Care Home: Barnston Court Nursing Home

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What the care home does well Barnston Court constantly reviews its practice and is always striving to improve the service offered to the people either living in the home or to prospective service users. The service is flexible and reflective and the home`s management team have looked at where they are now and where they want to be in the future. This helps to ensure that the home is able to respond to changing needs, which in turn enables people to maintain as much independence as possible. There is a strong commitment from everyone working at the home that helps to ensure that the quality of care is provided to an excellent standard. Service users are treated with respect and dignity. We found that staff members were able to demonstrate an awareness of the diverse needs of the people they were supporting. Positive, relaxed and warm relationships were seen to exist between service users, relatives and staff members, those people that commented all said that the manager and staff members were very good. One service user said; "the staff are excellent, I cannot fault them at all". Routines within the home are flexible, this gives people some control over their lives and enables them to maintain their independence. There are plenty of opportunities for people to participate in social and other activities. A wide choice of meals are offered and the standard of catering is very good. What has improved since the last inspection? The home manager has continued to encourage/enable the staff members to undertake training courses. Improvements to the facilities, including the fitting of new blinds and carpets have enhanced the facilities available to the people living in the home. What the care home could do better: We consider that Barnston Court is an excellent service so rather than state what they could improve we would expect that the home continues to review its practice in order to ensure that the very high standard of care provided to the service users at the present time is maintained and where possible improved upon. Key inspection report Care homes for older people Name: Address: Barnston Court Nursing Home Barnston Lane Moreton Wirral CH46 7TN     The quality rating for this care home is:   three star excellent 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: Paul Ramsden     Date: 0 8 1 2 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 25 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 25 Information about the care home Name of care home: Address: Barnston Court Nursing Home Barnston Lane Moreton Wirral CH46 7TN 01516775573 01516040012 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Cozee Care Homes Limited care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: To accommodate five named service users who are under 65 years old within the overall number of 30. Date of last inspection Brief description of the care home Barnston Court is registered to provide nursing care to service users over the age of 65 years of age. The home is purpose built and comprises of five companion rooms and 20 single bedrooms located on the ground and first floor levels. The kitchen and laundry are located in the basement area. All levels of the home are serviced by a lift. The home has both stairs and ramped access to the front entrance and wheelchair access to the garden at the rear of the home. The home has a lounge/dining room and separate lounge on the ground floor. A conservatory leads off from the lounge/dining room. The garden is accessed via the conservatory patio doors. There is a car park at the rear of the home. Information about the current fees for the home are available from the manager. Care Homes for Older People Page 4 of 25 Over 65 30 0 Brief description of the care home A copy of this report can be made available upon request from the manager or via the Commissions website. Care Homes for Older People Page 5 of 25 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: three star excellent 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: This unannounced visit took place on the 8 December 2009 and lasted for a total of six hours and ten minutes. Paul Ramsden, Inspector, undertook the visit on behalf of the Care Quality Commission [The replacement body for the Commission for Social Care Inspection, CSCI, since 1 April 2009]. Any references to we or us in the report refer to the Commission. All of the key standards for older people were looked at. Feedback on the findings of the inspection was given to the home manager as the inspection progressed. This visit was just one part of the inspection. Prior to the visit the home manager was asked to complete an Annual Quality Assurance Assessment [AQAA] to provide up to date information about the service provided in the home. This is a very detailed questionnaire that provides us with a lot of information about the service before we go to the home. Care Homes for Older People Page 6 of 25 We looked at the Annual Service Review [ASR] that was carried out last year [This is a review of good and excellent services that takes place between key inspections, good services only have an inspection every two years and excellent services every three years]. Following the completion of the review we found no evidence to suggest that our quality rating had changed or that we needed to bring the inspection forward. During the visit various records and the premises were looked at. When looking at the documents relating to the type of care each person needs [assessments and care plans]we use a system called case tracking. This is a method that allows us to follow or track a particular situation in order to ensure it was dealt with appropriately. A number of service users and staff members were spoken with; they gave their views about the home and the service provided. Some of these comments have been quoted in the report. Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? What they could do better: 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 8 of 25 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 9 of 25 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. Information and opportunities to visit before moving in are available and service users are assessed before moving in to ensure their needs can be met at the home. Evidence: The home provides a range of information to prospective service users; these are presented in a Service User Guide and the Statement of Purpose. These documents contain all of the information required and they should provide sufficient information for anybody who is thinking of moving into the home. People are free to visit and look around Barnston Court prior to choosing to live there if they want to; they can also stay for a meal and have a trial visit before deciding. If they have any queries they can contact the manager, deputy or senior staff members. Pre-admission assessments demonstrating that the service users individual needs had been assessed in an accurate and consistent way had been carried out for the people whose files were looked at. The manager or deputy manager will usually carry out the Care Homes for Older People Page 10 of 25 Evidence: assessments and they will visit people in their own home, another care home or hospital to gather the necessary information before admitting someone. This provides an opportunity to make sure the home can accommodate the person and their individual needs. Following the assessment a letter is sent to the service user to confirm that the home can meet their