Care Home: Barnfield House Nursing Home

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What the care home does well Prospective residents` general needs are identified, and the person knows about the home before they move in, promoting the success of admissions to the home. Various strategies are used to try to ensure the home is run in the best interests of people living there, including practices that protect their financial affairs. Peoples` welfare, dignity and rights are also safeguarded through a number of policies and practices - including using any concerns and complaints constructively to improve the service, and respecting peoples` privacy. Staffing arrangements are sufficient to meet peoples` general needs. Medication is managed well, promoting peoples` safety. The food provided is nutritious and enjoyable, with individuals` likes/dislikes taken into consideration. Links are maintained with families, friends and the community around the home, so people benefit from supportive and interesting relationships. People enjoy a clean, well-maintained and homely environment. Attention to health and safety matters also protects staff and other visitors to the home. What has improved since the last inspection? This is the first inspection of the home as a newly registered service. What the care home could do better: CARE HOMES FOR OLDER PEOPLE Barnfield House Nursing Home 2 Barnfield Hill Exeter Devon EX1 1SR Lead Inspector Ms Rachel Fleet Unannounced Inspection 1st May 2008 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 Barnfield House Nursing Home DS0000071052.V363912.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. Barnfield House Nursing Home DS0000071052.V363912.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Barnfield House Nursing Home Address 2 Barnfield Hill Exeter Devon EX1 1SR 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) 01392 202204 barnfield@dchs.org.uk Guinness Care and Support Ltd Manager post vacant Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Barnfield House Nursing Home DS0000071052.V363912.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 with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) 2. The maximum number of service users who can be accommodated is 29. Date of last inspection N/ A Brief Description of the Service: Barnfield Nursing Home has existed as a care home for several years, under different ownership. Guinness Care and Support Ltd. (‘GCS Ltd.’) now owns the home, which is registered to provide general care - including nursing care - for up to 29 people over retirement age. Due to conversion of one bedroom to a lounge, the home can accommodate 28 people at present. Accommodation is on three floors, and includes two double bedrooms and three en suite bedrooms. People are encouraged to personalise their rooms with their own furnishings and pictures if they wish. There is a lounge/diner with an adjoining conservatory area on the ground floor, and a smaller lounge on the first floor. A passenger lift provides level access between floors. There is ramp access at the rear entrance to the home. The home has a garden area, and some provision for parking. In a residential area, it is near the centre of Exeter - relatively near to local shops, two GP practices, and a leisure centre with a swimming pool. Weekly fees at the time of the inspection were £500 - £636. The fee level partly depends on whether individuals are funded by Social Services or privately funded. Fees do not include the cost of aromatherapy (£5-10), reflexology, hairdressing (£10-25), private physiotherapy, private chiropody (£10), social outings, clothes, dry cleaning, newspapers and toiletries (which are charged at cost price). Barnfield House Nursing Home DS0000071052.V363912.R01.S.doc Version 5.2 Page 5 Inspection reports for the home, produced by the Commission (CSCI), are with other information about the home, kept in a file available in the entrance hallway. Barnfield House Nursing Home DS0000071052.V363912.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The inspection took place as part of our usual inspection programme. There were 22 people living at the home on this unannounced site visit, 17 of whom required nursing care. The visit lasted almost 10 hours over two days (1 & 6 May 2008). Zena Rutter, the acting manager, had previously returned a CSCI questionnaire about the home (the Annual Quality Assurance Assessment, or ‘AQAA’), which included an assessment of what they do well, and their plans for improvement. We had also sent surveys to 10 people who lived at the home, with three being returned, some completed with help from relatives or staff. Of 10 sent to relatives or supporters, five were returned. Two surveys sent to health and social care professionals were not returned. The inspection included ‘case-tracking’ of three people. The sample included men and women, people new to the home, people with sight problems, both privately funded and Social Services-funded people, people with more complex needs, and people we wished to follow up as a result of information gained before the site visit. We looked into their care in more detail, meeting with them, checking their care records and other documentation relating to them (pre-admission assessments, medication sheets, etc.), talking