Care Home: Barn Park Residential Home

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CARE HOMES FOR OLDER PEOPLE Barn Park Residential Home Barn Park Halwill Beaworthy Devon EX21 5UQ Lead Inspector Jo Walsh Unannounced Inspection 3rd March 2009 09:00 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 Barn Park Residential Home DS0000003646.V374368.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. Barn Park Residential Home DS0000003646.V374368.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Barn Park Residential Home Address Barn Park Halwill Beaworthy Devon EX21 5UQ 01409 221201 01409 221602 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) Mr William Derek Scantlebury Mrs Anna Patricia Scantlebury Mr William Derek Scantlebury Care Home 22 Category(ies) of Dementia - over 65 years of age (22), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (22), Old age, not falling within any other category (22), Physical disability over 65 years of age (22) Barn Park Residential Home DS0000003646.V374368.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th January 2008 Brief Description of the Service: Barn Park is a large Victorian House on the edge of Halwill village. It is registered to provide personal care to 22 elderly people, who may have physical disabilities, dementia or mental disorders. It is privately owned and managed. District nurses and local GP’s provide any medical care. The home has been extended but still retains many of the features of the original house. The property is set in extensive grounds. On the ground floor the home has a dining room, lounge leading to a conservatory, an additional private lounge, six single bedrooms, a bathroom with toilet and two other toilets. There is a stair lift to the first floor where there are twelve bedrooms, two of which may be used as double rooms, four of the single rooms have ensuite toilet facilities - one has an en-suite bathroom. There are two stair cases to the second floor, both with a stair lift, where there are two bedrooms with en-suite toilets and a staff sleep in room. The home has equipment to aid residents’ mobility. Current fees can be obtained from the registered provider. Additional charges, as stated in the home’s contract are: ‘Medical requisites, hairdressing, chiropody, newspapers, clothing and other items of luxury or a personal nature, and transport. The latest inspection report is situated in a drawer in the entrance hall of the home. Barn Park Residential Home DS0000003646.V374368.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 stars. This means the people who use this service experience good quality outcomes. This inspection took place during a week day in March and lasted approximately 6 hours. During this time 5 people who live at the home were spoken to about their experiences living at Barn Park. We also spent time talking to the staff group, the care manager and the registered manager/provider. We looked at some of the key documents including plans of care, assessments, risk assessments, staff recruitment files and medication records. This helps us to gain a picture of how well the home is run. Prior to the inspection taking place we sent surveys to a sample of people living at the home, staff and visiting health care professionals. Their views and those of people spoken to during the inspection are included throughout the report. The home are asked to complete an Annual Quality Assurance Assessment (AQAA) which gives us information about how the home maintains a safe environment, what training has been completed and tells us how they are reviewing their services to improve the care and support provided. This information helps to inform the inspection process. What the service does well: Barn Park provides people with a clean, safe, well-maintained and homely environment. Specialist equipment is in place to ensure the needs of frail and physically disable people can be safely accommodated. People who live there said • It’s home from home here • I am very pleased my family chose this home • I really enjoy the views I have and spend a lot of time looking out at the birds. • It is always cleaned and I like to go out in the garden when the weather is better. A good choice and range of meals are provided that take into consideration individuals’ likes and dislikes. One person said ‘’we always have freshly cooked food, there is always a choice and it’s really quite tasty, there is nothing I don’t like.’’ Barn Park Residential Home DS0000003646.V374368.R01.S.doc Version 5.2 Page 6 The staff team are well trained and supported which helps them understand the needs of the people who live at Barn Park. Good recruitment practices ensure people are protected, and regular handovers give staff opportunities to have input into planning for the care and support of the people who live at the home. People spoken to and those who returned surveys said staff treated them well and with respect and dignity. What has improved since the last inspection? What they could do better: The main entrance needs to be kept secure by other means than the current system used. Currently the front door is kept locked but there is a key in the entrance hall that anyone could use to gain entry. Plans of care should where possible be shared and agreed with the individual and/or their family or representative. The pipe work next to the door in the dinning room must be blocked in to prevent people from being at risk from a hot surface. Barn Park Residential Home DS0000003646.V374368.R01.S.doc Version 5.2 Page 7 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. Barn Park Residential Home DS0000003646.V374368.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Barn Park Residential Home DS0000003646.V374368.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Potential new people benefit from a good admission and assessment process, which ensures that the home can meet their needs. EVIDENCE: We looked at the pre admission for the two newest people admitted to the home. The care manager had gone to visit them and talked to the individuals and their current carers and where appropriate their family to be able to fully assess their needs. The pre admission assessment gave good details about the known personal and health care needs. There was also a section about the individual, what their social history was, what they enjoyed doing in the past and now. This gave a good picture of the individuals’ social and diverse needs, as well as telling a story about who the person is. This gives carers something to focus discussions on and enables individuals to be seen as people with interests and value to the community, not just individuals with needs. The home is commended for trying to gain a holistic assessment of people and not just concentrating on needs. Barn Park Residential Home DS0000003646.V374368.R01.S.doc Version 5.2 Page 10 Individuals spoken to said that they were asked about what support they needed and staff confirmed that pre admission assessment information is discussed and shared with them before a new person is admitted. Where an individual is placed by a funding authority, the home makes sure they have a copy of the care management assessment and care plan, as well as doing their own assessment. Barn Park Residential Home DS0000003646.V374368.