Care Home: Barnhaven

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What the care home does well People living at this home were generally very happy with life at the home; one person told us the service "cares for the elderly and look after us well," another said, " food excellent, cleanliness, home very clean". People spoke highly of the staff; we were told that one person they had " lots of confidence in the staff, they do lots of things for me". During our visit staff were attentive and friendly in their approach to people living at the home. We saw staff skilfully meet the needs of individuals and ensure that individuals were offered choices. Good information is available to people to help make a decision about whether this home would suite their needs. People`s health care needs are well met and the home works with other professionals, such as Doctors and nurse specialists to ensure people have access to the care they need. People can be assured that caring staff will respect their privacy and dignity and enable them to make choices within their daily lives. People were generally happy with activities provided and most felt their social needs were met. People spoke highly of the food served at the home, which is of good quality and nutritious. The home can cater for various diets. People feel confident that their complaints or concerns will be addressed. There are systems in place to ensure that people living at the home are protected from harm or abuse. The environment is clean, comfortable and safe. People were very happy with their accommodation. The home has sufficient aids and equipment to support the need of the people living there. Many people praised the staff team for their caring approach and attitude. The staff morale at the home is high and staff feel valued in their role and have a good sense of job satisfaction. Staff are well trained and professionals were confident that they had the skills to meet the needs of the people living there. The home is well managed, with systems in place to ensure that people have their say about the development of the service. Overall, health and safety is well managed and people are safeguarded from harm. What has improved since the last inspection? One requirement and two recommendations for good practice were made as a result of the last inspection. The home has consulted with an infection control specialist regarding measures for commode sluicing and use. What the care home could do better: One requirement and 8 recommendations for good practice were made as a result of this inspection. The service does not currently undertake a consistent robust employment procedure before staff are employed at the home. Information relating to individual health and social care needs, obtained prior to a decision being made to admit people to the home is not recorded and retained for people who are admitted to home and who are not funded by Devon Sociall Services. When the decision has been made to admit a person to the service, based on an assessment of their health and social care needs, they are not notified in writing that the service can meet their assessed needs. Not all health needs for individuals are set out in an individual plan of care. Nutritional screening is not being undertaken on admission or reviewed periodically, and a record maintained of nutrition, including weight gain and loss and actions taken is not being recorded. Consideration should continue to be given to removing the sluice from the laundry and relocating it to a place to prevent the risk of cross infection at the home. All staff who handle food have not received appropriate basic food hygiene training to reduce the risk of cross infection at the home. Policies and procedures have not been be regularly reviewed and updated to reflect up to date current good practice. Key inspection report Care homes for older people Name: Address: Barnhaven Barnhaven Barnhaven Barnhay Bampton Devon EX16 9NB     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: Michelle Oliver     Date: 2 2 0 9 2 0 0 9 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 Older People Page 2 of 34 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 Older People 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Barnhaven Barnhaven Barnhaven Barnhay Bampton Devon EX16 9NB 01398331566 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: http/www.devon.gov.uk Devon County Council care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Barnhaven is a care home providing personal care and long stay accommodation for up to 15 older people. The home is owned and managed by the local authority, Devon County Council. The home is centrally located, in Bampton, a small market town, close to local shops, pubs, post office and other amenities. The home first opened in 1977, and comprises a two-storey purpose built building. All the homes bedrooms are single. There are shared bathrooms and toilets. There is a passenger lift to the first floor, and a call bell system is installed throughout the home. There are three lounges in the home for communal use and a dining area. The home has outdoor seating to the front of the building and there is a grassed area to the rear. Care Homes for Older People Page 4 of 34 Over 65 15 0 Brief description of the care home The current range of fees for client contribution is from £300.90 to £556.87 per week. The home ensures copies of this report are made available to staff residents and their relatives. Care Homes for Older People Page 5 of 34 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means that people who use this service experience good quality outcomes. One inspector, who spent 8 hours at the home, undertook this inspection. We spoke with people living there and staff and also spent time observing the care and attention given to people by staff. Prior to this inspection we sent surveys to 15 people living at the home, 5 staff and 5 health care professionals. Twelve of those living at the home, 5 staff and 2 health care professionals completed the surveys and returned then to us expressing their views about the service provided at the home. Their comments and views have been included in this report and helped us to make a judgement about the service provided. To help us understand the experiences of people living at this home, we looked closely Care Homes for Older People Page 6 of 34 at the care planned and delivered to three people. Most people living at the home were seen or spoken with during the course of our visit and three people were spoken with in depth to hear about their experience of living at the home. We also spoke with 5 staff, including the manager and assistant manager individually. A tour of the premises was made and we inspected a number of records including assessments and care plans and records relating to medication, recruitment and health and safety. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 34 One requirement and 8 recommendations for good practice were made as a result of this inspection. The service does not currently undertake a consistent robust employment procedure before staff are employed at the home. Information relating to individual health and social care needs, obtained prior to a decision being made to admit people to the home is not recorded and retained for people who are admitted to home and who are not funded by Devon Sociall Services. When the decision has been made to admit a person to the service, based on an assessment of their health and social care needs, they are not notified in writing that the service can meet their assessed needs. Not all health needs for individuals are set out in an individual plan of care. Nutritional screening is not being undertaken on admission or reviewed periodically, and a record maintained of nutrition, including weight gain and loss and actions taken is not being recorded. Consideration should continue to be given to removing the sluice from the laundry and relocating it to a place to prevent the risk of cross infection at the home. All staff who handle food have not received appropriate basic food hygiene training to reduce the risk of cross infection at the home. Policies and procedures have not been be regularly reviewed and updated to reflect up to date current good practice. 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 Older People Page 9 of 34 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering making Barnhaven their home can be assured that needs will be assessed to ensure the home can meet their needs. Improvement in record keeping processes and in ensuring people are informed in writing that their assessed needs can be met at the home will further improve person centred care. Evidence: Prior to this inspection we sent questionnaires to 15 people living at Barnhaven and received responses from 11. All, but one,who responded confirmed they had received enough information about the home before deciding to move in. During this inspection we looked at the admission records of three people, one of whom had moved into the home within the last 3 months. We talked to them about how they chose the home, about the information that was shared, and about the Care Homes for Older People Page 11 of 34 Evidence: discussions and agreements that were reached on the care they need. Not all were able to remember their admission clearly and generally their admission had organised by relatives or care managers. The manager told us that people considering making Barnhaven their home,their family or representatives are encouraged to visit the home, meet other people living there and have a meal if they choose before the decision is made to make it their home. Copies of comprehensive assessments of individual health and social care needs for people who are not privately funded and are admitted through care management are obtained. This is to ensure that the service can meet the needs of individuals admitted to the home. This will include ensuring the environment is suitable,that their dietary needs can be met, ensuring staff are appropriately experienced and competent to meet a persons individual needs and that people can continue to have links with family, friends and the local community, as they choose. However, although the manager told us they visit some people in either their own homes or hospital, to undertake an assessment of their individual health and social care needs, a record of this information is not kept by the service. In the 3 care files we looked at we saw no evidence that the service had confirmed in writing that following an assessment the service is suitable to meet individuals health and social care needs needs. This means that people may be unaware of whether the service is able to meet all of their needs. All people living at the home who we spoke to, who were able to communicate, confirmed that the service had provided information about the home before they decided to make it their home and had lived up to their expectations. The home does not offer intermediate care. Care Homes for Older People Page 12 of 34 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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. Care planning provides staff with the information they require to meet some of the assessed needs of individuals in a safe and respectful manner, while promoting their dignity and independence. continued improvement to ensure that care plans reflect all health and social care needs for people will ensure that these needs will be met. Evidence: During this inspection three peoples files were looked at in detail and all included information to ensure that staff are aware of how to meet peoples individual daily health and social care needs. We were told that plans are developed with people individually and relatives are involved with the persons consent and this was confirmed when we looked at care plans. The plans are clearly written and include a personal requirements sheet, which sets out individuals preferred routines and the way they like to be supported. The plans Care Homes for Older People Page 13 of 34 Evidence: also contain a moving and handling plan, risk assessments, a record of activities, and a record of