with staff, and observing any general care or interaction with staff. We met with at least 13 people who lived at the home. Five spoke with us in some depth; others were unable to give their views in detail, because of frailty or disability. We also spoke with a visitor and six nursing, care or ancillary staff, as well as the acting manager. Other records seen included those relating to staff, peoples’ personal monies, the kitchen, health and safety, and quality assurance. A tour of the building included the kitchen and laundry. We ended the visit by discussing our findings with the acting manager. Information gained from all these sources and from communication about the home since the last full inspection is included in this report. Barnfield House Nursing Home DS0000071052.V363912.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? What they could do better: Identifying each prospective resident’s social care needs would help to establish whether or not the home can meet those needs, before the person decides where to live. There is information for staff about peoples’ various care needs. However, more detail in some care records and monitoring of aspects of care would promote consistent care and ensure that people receive all the care they need. Recreational opportunities for people are being developed, although a more person-centred approach would provide some with a better quality of life as the individuals that they are. Some staff would benefit from more training on local safeguarding procedures, to ensure that people living at the home will be fully protected from abuse. Barnfield House Nursing Home DS0000071052.V363912.R01.S.doc Version 5.2 Page 8 Further staff training – both accredited and in relation to the needs of people living at the home - would also help to ensure people living at the home receive safe basic care and that their more diverse or changing needs are met. People are protected by the home’s recruitment policies, although care must be taken to ensure practices are always be in line with these policies, to ensure systems protect people from unsuitable staff. A manager is to be registered with us, to confirm there is a person in charge of the home who is suitable for this role in the long term. 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. Barnfield House Nursing Home DS0000071052.V363912.R01.S.doc Version 5.2 Page 9 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 Barnfield House Nursing Home DS0000071052.V363912.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3. (The home does not offer intermediate care – St. 6) Quality in this outcome area is good. Systems are in place to ensure peoples’ general needs are known to the home and the person knows about the home, before they move in, promoting the success of subsequent admission to the home. Individuals’ social care needs are not always identified before admission, however, creating a risk that the home may not be able to meet all their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One person who came from hospital told us they had had enough information and were able to see the home, including their bedroom, before moving to the home. Another person said they had been offered a choice of rooms when they looked around. A third person said their family had looked around on their behalf. Barnfield House Nursing Home DS0000071052.V363912.R01.S.doc Version 5.2 Page 11 A senior staff member showed someone around during our visit, giving them the home’s statement of purpose, Service User Guide and information about the fees. Large print versions can be provided. The manager said she would always meet prospective residents before they were admitted, even in relatively urgent situations, so no-one is admitted without having their needs assessed. We also saw Social Services assessments of needs and care plans. We saw the letter sent to people if they are offered a bed at the home, confirming that the home can meet their assessed needs. The AQAA said the home’s pre-admission assessments included individuals’ likes/dislikes, social contacts and how their existing activities can be continued if they move to the home. This was not seen on one recent pre-admission assessment we saw, with no subsequent care plan for the person’s social needs. There was more detailed and personalised information about another person whose records we checked. Barnfield House Nursing Home DS0000071052.V363912.R01.S.doc Version 5.2 Page 12 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 – 10. Quality in this outcome area is good. There is information for staff about peoples’ various care needs. However, a lack of detail in some care records and insufficient monitoring of aspects of care may lead to inconsistent care and a risk that people may not receive all the care they need. Management of medication is good, with practices in place that promote peoples’ safety. Peoples’ privacy is respected, promoting their dignity and rights. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One person told us they were ‘very well looked after.’ Care plans we saw for three people had been reviewed regularly, with the person and their supporters given an opportunity to be part of these reviews. Nurses told us they had more time for care planning and that the manager audited care plans, leading to development and improvement of the care plans. Care staff were Barnfield House Nursing Home DS0000071052.V363912.R01.S.doc Version 5.2 Page 13 generally aware of peoples’ needs, and how to meet them – information we saw in care plans. However, two people’s care records had little about their social history or social needs to underpin their social needs care plan. One person had poor sight, but there was insufficient detail in the relevant part of their care plan to guide staff as the action they should take to support the person properly and consistently as a team. Their plan said they liked to watch TV, for example, without specifying how staff were to make this a fulfilling event for the person. Two staff were not aware that one resident had sight problems. We saw detailed records, kept by the specialist Tissue Viability nurses as well as the home’s staff, about peoples’ wounds. Someone who was at risk of pressure sores was sitting on a pressure-relieving cushion. One person had bruised hands, which was shown on a recent ‘body chart’ in their care records, but with little other information recorded about this. Staff were unclear about possible causes, giving different possible explanations. We noted the person was on medication that might make them bruise more easily. We saw a good care plan relating to someone’s diabetes. This condition was not mentioned on their dietary care plan, so we discussed cross-referencing different parts of peoples’ care plans, with the manager. Not all nurses we spoke with knew the guidance in the care plan, and on one occasion there was no record to show that the care plan had been followed when the person’s blood sugar was outside of the expected range. People’s weights were being monitored well, with GP advice sought appropriately. In some cases, they lost weight when unwell, but regained it and had not lost weight overall over a period of 6-12 months. The cook said she is informed when people are losing weight so that she can work with care staff to increase the person’s calorie intake. One relative felt people did not have enough opportunity for exercise. Staff said they offered ball games, skittles, etc., to encourage people who were unable to walk to move and be active. One visitor was concerned about whether someone got enough to drink when they weren’t there to help them. We thus spent time in one lounge, observing how people were helped with drinks. When we looked at one person’s care plan, their fluid intake had been recorded in their notes nearly every day in recent weeks, showing a set target was being achieved every 24 hours. We saw during our visit, however, a cup of tea was left with them for nearly two hours, with an unclear entry made on their fluid chart. We brought this to the manager’s attention. Barnfield House Nursing Home DS0000071052.V363912.R01.S.doc Version 5.2 Page 14 At least two people had both empty cups and cold cups of tea in front of them. When asked about this, staff said people were given a drink when they were brought to the lounge during the morning after rising, having already had a drink with their breakfast, and then were served another on the 11am drinks round (which could be within 1-2 hours of the previous one). People we asked were happy with the way their medication was being managed. We checked administration records and medications for three people. Photographs of individuals and information about their allergies were kept with medication administration sheets. Stock levels were well controlled, and apart from two small omissions, records were appropriately kept. Temperature records for the drug fridge showed recommended levels for safe storage of most items, but minimum/maximum temperatures were not being recorded to ensure insulin, for example, was being kept at proper temperatures. The manager had discussed a medication error with staff concerned. However, there was no record that that this had included clarification of the correct medication administration procedure to be followed. The manager agreed this would be prudent. People said staff respected their privacy as much as possible, when in the bath, etc. Bathrooms and toilets had grabrails, raised toilet seats and locks, promoting peoples’ privacy and independence. There were ‘Do not disturb’ signs on bedroom doors. A relative who completed a survey thought having the same gender of carer available would be appreciated for certain aspects of personal care. Staff were able to tell us the expressed preferences of some of the people they looked after, and care records included information about peoples’ preferences. Unfortunately, the home has not been able to recruit many male care staff; the male residents we spoke to said they did not mind being helped by female staff. One lady said she would prefer it if only female carers helped her to move because they were gentler, but she added all the staff did their best. The manager agreed to see if everything was being done to ensure people were helped by carers of the gender they preferred. Barnfield House Nursing Home DS0000071052.V363912.R01.S.doc Version 5.2 Page 15 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. Opportunities for choice and fulfilment are being improved, although a more person-centred approach would provide some people with a better quality of life as individuals. Links are maintained with families, friends and the community around the home, so people benefit from supportive and interesting relationships. Food provided is nutritious and enjoyable, with individuals’ preferences taken into consideration. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Most people living at the home said they had enough to do with their time. One person said, ‘Time flies’ when asked if they had enough to do. However, they said they were limited in what organised activities they could join in with because they had impaired sight. Another person also felt there could be better provision for people with poor sight. Two visitors suggested a better range of activities, such as one-to-one cookery sessions, entertainments and outings would help to improve the service Barnfield House Nursing Home DS0000071052.V363912.R01.S.doc Version 5.2 Page 16 provided. Minutes of a recent residents/relatives meeting showed people had been asked for suggestions on activities and menus. Staff said the daily routine had very recently been improved, so they could help people get up in a more timely way and so staff had more time for activities. Some people living at the home felt their peers were too frail to take part in activities currently. The printed activity programme available to people living at the home included seasonal events, Bingo, pamper days, music, and exercises/games. The House Manager had undertaken a course about exercise for the elderly so she could lead appropriate activities. Peoples’ spiritual or faith needs were recorded well – showing whether the person wished to go to church services, etc. The manager is still trying to find someone to lead a regular service at the home, because at present people would have to attend local churches. However, there was relatively little other information about individuals in their care records to guide development of activity programmes in line with peoples’ interest or past occupations, etc. When asked if they got enough information from the home, one relative pointed out there is information on notice boards in the lounge areas, and said that the staff rang them up as necessary, adding staff were always friendly. This was reflected by another relative who also said staff were ‘Very good at letting me know.’ One person, when asked what the home does well, said, ‘Staff always welcome me’. Relatives are welcome to attend the Residents’ meetings. People said bedtime and rising times were flexible, to suit them. One person said they were helped to get up early - which they preferred, having been an early riser for much of their life. Someone who stayed in their bedroom a lot said they were always left with the call bell. Bedrooms were personalised with peoples’ property, reflecting their lives and interests. Keys could be provided if people wished to lock their bedroom door, and there were individual facilities for secure storage of valued personal items. The trolley shop was taken round during the visit. This was done almost daily in the week, so people were able to buy sweets, greetings cards, etc. One person suggested it would be good if people could have more input regarding food, especially for special occasions such as birthdays and Christmas. We saw from minutes of a residents/relatives meeting that people were able to chose from given options what they wanted for Christmas lunch. The manager said she would look into how this suggestion could be acted on further. One person said they would like more vegetarian options. The cook told us she speaks with individuals, especially new residents, about their preferences and Barnfield House Nursing Home DS0000071052.V363912.R01.S.doc Version 5.2 Page 17 diet, tries various dishes, and gets feedback from people on whether they liked them or not. She goes around the home daily to get peoples’ menu choices for the next day. There was a list of each person’s dietary likes/dislikes in the kitchen, with special dietary needs also. Other people told us they got enough food, with enough variety. One person especially liked the porridge, which was available daily. One survey from someone living at the home said, ‘Appetite poor but staff try to tempt the appetite!’ Homemade cakes were cooling in the kitchen, with an appetising smell when we arrived. Menus for two weeks were available on dining room tables. The cook said a summer menu was being drawn up with suggestions from people living at the home. One person wanted staff to buy them some fruit. Care staff said this was not necessary, since they could bring them their own bowl of various fruits provided from the kitchen. Barnfield House Nursing Home DS0000071052.V363912.R01.S.doc Version 5.2 Page 18 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. Peoples’ welfare and rights are safeguarded through a variety of policies and practices, including that concerns and complaints are heard and used to improve the service provided. However, staff would benefit from more training on the Local Authority’s safeguarding procedures, to ensure people living at the home will be fully protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People said they felt able to complain if necessary, and found the manager approachable. We