needs and to make arrangements for admission. Where applicable copies of information provided by the Local Authority is also obtained prior to admission. This provides background information as to the reasons why a move to the home is needed and is very useful when combined with the homes own assessment. Intermediate care is not provided at Barnston Court. Care Homes for Older People Page 11 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users care plans seen were very detailed and well maintained; they provided all of the information needed for staff members to be able to take appropriate action to meet an individuals needs. Evidence: The manager or deputy manager is responsible for drawing up a service users plan of care. They are generated from the information gathered during the assessment. All of the care plans seen were of a very good standard and provided the staff with all of the tools needed to identify any assessed need and how it is to be met. The care plans seen were all up to date and were written in a style that would enable someone reading it to have a good idea of what help and assistance someone needed at that time. Care plans were being reviewed, with input from the service user or their representatives and where necessary re-written on a regular basis. Staff members spoken with could show that they had a good understanding of the people they were supporting and they were able to meet their diverse needs. Care Homes for Older People Page 12 of 25 Evidence: Care staff work to a high standard in order to ensure that service users receive the care they need. One of the service users spoken with told us; the staff are very good, it is superb. A staff member said that the quality of care was; spot on. Staff members monitor a persons health and other needs daily and there was evidence to show that people were receiving the appropriate support from GPs etc. A key worker system is in place [This is a system used in the majority of homes and involves particular staff members working more closely with certain service users]. The changing needs of individuals are discussed as and when required. We were able to see this in practice during the visit when information about an individual was passed onto the manager. The good communication systems in the home helps to ensure that any issues that have been identified are addressed promptly. It was seen throughout the visit that service users were being treated with courtesy, respect and good humour by staff. They were seen to be interacting with individuals in an appropriate way, knocking on bedroom doors before entering and addressing people according to their wishes. The service users spoken with made a number of positive comments about the home and the staff members supporting them. All personal care is carried out in the privacy of a persons bedroom or one of the bathrooms. Barnston Court has a written policy on the receipt, administration [including self administration], safekeeping, handling, recording and disposal of medication within the home. The home uses a blister pack system dispensed by a local pharmacist. The arrangements for the administration of medicines during this inspection visit were considered to be very good and the service users were being given their medication as prescribed. Every staff member who dispenses medication has received training in this area. The home manager audits the medication procedures within the home on a regular basis. Care Homes for Older People Page 13 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are able to maintain contact with family and friends and those spoken with were very positive about the home and the support they received. Evidence: Service users spoken with during the inspection confirmed that their lifestyle was flexible and that staff members respected their wishes. They told us that they were able to move freely around the home and that they were able to make choices in many areas of daily living; for example, times of rising and retiring, whether or not to join in with planned activities and where to spend time and with whom. The home employs an activities co-ordinator who works with the service users during the day and at weekends. A high number of activities take place within the home and care staff were observed to be spending time with people on a one to one basis to provide stimulation and to play games. On the day of the inspection visit we saw some service users going out with the activities co-ordinator to the British Legion, other people went out with their family members. The manager explained that the home tried to access as many community activities as possible. There is no pressure to join in with any activities and if someone does not wish to do so the co-ordinator will try and spend some time on a one to one basis with them. One of the service users we Care Homes for Older People Page 14 of 25 Evidence: spoke to confirmed this. A daily activities record is maintained, this ensures everyone is asked about activities and whether they want to participate. The manager conducts regular surveys of service users to obtain their views and to establish that the home is meeting their individual needs and preferences. Service uses and relatives meetings are held regularly and the manager speaks with service users, their relatives and other visitors to the home as often as possible. Various religious denominations conduct services in the home and residents are free to attend if they wish to do so. They are also able to attend their own church if they are able to. A hairdresser visits the home on a regular basis. New service users and/or their representatives are asked to complete a food questionnaire to identify their individual preferences and dietary needs in order to ensure that where possible their wishes can be met. This information is kept by the chef who then prepares meals in line with service users preferences. Surveys on the meals are undertaken regularly and menus are changed according to suggestions. Meals can be taken in the lounge/diner or in the privacy of a residents own room. There is a menu that has the flexibility to meet individual needs and choices and special diets are provided if required. The meals served on the day of the inspection looked and smelled appetising and people spoke very positively about the quality of the food they were eating. The chef uses fresh ingredients as much as possible and ensures that the quality of the food purchased is of a high quality. The kitchen was seen to be very clean, tidy, and well organised. During a discussion with the chef he was able to show a very good understanding of each persons individual likes and dislikes; we feel that the catering staff members are trying their best to give people what they want. The home has recently been awarded an excellent rating from Wirral councils environmental health department Care Homes for Older People Page 15 of 25 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. Service users and relatives are able to complain/make suggestions and action would be taken to respond to their concerns. Evidence: There is a written complaints procedure for the home; this is on display in the entrance area. Information about complaints is also included in the Service User Guide and Statement of Purpose. Service users spoken with knew who to speak to if they had any concerns and felt confident that the appropriate action would be taken. The home has not received any complaints in the previous 12 months. The home has an adult protection procedure [now called safeguarding] that complies with