health care needs, which includes any health care appointments or visits made. Care plans include personal requirements of each person including how they choose to live their lives 24 hours a day. Not all information provided in assessments undertaken by health care professionals prior to admission were included in care planning. For example a community nurse had informed the home that a person had a hearing impairment but chose not to wear aids and that they also needed to wear glasses at all times. No information relating to how staff would meet these needs had been recorded. Other information included requires support at night to get (the persons) legs out of bed as (the person) chooses to have bed rails. Once again no information relating to how this would be managed had been provided for staff. No care plans had been developed for another person to provide information, or to monitor their condition, in relation to two chronic medical conditions and two acute conditions. This means that they are potentially at risk of their health care needs not being met or monitored. Staff maintain individual daily reports for all people living at the home. We looked at the daily reports for 3 people and they consisted mainly of a record of personal care delivered and peoples continence rather than how staff had provided person centred care, the way people lived their lives or whether or how individual care plan goals had been met. When information had been recorded about health needs this did not include details of what action had been taken to meet the needs. For instance one daily record we looked at asked staff to please monitor that (the person) doesnt continue to refuse food and especially fluids. No further information about how this was being monitored had been recorded until six days later when staff wrote that the person was refusing to drink as (the person) would need to go to the toilet. Staff had also recorded that they had told the person about the importance of drinking enough. However, we read some good information of how staff had noted a change in the persons state of health the result of which was that they were treated for an infection. We also saw an entry stating, Worrying about pads and another stating that a person had been told that a close relative had died, but no information of whether the people had been reassured or had their concerns acted upon. Care Homes for Older People Page 14 of 34 Evidence: Assessment of potential risks to people living at the home is undertaken as part of the care planning process and kept under review. This includes the risks of falling, fainting, infection and use of bed rails. However, assessments of individuals nutritional status are not undertaken when they are admitted to the home. This means that people are at potential risk of their nutritional needs not being met. We were told that care plans are reviewed regularly, appropriate changes are made to reflect changing needs and individuals, and their relatives are encouraged and supported to be involved in this review. All staff are required to look at reviewed care plans so they are aware of any changes, and to sign to confirm they have done so. This means that staff are aware of peoples changing needs and are provided with relevant information to enable them to meet the needs in a way the person chooses. However, we looked at the care plans for one person that, although all care and assistance had been undertaken to accommodate changes in the health and social care needs, the care plans had not been reviewed or updated to reflect theses changes. This means that the person is potentially at risk of their health and social care needs not being met in a consistent way. The home monitors peoples dental and optician checks and chiropodists are used according to peoples needs. Information relating to the involvement, and advice from health care professionals such as skin care specialists and community nurses were included in peoples plans of care. This means that they benefit from the involvement of health care professionals to ensure that health care needs are met. The manager described a good relationship with health professionals such as district nurses, community psychiatric nurse, pharmacist and doctors. Questionnaires returned by health care professionals prior to this inspection agreed that the home always or usually meets, and seeks advice and acts upon it to improve, individuals health care needs. A community nurse commented, The service has good relationships with clients, understanding their needs and supporting them to the best of their ability and Also very good at involving district nurses and doctors immediately if there are any concerns. During this inspection arrangements were made for a person living at Barnhaven to be transferred to hospital following a fall several days ago. We saw good recording of events leading up to the persons admission, records of the concerns of staff at the home, phone calls and visits that other health care professionals had made to the Care Homes for Older People Page 15 of 34 Evidence: person at the home. Clear accurate details were given to Devon Ambulance Service when they came to the home and to the hospital when they rang after the person had arrived at hospital. Relatives were told exactly what was happening and updated regularly by the manager. The ethos of the service is that everyone would be able, and would want to look after their own medicines when they come to live at Barnhaven. Risk assessment are undertaken for all people when they move to the home to find out whether they choose to look after their own medicines and if they do that they are able to do so safely. The assessment included details of any risks such as the persons awareness of why they are taking their medicines, the implications and importance of the times and amounts of medicines they take and their ability to read the labels or open the containers. Lockable storage is provided in all private rooms at Barnhaven to ensure safe storage of medicines. Medication is well managed at the home; records we looked at were