saw a written record of complaints and the response to complainants from the manager. One person who had made a complaint said the manager was addressing the issues they raised, and staff were also trying to help to sort the problem out. We ourselves have not investigated any complaints about the home. Two people said they did not know how to make a complaint. We saw from minutes that the complaints procedure was discussed at each residents’/relatives’ meeting, to try to ensure people knew how they might make complaints. The manager said copies of the procedure had also been left by the visitors’ signing in book, as well as in each bedroom. Barnfield House Nursing Home DS0000071052.V363912.R01.S.doc Version 5.2 Page 19 When asked in a survey if they knew who to speak to if they were unhappy about anything, one person said they had poor sight and couldn’t see staff properly, making it difficult for them to identify the person they should speak to. We discussed with the manager whether staff would benefit from training on caring for people with sight problems, the need to introduce themselves, etc. People said they felt safe with staff. The manager was aware of her responsibilities and knew who she should report safeguarding matters to. Staff we spoke with knew they must report abuse, although they were not always aware of whom to contact outside of GCS Ltd. if necessary, and not all recognised the term ‘safeguarding’. One staff member could describe behaviours that are considered abusive, and knew some of the organisations to whom any concerns could be reported, but they didn’t know about the Local Authority’s role. They said they had not had a recent update on safeguarding. Similarly, another staff member didn’t know the organisations with safeguarding responsibilities, but they knew what was considered abusive practice, and the complaints procedure. Barnfield House Nursing Home DS0000071052.V363912.R01.S.doc Version 5.2 Page 20 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 & 26. Quality in this outcome area is good. People benefit from a clean, well-maintained and homely environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People told us the liked their bedrooms, and that they had enough lighting, hot water, etc. When asked if repairs were attended to quickly, one person said they only had to mention it and something would be done promptly. One relative, asked what the home does well, said it was a ‘Very homely place’. We saw records kept over time by the House Manager, showing redecoration and other maintenance carried out over the last year. Some areas had been recarpeted since the last inspection and other areas were looking brighter, with two dining tables now provided in the main lounge. A new boiler has been Barnfield House Nursing Home DS0000071052.V363912.R01.S.doc Version 5.2 Page 21 fitted recently, also. We saw records of regular checks of equipment as well as the fabric and furnishings. Armchairs were regularly steam-cleaned, for example, and radiator covers were removed yearly for cleaning purposes. Several bedrooms had dimmer switches, and door locks to promote peoples’ privacy. We informed the manager that one survey had said an extra chair in someone’s bedroom, for visitors, would be useful. We saw from minutes of a residents’/relatives’ meeting that a similar request was being addressed by the home. We pointed out to the manager that one person’s call bell was across the room from their bed, so they couldn’t use it when in bed. She said she would look into this. One person suggested wheelchair access at the front of the home, rather than having to go round the back of the building, would be appreciated. Other suggestions included having a private room where visitors could be received, having a toilet for visitors, and having some lighter wheelchairs for outings, to make it easier to take people out. We passed these ideas to the manager for her consideration. People told us the home was kept clean enough for their liking. As we looked around the home, we saw equipment such as hoists and wheelchairs were clean. We later saw records showing there were systems for ensuring this was done. There were no malodours. The cook showed us the weekly cleaning records for the kitchen, and she said it was also deep-cleaned every three months. A recent inspection by an Environmental Health Officer had a positive outcome. We saw staff used disposable gloves and aprons when helping people with personal care, and we saw stocks available around the home. Disinfecting hand gel was available and used, with staff aware of how to use it correctly. Suitable bags were used to transport any soiled items to the laundry room. Washing machines had appropriate programmes for proper cleaning of laundry. We saw the surface of a bath had been damaged, which would affect how well it could be kept clean. The House Manager said quotes were already being obtained for a replacement bath. Barnfield House Nursing Home DS0000071052.V363912.R01.S.doc Version 5.2 Page 22 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. Staffing arrangements are sufficient to meet peoples’ general needs, although further staff training and development would help to ensure people living at the home receive safe basic care and that their more diverse