as this is an outstanding requirement from the last Professionals told us that many of the staff had the skills and experience to care for people with complex needs, one health professional told us, “Some staff are excellent, others are gaining confidence and experience”. Staff told us Barley Close DS0000063867.V373139.R01.S.doc Version 5.2 Page 28 one of the best things about Barley Close was the training it provided. However two staff mentioned that they did not like the electronic learning the company had introduced to the home for some training. One told us, “It doesn’t suit my way of learning”. Staff had attended a number of training sessions related to the care of people living at the home, for example Total Communication, Epilepsy, Autism and other good practice training. Several staff were keen to develop their skills and said they would like to know more about Autism and death and dying. 50 of care staff do not a hold nationally recognised care qualification (NVQ2 or above). We spoke with three staff who had obtained a NVQ and the manager told us that 8 staff were currently registered to complete the course. This will ensure that staff have general competencies and skills. A structured induction is place to help new staff understand their roles and how to work respectfully and safely with people. The induction covers the principles of the Learning Disability Qualification (LDQ), an induction award for supporting people with a learning disability. We looked at the recruitment files of three staff. Application forms had been completed and full employment histories. The files contained evidence that all the necessary references and checks had been obtained before the person started working at the home. This protects people. Barley Close DS0000063867.V373139.R01.S.doc Version 5.2 Page 29 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall the management of the home is satisfactory. The quality assurance systems ensure people can ‘have their say’ and that the home is run in people’s best interests. Satisfactory systems are in place to promote the health and safety of people living and working at the home. EVIDENCE: A new manager has been appointed since the last inspection and she took up her post in May this year. An application to register the manager is currently with CSCI for consideration. During the inspection the manager was well organised and able to find all of the information we requested. The manager was also receptive to our recommendations for improvement to the service during the feedback session. She has an open and friendly approach. Barley Close DS0000063867.V373139.R01.S.doc Version 5.2 Page 30 Three staff told us they did not feel well supported or valued by senior managers. One said, “I am not feeling terribly well supported” and “Management don’t understand what goes on in the home. They don’t understand the level of care people need”. These comments were fed back to the manager and operations manager during the inspection. There are a number of ways the home reviews the quality of the service it is providing. The Expert by experience found, “The residents have meetings at the home. Lots of things to do with the home and any problems the residents may have are talked about and the residents are helped to choose where to go on holiday. If the problem is personal the residents can have a one to one meeting. Having these meetings give the residents the chance to make choices about what happens with the home and their life at the home. The Manager wants to get outside Advocacy for the residents”. We looked at the results of questionnaires sent to people living at the home, their family and outside professionals. Although there was a low return from families and professionals, overall the responses were positive. As part of the home’s quality assurance process, a representative of the company visits the home at least once a month to carry out regular management checks and ensure the home is running smoothly. Staff told us and record showed that mandatory training, such as moving and handling, fire safety, food hygiene and first aid is up to date. This ensures that staff can work safely and that people are protected. The AQAA showed maintenance or servicing of gas and electrical systems was up-to-date. Also that other equipment, such as fire detection equipment and the hoists were serviced regularly. However during our visit we noticed that the Portable Appliance Testing was overdue by several weeks. The manager told us this was being organised. We found a rodent trap on the floor of the dining and raised our concern with the manager as some people ‘get about’ on the floor. The manager completed a risk assessment and considered the risk to people as low. Barley Close DS0000063867.V373139.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 2 3 X 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 X 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 1 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Barley Close DS0000063867.V373139.R01.S.doc Version 5.2 Page 32 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA33 Regulation 18(1a) Requirement You must ensure that sufficient staff are on duty at all times to meet the needs and goals of the people living at the home and ensure their safety. (Previous timescale of 30/11/07 not met) Timescale for action 30/12/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations The information in the Service Users Guide should be updated in relation to the manager and should include information about transport costs, to ensure people and their representatives are provided with accurate information about the services the home provides. In order to ensure that people are supported in a consistent way, it is recommended that – Care plans be developed with the involvement of people living at the home and/or their representative. In order to protect people rights, where decisions are made on behalf of individuals, which may restrict privacy or choice, the home should discuss actions with a DS0000063867.V373139.R01.S.doc Version 5.2 Page 33 2. YA6 3. YA7 Barley Close 4. YA12 multidisciplinary team and the person’s representative. You should ensure that the use of listening devices to monitor health needs is appropriate, by obtaining a multidisciplinary decision about using them through discussion with relevant community health professionals about each individual case. You should continue to develop opportunities to enable people to fulfil their social interests and to engage in local and social activities. You should make sure that leisure activities for people are not restricted. You should that ensure that staff have the skills and knowledge to support people to express their sexuality. There should be clear decision making process (See recommendation number 2) when medicines are given covertly (e.g. in food). This will promote an open and transparent process that ensures decisions are made in peoples’ best interests. To ensure the home is maintained to a satisfactory standard for people living there, you should continue with the redecoration and refurbishing or the home. 5. 6. YA18 YA20 7. YA24 Barley Close DS0000063867.V373139.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Barley Close DS0000063867.V373139.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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Other inspections for this house

Barley Close 18/10/07

Barley Close 09/11/06

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