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals’ personal, social and health care needs are well planned and well met. EVIDENCE: People who live at the home said • Everything works very well, staff are very good, and they help me get up in the mornings. • My health care is very well looked after. You can see the doctor when you need, the chiropodist comes about every five weeks, an optician visits and they have even organised for me to have massage and take me for the appointments. • Staff are lovely and we are well looked after. All the staff spoken to and those who returned surveys said that what they did well was to provide good personal care to people. Each person has a well documented plan of care and is reviewed monthly. Plans are well organised so that information is easy to find and includes Barn Park Residential Home DS0000003646.V374368.R01.S.doc Version 5.2 Page 12 sections on care and support needed, risk assessments including moving and handling plan, nutritional screening tool (MUST), weight charts, falls monitoring form and mental capacity and ability to make informed decisions assessment. There is also daily records, that staff complete to monitor individuals emotional well being and any significant events, and daily charts to say what personal care and support each person has received both morning and evening. This gives a comprehensive picture about the individuals and ensures that staff provide care and support in a consistent way. Staff spoken to said that plans of care are useful and are now more comprehensive. The plans of care should now be shared and agreed with the individuals or their carer/representative where possible. They could also be further enhanced by including more personal detail about individuals preferred daily routines so that care can be offered in a person centred way. The home have good systems in place for ensuring there is an audit trail for all medications brought into, dispensed or returned to the pharmacy. Medication is appropriately stored and records relating to the administration appeared well kept and accurate. Where an as needed medication has been prescribed, there are clear instructions in the individuals care plan as to when this should be considered for use. This information should also be kept with the medication records for ease of use for those administering. The care manager agreed to ensure this happens. Controlled medications are double locked and double signed if administered. All returns are recorded and signed by the pharmacist. Any additional medications such as antibiotics is usually brought up and signed in by the community nurse and double signed by a senior member of staff in the home. Individuals are treated with respect and dignity. People spoken to said that staff always treat them well. Care practices observed throughout different times of the day backed this up. Staff provided care and support in a kind and respectful way. One person confirmed that staff knock on the bedroom door before entering. The registered manager said that although they are registered for 22, they do not use the 2 shared rooms as double occupancy and would only do so if say they had a married couple in who wanted to share a room. They believe that shared rooms can compromise individuals’ personal space and right to privacy. They are going to build an extension to increase the bedrooms by two in line with their registration. Barn Park Residential Home DS0000003646.V374368.R01.S.doc Version 5.2 Page 13 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): 12-15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Routines and activities are flexible for people. People are consulted and listened to regarding the choice of daily activity EVIDENCE: The routines of the home appear flexible and those people spoken to confirmed that they were able to make choices about when they got up, where they ate and how they spent their time. During the inspection people were being assisted at different times throughout the morning to get up and have their breakfast. The care manager tries, when completing the assessment information to get an idea of individuals social history and what sorts of things they enjoy doing. This can then help to plan for activities, recently for example they have had people in who enjoy knitting and this has become a regular activity that some people enjoy. The home provides regular entertainment and activities. They have someone that comes in twice week and facilitates games, activities and quizzes with people. They also have a paid entertainer who plays music and sings fortnightly, and the staff will do activities after coffee break in the mornings if Barn Park Residential Home DS0000003646.V374368.R01.S.doc Version 5.2 Page 14 their routine allows. This includes things like quizzes, which people really appear to enjoy. Several people spoken to said they enjoyed this. People are supported to stay in touch with their family and friends via letters and phone calls. Visitors are welcome at any time and the registered manager said that people are always welcome to stay for a meal at no extra charge. Staff spoken to said that what they did well was ensure that individuals have choice and are helped to make decisions to maintain control in their lives. One staff member said ‘’we make sure that the person is given the time to make decisions for themselves, like what they want to wear, what options they want for their tea, they are small things but they help to make the person stay in control.’’ The home offers people a good choice and range of meals that takes into consideration their likes and dislikes and any dietary requirements. The cook said that everything is prepared fresh and that they have regular deliveries of fresh fruit and vegetables. The main meal of the day is lunch time and there is a menu board displaying what this is for each day. The tea time choice is usually more flexible and records are kept of all meals offered. People spoken to said • The food is very good • Quite good, they will always get you something extra if you want it • Yes lovely! Barn Park Residential Home DS0000003646.V374368.R01.S.doc Version 5.2 Page 15 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): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals’ views are listened to and acted upon. EVIDENCE: The home has a stated complaints procedure and everyone who lives at the home is given a copy. Those people, who were able to say, knew who they could make any concerns known to. The Commission has not received any complaints over the last 12 months and nor has the home direct. The registered manager/provider said this is due in part to the fact that he is available several days per week and takes the time to make sure individuals are happy with everything. The home has policies and procedures in place to protect vulnerable people and staff