Care Home: Barnfield House

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What the care home does well The home continues to undertake a detailed pre admission process to ensure that people who are considering moving to the home have sufficient information about the service. Careful planning takes place to ensure that the manager is confident that the admission to the home will be successful for the new person and those people already living there. The home continues to maintain an ethos of ensuring that peoples choices and preferences are the focus of care delivery. People who come to the home are supported to maintain independence to what ever level they are comfortable with. The processes in place to support people to self administer medication have been improved and ensure that clear records, risk assessments and reviews are undertaken to support the safety of people using the service. The registered provider has built an extension of 4 new beds as part of an ongoing maintenance program. The 4 rooms have been registered as part of this inspection and provide suitable and pleasant accommodation for people using the service. What has improved since the last inspection? The home has registered a manager with the Care Quality Commission. The new registered manager has also completed Level 4 Registered Managers Award. This will promote and develop the management of the service. The manager has improved the care plans so that each person has risk assessments and a sufficient plan of care in place to manage those risks safely. The care plans are reviewed and updated regularly to reflect changes of care. People using the service are included in those reviews. Recruitment procedures have improved with prospective staff having had the appropriate checks in place before starting work at the home. Most records are in place but some records still need to be adjusted to reflect good practice. The management of items in the fridge had improved with all items being dated when opened to ensure their safe use. The policies relating to complaints and whistle blowing have been updated to include the contact details for external services. This means that people know who to contact outside of the home should they want to. The homes policies for the making of wills has also been updated to protect people using the service and staff. Staff training and the staff training records have been improved to show clearly which staff have undertaken training in mandatory areas. This means that the registered manager is able to address any shortfalls in training. The management of accidents has been developed to include monthly audits to look for trends and incidences to enable the manager to promote accident prevention What the care home could do better: The older part of the home needs to continue with the ongoing maintenance program to ensure that all people living at the home have a suitable and pleasant environment to live in. Staff supervision and appraisals are recommended to be undertaken to ensure that all staff are aware of the management , ethos and good practice standards of the service.The registered provider is also recommended to supply all staff with contracts and job descriptions. This are recommended to ensure that staff are clear about the terms and conditions of their employment. The manager is recommended to risk assess all free standing units to ensure that there is no risk of injury to people using the service. The registered manager is recommended to update the homes abuse awareness policy to ensure that it reflects local area policy and avoid any confusion for staff. The registered manager is recommended to ensure that prescribed creams kept in peoples rooms are named and dated when opened to ensure that they do not exceed their shelf life. The registered manager is recommended to develop care plans to ensure that all areas of risk, need, choice an preference are included in the care plan itself. This will enable staff to easily and quickly access the information they need. Key inspection report Care homes for adults (18-65 years) Name: Address: Barnfield House 9-10 Barnfield Terrace Station Road Liskeard Cornwall PL14 4DT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Gail Richardson     Date: 2 6 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Barnfield House 9-10 Barnfield Terrace Station Road Liskeard Cornwall PL14 4DT 01579347617 01579347617 rebmill@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Rebecca Joy Miller,Michael Stephen McGillicuddy Name of registered manager (if applicable) Mrs Lynda Penney Type of registration: Number of places registered: care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is 14. 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: Mental disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Barnfield House is registered to provide accommodation and personal care for up to 14 people with a mental health condition. It is situated close to the local train station, bus services, shops and facilities of Liskeard. The accommodation comprises what was originally two houses, adapted to become one. Accommodation is offered in Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 18 1 1 0 6 2 0 0 9 Brief description of the care home predominantly single rooms with 2 shared rooms provided. Stairs provide access to the upper floors. There is parking access at the side of the building. The home provides a Statement of Purpose and Statement of Intention together with a copy of the last key inspection report and complaints procedure in the main entrance to the home. Barnfield House is an established service, which came under new ownership in March 2006. The owners are Dr. R. Miller and Mr S McGillicuddy. A manager has been in post since August 2008 and registered with The Care Quality Commission in 2009. The home charges 364.89 pounds per week (Correct as of July 2009).This does not include toiletries, Chriopody, Hairdresser and newspapers/magazines. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection, which took place over two days on the 23rd and 26th April 2010 by Regulation Inspector Gail Richardson . For the purpose of this inspection the term We will be used when referring to the Care Quality Commission. The last key inspection took place on the 11th June 2009, were a 1 star adequate rating was assessed. We received ongoing correspondence from the registered provider to tell us what actions were being taken to address the areas raised. The Care Quality Commission requested the manager complete an AQAA ( Annual Quality Assurance Audit ), which gives details of all aspects of the home. A tour of the home took place and some of the bedrooms and all communal areas were seen. There were 14 people currently residing at the home. We spoke to six of the people using the service and four members of staff, the registered manager was available throughout the inspection. Care Homes for Adults (18-65 years) Page 6 of 30 As part of this inspection we surveyed the opinions of staff members, visiting health professionals and people using the service. Five responses were received. Comments received from those surveys and, following discussion with people using the service at inspection, all comments received are included in this report. We looked at records relating to care including three care plans, two staff files, and health and safety records. The focus of this inspection visit was to inspect relevant key standards under the CSCI Inspecting for Better Lives 2 framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are excellent, good, adequate and poor. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Adults (18-65 years) Page 8 of 30 The older part of the home needs to continue with the ongoing maintenance program to ensure that all people living at the home have a suitable and pleasant environment to live in. Staff supervision and appraisals are recommended to be undertaken to ensure that all staff are aware of the management , ethos and good practice standards of the service.The registered provider is also recommended to supply all staff with contracts and job descriptions. This are recommended to ensure that staff are clear about the terms and conditions of their employment. The manager is recommended to risk assess all free standing units to ensure that there is no risk of injury to people using the service. The registered manager is recommended to update the homes abuse awareness policy to ensure that it reflects local area policy and avoid any confusion for staff. The registered manager is recommended to ensure that prescribed creams kept in peoples rooms are named and dated when opened to ensure that they do not exceed their shelf life. The registered manager is recommended to develop care plans to ensure that all areas of risk, need, choice an preference are included in the care plan itself. This will enable staff to easily and quickly access the information they need. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the service is thorough in ensuring that prospective people using the service will have their needs identified prior to admission, to ensure all needs can be met at Barnfield House. Evidence: The home has a comprehensive Statement of Purpose and Service User Guide, this is provided to prospective people prior to admission. This information has been updated to reflect the building work taking place to extend the service. Since the last key inspection there has been no change in this outcome group, Significant time and effort is spent making admission to the home personal and well managed. The management of the home operates a three step approach to admissions. Initial inquiries are reviewed and discussed, further information is received in the form of assessment processes and relevant input from other health professionals. The second stage is the initial escorted visit to the home and the third stage is a visit to the home by the person, unescorted, to give the prospective person the opportunity to test run the service. Pre admission information and assessments Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: are completed on these visits. Before agreeing admission the registered person carefully considers the needs assessment for each individual prospective person and the capacity of the home to meet their needs. The lifestyle of the other people living at the home is taken into consideration to ensure a successful admission is managed. Staff at the home receive an ongoing training program to support their development and ensure that they can provide the skills both individually and collectively, to meet the needs of people using the service. Contract were not reviewed as they were seen at the last inspection. We recommended that room numbers be included into the contract to enable people to know what room they were contracted to. The registered provider has told us that the home benefits from the flexibility of moving rooms and does not intent to add this information to the contract. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans were seen to reflect the assessed and changing needs of people using the service in most cases. Ongoing development is needed to ensure all areas of assessed needs are included in the care plan. People are supported to make decisions about their lives in relation to the home and activities and are supported to take risks where needed Information is stored securely and appropriately. Evidence: Each person has a care plan and considerable work has been undertaken to improve how the care of each person is recorded. Most risks were identified and a plan in place to support the risk safely. The care plans reflected peoples assessed needs and in most cases a plan of care had been put in place. It was noted that in some cases the information was not easily accessible and a lot of reading was required to ascertain how some areas and risks were to be managed. These areas included both physical and mental well being. The manager is recommended to ensure that changing needs are identified and all areas of assessed need clearly recorded in the care plan. Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: The manager undertakes monthly reviews and although the people using the service do not document their input, each review is agreed verbally with them. The homes Annual Quality Assurance Audit told us that staff spend time talking with people using the service This chatting provides constant real timeinformation about the needs of our residents. The real value of this immediate feedback should not be underestimated. This level of real time communication allows us to assess, and if necessary change, the individual plan for the changing needs and personal goals of each resident on an almost constant basis. People using the service told us that they could choose their own routines of the day and change them when they wanted and were supported to make decisions about their lives. A relative told us The care assistants literally care about my relative. We were told by people using the service that they can attend residents meetings were their views are sought and used to change practices at the home. They told us that they can help to cook if they want to and can make hot drinks whenever they like during the day. People who are able are supported to manage their own finances, the systems in place are secure and audited to ensure that peoples private monies are safely managed. All records relating to people using the service are stored securely. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Choices are available for people to take part in age, peer and culturally appropriate activities and participate in the local community as and when they want to. Appropriate personal and family relationships are promoted and supported. People are encouraged to help plan menus and a healthy diet is promoted. Evidence: The way the service is managed in this area has had little change since the last key inspection. People living at the home told us that they choose how they spend their day; the activities they undertook were individual and based on their own needs and requests. Several people told us how they go shopping in the community, using the bus to independently travel around. People have locks on their bedrooms doors for privacy, staff were seen to speak to people respectfully and knock on doors before entering. People leave the home to visit and stay with family and friends and take holidays. Holidays are not organised by the home. Activities at the home are chosen at Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: residents meetings or by request and include social groups and art club. We observed that several people had returned to bed or were in their rooms mid morning. Relatives told us, I appreciate that some people dont like to interact with other people but a pet such as a cat would provide some stimualtion/ involvment. A relative told us theat they felt people need more motivation, less time alone in their rooms. Another told us that the service could do better by Make greater efforts to excercise the mind even if they are reluctant The home has smoking room which is seperate to another comunal lounge. No signage is available to inform people that this room is used for smoking. Popele must be made aware of the use of this room to enable them to avoid this area if prefered. The home promotes community links and development of family relationships but will also protect the person when needed. At this time nobody is working or attending educational development courses. The home provides free elephone access to all peopl eusing the service and plans internet access from May 2010. Currently nobody using the service has any request to practice any specific faith, however should that situation change, access is available within the community and people would be supported with that access. The menu is arranged by the manager and includes the preferences of people using the service . Breakfast is available from 09:00 but tea making facilities are available from 07:00. Lunch is a lighter meal with the evening meal being the main meal. The dining room is in need of refurbishment but plans are in place for this. Tables are set with condiments, napkins and plastic glasses. All meals are cooked by staff and all staff have undertaken Basic Food Hygiene training. People have access to the kitchen and can be assisted to cook. Peoples weights are monitored monthly and actions taken as needed. The kitchen environment is is need of refurbishment and is planned as part of a rolling programme of refurbishment. A relative told us, They keep my relative warm, fed and contented. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service receive the personal support they require. Records of visiting health professionals reflect that their health needs are assessed and the appropriate action taken. mediaction is well managed and supports and promotes peoples independance. Evidence: The home provides little personal care and acts mostly in a support and supervising role to promote peoples independence. People told us that staff were kind and supportive and gave them the help they needed. People are supported to visit their Doctor or the Doctor will come to the home, other services such as the Dietitian, Chiropodist and Diabetic Nurse are involved in the care provided and the records of input are clearly documented within the care plan. Care plans have been developed to include personal health care needs and how staff can meet those needs. A visiting health professional told us The patients are always well presented, the carers knowledgable to each case. There is good communication between Barnfield Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: and the surgery, good care of patients appointments kept /booked on time. The patients are always happy, good contact with carer The management of medications has improved. The management of self mediaction practice including risk management and monitoring is of a very good standard and is in place to minimise the risks to people using the service. the adminstration of mediactions are well managed. The registered manager is recommeded to ensure that all prescribed creams are dated when opened to ensure that their shelf life is not exceeded. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service and their representatives have access to the homes complaints procedure. Complaints are taken seriously and addressed quickly. Policies, procedures and staff training are in place to protect people using the service from abuse Evidence: One complaint has been received by the Commission which was responded to by the registered provider within an agreed timescale. The service has not received any complaints. We spoke with people using the service who were confident that if they had any issues or concerns they could approach the manager and staff and the issues would be dealt with. We spoke with staff members who were all clear about the procedure to be followed if a concern was raised with them or if they wish to make a complaint. Staff told us they were confident that any concerns raised would be acted upon appropriately by the management of the home. The homes whistle blowing and complaints policies contain all relevant information for people who may wish to make a complaint. All staff have received a CRB (Criminal Record Bureau) and POVA (Protection of Vulnerable Adults) check prior to commencing employment at the home. As part of Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: the induction, information and policies about protection from abuse are provided. All staff undertaking an NVQ also address this issue within that training. Further formalised training is booked as planned to ensure that all staff have received training in abuse awareness. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Barnfield House provides a homely, comfortable and safe environment, areas of the home require refurbishment to upgrade the standard of accommodation. The home provides equipment as identified and the standard of hygiene is good. Evidence: Barnfield House is a large converted older building. It provides accommodation over two floors with some bedrooms having en-suit facilities. Upper floor access is by stairs only. Most bedrooms, communal areas, kitchen and laundry were visited during the inspection. The home has recently registered 4 new beds in a purpose build extension. Whilst four beds have been registered only three are in use as the third is currently being used as a lounge/communal space. This is because a second phase of building work is to be commenced to upgrade the remainder of the home. When completed the temporary lounge will be returned to a bedroom. The living areas include two communal lounges one of which is a designated smoking area. There is also an accessible kitchen area and designated dining room, both of these areas require extensive refurbishment as appear to be in need of repair. People told us that they found the home suited their needs. Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: Most bedrooms are single occupancy with shared bedrooms being with the agreement of the people using them. Some bedrooms have en- suite facilities. Each bedroom was individual and the decor reflected the interests and needs of the occupant. All bedrooms have a lockable facility and some people were seen to keep their rooms locked. The home was maintained in a clean condition throughout.Staff were seen to have multiple roles, carers, cleaners, cooks, each role had an identified level of personal protective clothing and staff were able to tell us how the clothing for each role was managed. Hazardous substances are safely locked away and COSHH sheets are in use for all relevant substances. We noted that some free standing units , including wardrobes were not secured. All free standing units, including wardrobes, must be risk assessed and the appropriate action taken to ensure the safety of people using the service. The outside and garden areas are maintained and there is an inner courtyard in development which will has raised beds and level access. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a staff team who know the people using the service well. Staff are trained and feel appropriately supported. The recruitment procedures are mostly in place. Evidence: On the day of inspection there were three members of staff on duty which included the Registered Manager and two care staff. The registered provider is also available on an on call basis. Overnight there is one waking staff. The registered provider is available on call overnight when there is no available a sleeping staff member. We asked staff and people using the service if they felt there were sufficient staff and they confirmed that staffing levels were adequate. No agency staff have been used. All the people using the service spoken with at inspection were very happy with the staff at Barnfield and spoke in complementary terms about the kindness and helpfulness of the staff. People using the service and relatives told us , The staff are extremely caring, they do not shirk their duties, work hard and are liked by my relative. I have found Barnfield House a caring place where people are shown respect and sometimes real affection, my relative says they are fine and happy there. We spoke with staff on duty. They showed a good knowledge of operations in the Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: home, of their role and that of others. There is a staff training matrix in place which identifies all staff training which is taking place or planned. It is recommended that the registered provider who is included in the staff rota be included in the staff training matrix. It was noted that extended training is planned to take place in specialist areas relevant to the care provided. The home employs 12 staff of which two people are newly recruited. All excerpt three staff have completed a National Vocational Qualification and the training is in place for those three. This exceeds the National Minimum Standard recommendation. Currently no supervisions or staff appraisal are taking place. This is planned to start but has been delayed by the extension to the home. The registered manager is recommended to start this process as records of supervision are important to reference changes identified and improvements in care provision. Staff meetings take place regularly and staff told us that this is a good opportunity to discuss any issues. Recruitment procedures were mostly in place. We looked at two staff files for people recently employed at the home and most checks were in place to ensure the safety of people using the service. All staff have CRB (Criminal Record Bureau) and POVA (Protection of Vulnerable Adults) checks prior to commencing employment. It is recommended that the registered manager ensure that references are requested directly and no received to whom it may concern and that all recruitment documents are signed and dated when received. Recruitment procedures must be robust and all checks in place prior to people commencing employment at the home to ensure the safety of people using the service. We did not see any staff contracts or job descriptions. This are recommended to ensure that staff are clear about the terms and conditions of their employment. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home has developed to include quality assurance monitoring. The health, safety and welfare of residents is promoted and protected. Evidence: The registered manager is Linda Penney and she is now registered with the Care Quality Commission (CQC). She has recently completed the NVQ level 4 in management. The current management systems of the home support and promote positive outcomes for people using the service. The home has recently employed a compliance officer to over see the management of quality and review. People using the service and relatives told us that the manager is approachable and available when needed. The home has a very clear ethos of supporting people in the manner that they request. This means that people are supported to live a life that they choose within any boundaries of their health needs. The home is due to renew its own quality review process this month as part of an Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: annual program. The results of the quality audit are used to make any changes needed to care provision at the home. Accident records are in place and are audited monthly to identify any repeated incidences or trends and therefore promote accident prevention. All records maintained at the home are stored securely and in line with the Data Protection Act. Health and safety records inspected included the fire log, servicing and checking of fire equipment and systems, gas and electricity and of portable electrical equipment were seen. All records seen were well organized and up dated. The home has recently employed a caretaker/ maintenance person for the home to ensure daily maintenance. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 The registered manager is recommended to develop care plans to ensure that all areas of risk, need, choice an preference are included in the care plan itself. This will enable staff to easily and quickly access the information they need. The registered manager is recommended to audit peoples personal monies stored at the home on a regular basis to ensure that all accounts remain up to date. The registered manager is recommended to ensure that all prescribed creams are dated when opened to ensure that their shelf life is not exceeded. The registered person is recommended to ensure that the homes policy in abuse awareness is adjusted to reflect local area policy to ensure that staff are clear of the actions they must undertake. The registered manager is recommended to undertake a risk assessment for all free standing units including wardrobes and take appropriate action to ensure their safety. 2 10 3 20 4 23 5 26 Care Homes for Adults (18-65 years) Page 28 of 30 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 6 31 It is recommended that the registered provider who is included in the staff rota be included in the staff training matrix. The registered provider is recommended to supply all staff with contracts and job descriptions. This are recommended to ensure that staff are clear about the terms and conditions of their employment. The registered manager is recommended to start staff supervision and appraisal as records of supervision are important to reference changes identified and improvements in care provision 7 34 8 36 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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