all of the relevant legislation and good practice guidelines. This is designed to ensure that any possible problems that arise are dealt with openly and people are protected from possible harm. The manager was able to demonstrate that she was fully aware of the process to be followed and that the training for staff members in this area was up to date. There has been one safeguarding issue raised at the home since the previous inspection took place; this was dealt with appropriately. Care Homes for Older People Page 16 of 25 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. The facilities and accommodation is of a good standard; this means that service users are living in a safe, homely, comfortable environment. Evidence: The home is located near to the centre of Moreton, close to shops and other community amenities. Service users visit the local shops on a regular basis. The building is on two floors with a passenger lift and two stairways providing full access to all areas of the home. A tour of the premises was undertaken; this included communal areas and a number of bedrooms. All bedrooms seen during the visit were personalised, comfortable, well furnished and contained items of furniture belonging to the individual. Barnston Court provides an environment that can fully meet the needs of the service users that live there. It is being maintained to a good standard and we did not see any hygiene or cleanliness issues. Improvements to the home continue to be made. Since the last inspection decoration has been ongoing and new blinds and carpets have been fitted. Aids to help maintain independence, for example a call system and bathing aids have been provided. A new hoist has recently been provided. Care Homes for Older People Page 17 of 25 Evidence: There are fully accessible well maintained garden areas available for service users to use. The laundry within the home is well equipped and good systems are in place for the care of peoples clothes. The manager explained that new washing machines had been fitted since our last visit. Care Homes for Older People Page 18 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are protected by a well trained and committed staff team who work hard to improve the quality of life of the people living in the home. Evidence: Nursing and care staff on duty and rotas seen demonstrated that staffing levels and the skill mix of staff was able to meet the needs of the service users within the home. The staff members were seen to be cheerful and friendly. We spoke to a number of them during the visit; they all had a very good understanding of their roles and were very knowledgeable about the needs of the people they were supporting. The service users and visitors we spoke with were very complimentary about the staff members attitude and competencies. One of the service users said; I could not complain about anything, the staff are lovely, could not be kinder, they are excellent. The manager told us that the home had not had to use any agency staff for years; we think this is very unusual so it is to the homes credit that they have been able to do this. The nursing staff members employed undertake continuous training as part of the professional requirement for them to do so. The home is a training base for student nurses enrolled with Chester University. We spoke to two of the students on placement and they told us that they felt there was a really good atmosphere in the home; we have been made to feel welcome and have been encouraged to participate rather than just observe. Both the manager and deputy manager are qualified to Care Homes for Older People Page 19 of 25 Evidence: mentor the students According to the manager and the AQAA 95 of the care staff members are either qualified or are working towards a National Vocational Qualification [NVQ] level 2 or 3 in care, a recognised qualification for people working in the care profession. The manager is a qualified NVQ assessor. The staff file seen contained all of the required information and a thorough recruitment procedure was in place for the protection of residents. The homes manager confirmed that all new staff are checked against the POVA list and that a satisfactory CRB disclosure must be obtained before employment commences. Any gaps in the employment history are checked. New staff members undertake an in-house induction followed by a thorough induction training programme, including adult protection. This meets the Skills for Care Induction Standards. We were able to see an induction record for one of the most recently appointed staff members. Barnston Court provides a range of training courses for staff members; this includes mandatory training such as safer handling, fire safety and adult protection as well as other courses such as equality and diversity. The staff members spoken with confirmed that training courses were readily available and that they considered that they were well trained. Care Homes for Older People Page 20 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is being very well run and managed on a day to day basis, this helps to ensure that the needs of the service users are met and that there are appropriate procedures in place to maintain their safety. Evidence: The home manager is experienced and knowledgeable and was able to display a clear sense of direction and best practice. She was able to clearly demonstrate an awareness of the needs of the service users living in the home and how to manage the staff team. The home manager is a qualified nurse and also has an NVQ level 4 in management. She attends courses/training in order develop the skills to fulfill her management responsibilities. A number of positive comments about the managers capabilities were made by both service users and staff members. The manager is supported by a deputy manager and two team leaders. There is is a strong and committed staff team within the home who work hard to Care Homes for Older People Page 21 of 25 Evidence: ensure that the quality of care provided is maintained at as high a level as possible. The home holds an ISO 9001 accreditation [this is an internationally recognised quality management system] and also has its own quality monitoring system in place to order to ascertain whether service users and relatives/representatives are happy with the standards of care being provided. Six monthly questionnaires are sent out to obtain information and personal views about the home. One to one discussions are held with service users to gather additional information. Small amounts of money are held for some service users; this covers the cost of items such as hairdressing. Detailed records are held of all transactions and any receipts are kept. Any accidents are recorded and the home manager regularly audits these in order to ensure that any trends, for example, a service user having a number of falls are identified and addressed. The home has a comprehensive range of policies and procedures to promote and protect both service users and staff members health and safety. The maintenance records seen demonstrated that the appropriate service contracts were in place. These included, bathing aids, the fire alarm system and the gas and electrical installations. The fire safety log book showed that the tests on the system and emergency lighting were being carried out at the recommended intervals and that drills and training were also up to date. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 24 of 25 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. 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