accurate, up to date and indicated that it is appropriately received, stored, administered and returned. Only senior members of staff who have undertaken appropriate training have responsibility for administering medications. Controlled medications are appropriately stored in a separate cabinet and signed by two staff when administered, which is good practice. The home has a list of homely remedies or medicines that may be bought over the counter without a prescription,which includes such things as pain relievers and indigestion medicines. The list of medicines has not been agreed with peoples doctors to ensure that none of these homely remedies may interact with already prescribed medicines. The manager told us that the home would always check with a persons doctor before giving an unprescribed medicine. This means that people are kept safe by the homes management, storage and administration of medicines at the home. People felt that their privacy was respected and staff were seen to knock on doors and wait to be invited in before doing so and were also seen offering personal care in a discreet manner. All people living at Barnhaven have a lock on their bedroom door, which can easily be accessed by staff in an emergency, to ensure their privacy. We sent surveys to 15 people living at Barnhaven, prior to carrying out this inspection, and received responses from 12.In response to what does the home do well people made the following comments: Everything very good here, care for the elderly, Care Homes for Older People Page 16 of 34 Evidence: look after us well and another everything. Throughout this inspection we saw staff treating people respectfully, and although busy, took time to speak with them and much laughter was heard. One person told us that they are very happy here, food is lovely and all the staff are so kind. Care Homes for Older People Page 17 of 34 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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 living at Barnhaven are supported to live their lives as they choose, encouraged to maintain contacts with friends and family and are provided with a choice well prepared nutritious meals. Evidence: People living at Barnhaven told us they are offered choices in all aspects of how they live their daily life. They told us they can get up, and go to bed when they choose and do whatever they choose to do during the day. We arrived at the home at 9.15 am; some people were sitting in the lounge, some in the dining room and others were in their rooms. All those we spoke to told us that they had chosen to get up when they had. Nine people who responded to surveys told us that there were always activities at the home they could take part in; two people felt this was usually the case. Prior to this inspection an activities organiser visited the home on a weekly basis, however this is not currently happening and staff are involved in supporting people to undertake activities or hobbies that they choose. As a result of the service listening to Care Homes for Older People Page 18 of 34 Evidence: peoples views more frequent visits from a touring entertainer have been arranged, which several people told us they enjoy. We asked staff how they prevent people who prefer to stay in their room from the risk of social isolation and were told that staff visit them frequently, talk to them about daily events, their interests and tell them what activities are taking place so that they may change their minds. During this inspection we saw care staff visiting people who preferred to spend time in their rooms to make sure they were comfortable and did not need anything. All rooms have a nurse call system, which means that people can call for staff when they wish. We saw records of various activities undertaken and enjoyed by people living at Barnhaven. These include musical quiz, cards, clothes shows, chats, various board games and manicures. During this inspection we saw a wide choice of board games, puzzles, videos and tapes including a wide variety of music. The manager told us that rather than having a set programme of daily activities people living at the home prefer to have a daily choice. This means that they will only do things they want to do when they want to do it. We saw a group of people enjoying a game of snakes and ladders, several people enjoying a manicure, some people were reading books and daily papers, one person was getting ready to go out for a stroll and another person, who chose to stay in their room, was knitting. All those we spoke to told us that they enjoy the quality of their life at the home and that they are encouraged and supported to do just what we want to do. The atmosphere at Barnhaven throughout this inspection was cheerful, relaxed and full of fun. Several people spoke about how their relatives or visitors are made to feel welcome at the home. Visitors are offered drinks and are made to feel at home. We looked at the visitors book and it was clear that many people received visitors and they came at different times of the day. Throughout the day of this inspection several people came to Barnhaven. People moving into Barnhaven are encouraged to bring personal possessions and small items of furniture with them to make their rooms feel homely and this is agreed before admission. All of the rooms seen during this inspection were personalised and people spoke about the pleasure having their own things around them gave them. Care Homes for Older People Page 19 of 34 Evidence: All people we spoke to, and those who responded to surveys, told us how much they enjoy the meals served at the home. Comments included food is excellent and always fresh and hot. People can choose to have their meals in the pleasant dining room or in their rooms if they wish. The home has a comfortable, homely dining room; tables are well laid with tablecloths, condiments, cutlery and napkins. People are told what the days lunch menu choices are after breakfast each day. We were told that the menu has been improved taking into consideration peoples likes and dislikes and the service also has a special