or changing needs are met. People are protected by the home’s recruitment policies, although care must be taken to ensure practices are always in line with these. This judgement has been made using available evidence including a visit to this service. EVIDENCE: When we arrived, there were two nurses on duty with four carers (including a regularly employed bank staff), to care for 22 people. The manager, the house manager, two domestics and a laundry staff were also on duty. Of the 22 people living at the home, five did not need nursing care. Two male residents separately said that they appreciated that the staff didn’t fuss over them, also saying staff were very friendly in a gentle way and very nice. Two relatives commented specifically on the friendliness of staff, when asked what the home does well; one said they ‘mix in with patients, having a laugh & a joke.’ Barnfield House Nursing Home DS0000071052.V363912.R01.S.doc Version 5.2 Page 23 We saw people in the lounge and conservatory did not have a call bell within easy reach. One person said staff were always around, adding ‘Very much so’, when we asked how they got staff attention. They said they didn’t go far without a staff member speaking to them. However, another person said they sometimes had to wait for staff to attend to them. A visitor thought people weren’t always attended to in a timely way when in the lounge, especially in the evenings. Staff said a call bell was usually left with a specific person, for them to ring it on behalf of their peers. They acknowledged that when people were being helped to bed in the evenings there might be fewer staff around the lounge areas. One staff member said people were not always assisted up until very late in the morning. Other staff said the morning routine had recently been altered, addressing this problem, although if staff rang in sick at short notice people might be helped up later than they might like. One person living at the home said the staff were a bit overworked but they never snapped at people and if they had ‘five minutes’ they would sit and chat. Two relatives suggested more staffing was needed. One thought staff skills could be developed so there was more care and proactive attention to seeing if people needed anything. One suggested better organisation of evening staff was needed perhaps. We looked at recruitment information for four staff. Required information had been obtained except that there was only one reference available for one person rather than two references. The manager said she would follow this up with the head office staff (who obtained references), but also said the staff member was leaving the home the next day. All had had an initial police check obtained, with full police checks also obtained for three of them, before they started working at the home There is always a registered nurse on duty, as confirmed by staff and the work rotas. Of 15 care staff, three had a recognised care qualification (NVQ2 in care) and four were undertaking it – including two staff that we spoke with. Staff said they had had updates of health and safety topics, and were updated when peoples’ needs changed or if someone was admitted with particularly different needs. One part-time staff member suggested training on caring for people with sight problems, confusion or dementia would be useful. A full-time staff member said they had had training in the last year about caring for people with dementia, and they had subsequently shared their new knowledge with other staff who did not attend. They also described recent learning about continence management in relation to someone’s particular needs, which they said was very useful in helping them understand the person’s problem. Barnfield House Nursing Home DS0000071052.V363912.R01.S.doc Version 5.2 Page 24 Staff training records showed that health and safety matters were regularly addressed but did not evidence much training specific to the needs of people living at the home. We saw evidence that staff had opportunity to meet the manager for one-toone supervision sessions. During these, she discussed their work performance, including any issues or concerns about their practice, clarifying standards or actions expected. Staff said developmental goals were also set during supervision, and training could be discussed. See also the earlier section on ‘Health & Personal Care,’ where related matters are discussed. Barnfield House Nursing Home DS0000071052.V363912.R01.S.doc Version 5.2 Page 25 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. A manager has yet to be registered with us, to confirm there is a person in charge who is suitable for this role in the long term. The current manager of the home uses various strategies to try to ensure it is run in the best interests of people living there, including practices that protect their financial affairs. Attention to health and safety matters also protects staff and other visitors to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has run the home for over a year. She is a registered nurse, who has achieved a recognised management certificate. She said she had had Barnfield House Nursing Home DS0000071052.V363912.R01.S.doc Version 5.2 Page 26 training on end of life care, tissue viability, management and staff development in