have training in the protection of vulnerable adults. Those staff interviewed were aware of what they should do if they suspect abuse. Barn Park Residential Home DS0000003646.V374368.R01.S.doc Version 5.2 Page 16 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): 19,16 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Barn Park provides a clean homely and reasonably safe environment for the people who live there. EVIDENCE: During this inspection all of the communal areas were looked at and most of the individual bedrooms. The home employs two cleaners who work mornings and keep the home clean and fresh smelling. There was no malodorous smells present. Some areas of the home are looking a little worn and in need of refurbishment, but all areas were clean, warm and homely. Individuals have personalised their rooms. Locks are fitted to bedroom doors, but these are individual keys. None of the current people living at he home use the bedroom door locks, but if everyone decided they did want to, there may be an issue in ensuring access in an Barn Park Residential Home DS0000003646.V374368.R01.S.doc Version 5.2 Page 17 emergency. The home should ensure that if locks are used that this is included in their fire risk assessment. There is some pipe work near the dining room door. The pipes are very hot and need to be boxed in to help reduce the risk of burns from hot surfaces. The registered manager/provider said this has not been licked up before and agreed to do this as a priority. Planning has been agreed to extend the home to include two new bedrooms. The home will remain as being registered for 22, but this will allow all rooms to be single occupancy. The registered manager is aware that new bedrooms need to comply with national minimum standards and have an en suite. They have given another large bedroom en suite facilities. Since the last inspection they have made access to the garden easier with a ramp from the conservatory, but this is a little to steep and they are aware this needs to be lengthened to reduce the steepness. They have also repaved areas so that the ground is more even and safer for people to walk on. The home needs to ensure that access to the home is not made available to everyone, i.e. they should not leave the key in the main entrance porch. The laundry area has been expanded and any soiled laundry is placed in bags. Gloves aprons and gels were available throughout the home, and staff were aware of infection control policies and procedures and were seen to put these into practice. Barn Park Residential Home DS0000003646.V374368.R01.S.doc Version 5.2 Page 18 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): 27-30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff group are experienced and sufficiently trained and supported to ensure the needs of the people who live at the home are well met. EVIDENCE: The staffing levels are sufficient to ensure that the personal needs of the people who live at the home are met. Normally 4 carers, as well as ancillary staff to provide meals, do laundry and keep the home clean. Staff spoken to and those who returned surveys said that there were usually enough staff to meet the needs of the people who live at the home. One person did comment that they were sometimes down at weekends due to people ringing in sick and that they could do with a bank of staff to call on. Training records show that staff have training in all key areas of health and safety, as well as some specialist areas such as working with people with Dementia, the Mental Capacity Act and sensory deprivation training. Staff spoken to said that they were offered regular training updates, including opportunities to complete NVQ (National Vocational Qualifications) in care. The AQAA returned says that more than 50 of staff have or are working towards an NVQ2 or above. Barn Park Residential Home DS0000003646.V374368.R01.S.doc Version 5.2 Page 19 A sample of staff files were looked at (3) and relevant checks and references had been taken up to ensure that individuals were suitable to work with vulnerable adults. Barn Park Residential Home DS0000003646.V374368.R01.S.doc Version 5.2 Page 20 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): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run and in the best interests of the people who live there. EVIDENCE: The registered provider is also the registered manager and has many years experience in running the care home. They now have a care manager who oversees all assessments, plans of care and staff. She has an NVQ 4 in care and her registered manager’s award. The lines of their roles now appears clearer and some staff report that communication between management and staff have improved. One said ‘’we still need more meetings and a better understanding of who is doing what, although it now seems clearer that the care manager is in day to day charge and she is doing a good job.’’ Barn Park Residential Home DS0000003646.V374368.R01.S.doc Version 5.2 Page 21 The care manager said they try to keep abreast of both staff training needs and ensuring that management has up to date training. The care manager and registered manager are currently doing a distance learning on staff supervision as they recognised this was an area they needed to improve on. The home uses surveys from time to time, but find that with the people they support, this is not always the most helpful tool to gain their view on the quality of care and support. They spend time with individuals on a regular basis asking them what they need, wish or would like to change. It is agreed that this could be documented so that they can eminence that individual views are sought. The registered manager said they do not hold money for any individual, but if anything is purchased on their behalf an invoice is issued retrospectively to their family or representative. Information provided by the home prior to the inspection shows that they have up to date policies and procedures in place for all safe working practices, staff have training in these areas to ensure both they and the people they support are safe. Barn Park Residential Home DS0000003646.V374368.R01.S.doc Version 5.2 Page 22 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 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 Barn Park Residential Home DS0000003646.V374368.R01.S.doc Version 5.2 Page 23 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. 1 2 3 Refer to Standard OP19 OP7 OP36 Good Practice Recommendations The home should ensure that all areas are safe and secure, this includes risks form hot pipes and removing the keys from the main entrance. Plans of care should shared possible be shared and agreed with the individual and/or their representative. Staff supervisions should be documented. Barn Park Residential Home DS0000003646.V374368.R01.S.doc Version 5.2 Page 24 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 Barn Park Residential Home DS0000003646.V374368.R01.S.doc Version 5.2 Page 25 - 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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