menus for Bank Holidays. The home has a serving hatch between the dining room and kitchen and meals are served individually by the cook using this hatch. the cook told us that it was nice to have involvement with people.The cook referred to individual choices as well as taking into individual likes and dislikes of vegetables and how individuals like to have their meal served. We were told that the cook is developing a pictorial menu so that people who may have hearing difficulties will be able to make informed choices. The meal we saw being served on the day of our visit was well presented, hot and everyone said they had enjoyed it. The meal was served at a leisurely pace and staff assisted those who needed help discreetly. The service has recently intoduced offering people living at the home, fruit when afternoon tea is served. The manager told us that ways in which they aim to continue improvement at Barnhaven will include providing more activities for people, devise a planned daily activities programme to be carried out when possible and to introduce nurtitional screening for all people when the move into the home. Care Homes for Older People Page 20 of 34 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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 has a clear and simple complaints procedure that ensures complaints are responded to promptly with satisfactory outcomes. Staff have a good knowledge and understanding of the forms of abuse thereby ensuring that people living at the home are protected. Evidence: The home has a detailed, clear and simple complaints procedure, which is prominently displayed for all people living at the home, visitors and staff to see. The home has developed a system to maintain records of all complaints received and how they are managed. No complaints had been made to the home or to the CQC since the last inspection. People living at the home that we spoke to during this inspection said that if they were unhappy about anything they would not hesitate to raise any matter at any time and were sure that it would be dealt with to their satisfaction. Staff said that if anyone made a complaint they would report it to either the manager or senior carer. If it was something that they were able to sort out themselves then they would. They were confident that no issue that was raised would ever be ignored. There was nothing to suggest that people living at the home are anything other than Care Homes for Older People Page 21 of 34 Evidence: well cared for. People spoken to told us that staff were very helpful, respectful and that nothing was ever too much trouble for them. The manager told us that all staff have received training in Adult Protection issues. A procedure for responding to abuse is available and staff were aware of this. Staff were able to describe differing types of abuse and gave good details of what they would do if they suspected abuse was occurring. They were aware of the homes Whistle-blowing policy and that it would support them in reporting bad practice. They felt confident that they would be listened to if they raised concerns about bad practice. All of the people living at the home who responded to questionnaires agreed that they always or usually know who to speak to if unhappy or wanted to make a complaint. Staff who responded to questionnaires also confirmed they knew what to do if a person living at the home or a relative had concerns about the home. Care Homes for Older People Page 22 of 34 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, 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. 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. Barnhaven provides a comfortable, clean and safe environment for those living in, working at and visiting the home. Evidence: The home was clean, comfortable and homely at the time of this inspection. The providers and management have worked hard to improve and maintain the home since the last inspection. We saw bedrooms that were well decorated, bright and homely. The majority of them had been personalised and people living at the home told us that they were happy at the home. Environmental risk is being well managed and decoration, fitting and fixtures such as furniture, curtains, carpets, pictures, lamps throughout the home are of a good quality. Because of the age and design of the building maintenance and redecoration is ongoing. The home has two floors [with a passenger lift between assist people who cannot manage stairs] a lounge on each floor and spacious dining room on the ground floor. Ample space is available for activities and for those who like to walk or have mobility problems and need the use of a wheelchair. Signs directing people to bathroom, toilets, lounges, dining room and to peoples individual rooms were well presented. Care Homes for Older People Page 23 of 34 Evidence: The home was clean and fresh and people living there commented positively on the cleanliness of the home; this was observed on the day of the inspection and in responses to surveys. During this inspection we saw a list of duties the domestic carries out regularly and a routine for cleaning the kitchen. The home has policies in place for reducing the risk of cross infection and ensuring a hygienic environment and during this inspection we saw staff following these policies by using gloves and aprons and washing there hands appropriately. We were told that the service has consulted with infection control specialist, as required at the last inspection, regarding current measures for sluicing commodes as a result of which no changes to the way this is being carried out were suggested.Staff continue to ensure commodes are only sluiced first thing in the morning when no laundry is present to help to reduce the risk of cross infection. A recommendation was made at the last inspection that the home should look at moving the sluice to a different area, away from the laundry, which would ensure that risks from cross infection is further reduced. However, the sluice area continues to be in the same room as the laundry, which is not ideal. The providers have