recent months. People living at the home, as well as the staff, said the manager made herself available to them if they had a query, etc. The House Manager who managed the housekeeping staff was undertaking the Registered Manager Award. An application to register a manager with the Commission is still awaited from GCS Ltd. We saw monthly reports of the provider’s representative’s visits to the home, although we noted that recent visits had not included many conversations with people living at the home. Minutes of a recent residents/relatives meeting showed extra staff were available to help people with hearing problems understand and participate. People had been told about our inspections, the change in the morning routine and quality assurance findings at this meeting. The AQAA said such meetings took place three-monthly, as confirmed by the minutes. Quality audits were carried out six-monthly, consulting service users, their visitors, community-based professionals who supported them, and staff from the home. We saw the manager’s report on the latest findings and what action was to be taken as a result, with timescales, etc. to improve the service in line with peoples’ comments. The manager confirmed she does not act as appointee for anyone at the home. We looked at the personal monies records for three people. These were well kept, with two signatures and receipts available to verify the transactions recorded; cash balances held matched the totals shown on records. The owner’s representative also carried out audits on their monthly unannounced inspections. See ‘Staffing’ section regarding staff training on manual handling, fire safety, first aid (including the nursing staff), etc. There was manual handling information in peoples’ bedrooms to promote appropriate handling. We noted from accident records that there were at least three skin tears recently sustained possibly during handling by staff. The manager said this was identified during the home’s own audits and consequently staff were having retraining to address this, with a session taking place during our visit. People we asked said they were not aware of any hazards or outstanding repairs at the home, and they felt able to get about safely. We saw a lift servicing certificate dated 19/7/07, an electrical safety certificate dated 3/2/04, and evidence that gas fires and fire safety systems had been serviced this year. Bath water was in safe limits where we checked it; the fixed bath hoist there was serviced in the last six months. The cleaning chemicals cupboard was locked, for safety reasons. First aid boxes were checked regularly, with records of this kept. Barnfield House Nursing Home DS0000071052.V363912.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Barnfield House Nursing Home DS0000071052.V363912.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? N/A 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 OP18 Regulation 13(6) Timescale for action You must make arrangements by 31/08/08 training staff, or by other measures, so they know local safeguarding procedures – To ensure people living at the home are as fully protected from abuse as possible. You must submit an application for registration of a manager To ensure anyone who manages the home is fit for this role in the long term, and so they are not guilty of an offence under the Care Standards Act 2000. Requirement 2 OP31 Under Care Standards Act 2000 11 (1) 31/08/08 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 OP3 Good Practice Recommendations It is recommended that each new service user is admitted only on the basis of a full assessment of their needs, which DS0000071052.V363912.R01.S.doc Version 5.2 Page 29 Barnfield House Nursing Home includes their social interests To establish whether or not the home can meet all their needs if they choose to live at the home. 2 OP7 It is recommended that there is sufficient information for staff, in each person’s care records, about peoples’ diverse care needs and how to meet them, with sufficient monitoring of care given – To ensure people receive consistent care and receive all the care they need. 3 OP12 It is recommended that recreational opportunities for people are developed in a more person-centred way – To ensure people have a better quality of life as individuals. 4 OP28 It is recommended that at least 50 of the care staff (excluding the registered nurses) are trained to NVQ Level 2 in care or an equivalent – To ensure people living at the home receive a safe basic level of care at all times. 5 OP30 It is recommended that there is a staff training and development programme that ensures staff can fulfill the aims of the home and meet the changing or diverse needs of people living at the home – So that peoples’ needs are met currently and in the future. 6 OP29 It is recommended that you ensure there has been a thorough recruitment procedure for each prospective staff member, before they are employed – To ensure protect people living at the home from unsuitable staff. Barnfield House Nursing Home DS0000071052.V363912.R01.S.doc Version 5.2 Page 30 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 Barnfield House Nursing Home DS0000071052.V363912.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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