been consulted about the position and associated risks of the pacement of the sluice but this has not been undertaken. At the time of this inspection there was a good supply of protective clothing and handwashing facilities at the home and the laundry was clean and well equipped with washing machines and driers, which should effectively reduce the risk of cross infection. Everybody was well dressed at the time of this visit and several said that their clothes are well looked after. Care Homes for Older People Page 24 of 34 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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 living at Barnhaven are provided with well trained staff , usually in appropriate numbers to meet the health and social care needs. Evidence: On the day of the inspection an assistant manager, two carers, a cook, a cleaner and a maintenance person were on duty throughout the morning. In the afternoon, this changed to a two care staff, and a manager being on duty. The rota shows that there are two waking staff and one sleeping staff on duty throughout the night. We were told that there are usually two cleaners on duty and that the cook goes off duty at 1:30 but returns at 4pm to prepare and serve the evening meal. All laundry at the home, and activities, are dealt with by care staff. People who responded to questionnaires and those spoken to during this inspection said that staff responded to their needs promptly. This was confirmed during this visit when staff responded promptly to peoples needs in a kindly manner. Throughout the day we saw staff asking people if they wanted a drink, asking whether they were comfortable, reassuring people, visiting those who wished to stay in their rooms and engaging people in conversation. However, staff told us there is not enough staff. Could do with an extra person for about an hour in the mornings to help people get up. Care Homes for Older People Page 25 of 34 Evidence: A person living at Barnhaven told us they were very happy at the home, staff are kind but sometimes they have to wait to be assisted to the toilet as there dont seem to be enough staff on duty to help all of us as we all seem to need help at the same time, which isnt surprising as we all have meals and drinks at the same time. In response to what could the home do better people who responded to surveys commented more staff and another would like to see more staff in the kitchen and dining room. A member of staff thought the home could improve by employ more staff. Other comments in relation to staff included The staff are friendly and helpful and another lots of confidence in the staff, they do lots of things for me, but the staff are too busy but much better than other staff in other homes. We discussed staffing levels with the manager and were told that if the needs of people living at Barnhaven increase the manager can fine tune staffing levels. The manager discussed the recruitment procedure at the home and how it has been developed so that it considers the needs of people living at the home. They stressed the importance of making sure that only good quality carers are recruited so that a high standard of service can be offered at the home. We looked at three recently employed staff files. Not all included evidence that the home had conducted a robust recruitment procedure. Files included details of past employment, application form and two references. Two did not include details of police checks being completed before being employed at the home and there was no proof of identity for another. This procedure means that people living at the home are not consistently protected by the homes recruitment procedure. All newly employed staff undergo a period of training when they start working at the home to enable them to get to know those living there, the homes philosophy of care, safety procedure, care procedures, and the general layout of the home. The time taken to complete this training will depend on past experience and individual ability. All 4 staff that responded to questionnaires confirmed that their induction training covered everything they needed to know very well when they were first employed at the home and that they are given training that is relevant to their role. The manager is very aware that to ensure that people are well cared for staff need to be provided with up to date training and is committed to provide this. The home is due Care Homes for Older People Page 26 of 34 Evidence: to provide training in relation to Basic Food Hygiene for all staff as all staff are involved in the handling of food at the home. Information received from the home prior to this inspection indicated that 56 of staff are undertaking or have nationally recognised qualification (NVQ) This means that people living at the home will benefit from being cared for by well trained staff. Staff are kept up to date about people living at the home by having a handover meeting at the beginning of each shift when information is shared about individuals and any issues or problems that occur. One person living at Barnhaven commented in a survey the morning handover is sometimes too long and I have been kept waiting. During this inspection we sat in on a handover and up to date information was given to all staff. One carer who had not been on duty for a few days was told of changes and they later read the appropriate care plan files for current information. This means that people living at the home are cared for by staff that are kept up to date with changes and know how to manage them. Care Homes for Older People Page 27 of 34 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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 has a management structure in place that together is working hard towards trying to make sure the home is run in peoples best interests. Health and safety is managed well. Ensuring that all staff who handle food have received appropriate training with further protect peoples health and safety. Not all policies and procedures to be followed at the home have been reviewed to reflect up to date information. Evidence: Since the last inspection the management structure at the home has changed. The manager and assistant manager were seconded to another Devon Council home and the manager at Barnhaven is currently completing their Registration application to the Care Quality Commission. Care Homes for Older People Page 28 of 34 Evidence: Prior to this inspection the Manager sent us information about the management of the home and how the home has carried out improvements based on the feedback from the last inspection. Records are securely stored and would be made available to people living at the home, or their representative, with their consent. Records are kept in lockable filing cabinets, and those seen were up to date. The manager told us that it is important that people using the service are given the opportunity to voice the views and opinions regularly. This is undertaken in a variety of ways. Peoples feedback about such things as the quality of their life at the home, staffing, meals, cleanliness and activities is sought on a daily basis and any issues will be dealt with there and then if possible Quality Assurance questionnaires are given to all those who live at Barnhaven, those who have day care services and also to any outside agencies involved with the service, annually. Questionnaires are given to short stay and those who spend a period of respite at the home at the end their stay. The surveys are independently audited and a report is published with the results of surveys. Residents meetings are held at the home when people discuss topics such as menus, outings and activities. Minutes of these meetings are posted on a notice board in the entrance to Barnhaven. This means that people living at the home are encouraged and supported to have a say in the running of the home. Devon County Council, the registered providers, also carry out audits on all their homes and monthly unannounced visits are conducted by a representative of the providers. Health and safety at the home is generally well managed. During our tour of the building no immediate hazards were identified. Information received before this inspection indicated that all equipment is well maintained regularly all of which contributes towards ensuring that Barnhaven is a safe place for people to live. Care Homes for Older People Page 29 of 34 Evidence: Information received prior to this inspection indicated that several policies have not been up dated for some time. These include Code of Conduct, which according to information has not been reviewed since 2001 and Safeguarding Adults which has not bee reviewed since 2003. This means that information provided to staff is not up to date or accurate. The service manages personal allowances for some people living at the home. Records were checked and found to accurate and well maintained. These are also independently audited regularly. We also spoke to an advocate for one person who came to the home during this inspection to discuss their current financial situation. The staff recruitment files looked at during this inspection were not consistent and potentially put people using the service at risk of having staff who have not undergone a robust recruitment procedure. All staff have received recent manual handling training and the home employs a person who is a manual handling trainer who staff can refer to and who can train new employees. Regular staff meetings, and individual appraisals are undertaken at the home. We were told that staff are encouraged to discuss any concerns with the management team. All staff that responded to questionnaires and those spoken to during the inspection confirmed that the manager or deputy met with them regularly to give support and discuss how you they were working. Comments included overall, the running of the home, I think is excellent. Care Homes for Older People Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 26 23 The home must consult with the infection control specialist regarding current measures for commode sluicing and use. 30/12/2006 Care Homes for Older People Page 31 of 34 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 1 29 19 The registered person must 26/11/2009 not emply a person to work at the care home unless they have obtained all the information and documents required in Paragraphs 1-9 of Schedule 2 of the National Minimum Standards. this relates to no evidence of police checks, prrof of identity or photograph being available in soem of the staff files we looked at. To ensure that people living at the home are protected. 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 3 Information relating to individual health and social care needs, obtained prior to a decision being made to admit people to the service, should be recorded and retained. Care Homes for Older People Page 32 of 34 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 2 3 When the decision has been made to admit a person to the service, based on an assessment of their health and social care needs, they should be notified in writing of the decision. Peoples health needs should be set out in an individual plan of care. This relates to no care plans being completed for two existing and two acute health needs for one person whose care plans we looked at in detail. 3 7 4 8 Nutritional screening should be undertaken on admission and reviewed periodically, and a record maintained of nutrition, including weight gain and loss and actions taken. Consideration should be given to removing the sluice from the laundry and relocating it to a place to prevent the risk of cross infection at the home. Staff should be employed in such numbers to meet all social and health care needs of people living at the home. All staff who handle food should have appropriate basic food hygiene training to reduce the risk of cross infection at the home. Policies and procedures should be regularly reviewed and update to reflect up to date current good practice. 5 26 6 7 27 38 8 38 Care Homes for Older People Page 33 of 34 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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