Care Home: Barons Down Nursing Home

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What the care home does well Barons Down offers residents a homely and comfortable place to live. Staff involved in the inspection said that they work well together and are able to offer residents the support they need and want. Residents were equally positive saying `the staff are very good` and `they will do anything for me`. What has improved since the last inspection? The requirements made at the last inspection have all been fully or partially addressed. The statement of purpose has been reviewed and is now available for people living at Barons Down, and for those making enquiries about the services offered. A considerable amount of work has been done to develop the care planning system and appropriate staff training has been provided. What the care home could do better: No requirements have been made following this inspection, although some areas for further improvement were identified and have been included in the body of the report. Key inspection report Care homes for older people Name: Address: Barons Down Nursing Home Brighton Road Lewes East Sussex BN7 1ED     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: Kathy Flynn     Date: 2 2 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 24 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Barons Down Nursing Home Brighton Road Lewes East Sussex BN7 1ED 01273472357 01273479104 brooklandsnursinghome@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Hadi Rajabali,Mrs Shehnaz Rajabali Name of registered manager (if applicable) Mrs Marion Conway Type of registration: Number of places registered: care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 24. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Physical disability (PD). Date of last inspection Brief description of the care home Barons Down is registered to provide nursing care for twenty-four service users, who are over 65 years of age and may also have a physical disability.The home is purpose built and is located in a quiet residential area on the outskirts of Lewes. Local amenities can be found within walking distance of the home and there is nearby access Care Homes for Older People Page 4 of 24 Over 65 24 0 0 24 2 8 0 4 2 0 0 9 Brief description of the care home to public bus routes. Free car parking is available at the home. Rooms are located over three floors, all of which are served by a passenger shaft lift. Eighteen rooms are for single occupancy of which all have en suite facilities. There are three double rooms that do not have en suite facilities. There are additional toilets and bathrooms located throughout the homeThe home has a number of specialist equipment in use such as mobility aids, adjustable nursing beds and hoists. There is a small patio area leading off from the lounge/dining area that is accessible to service users. Care Homes for Older People Page 5 of 24 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 the people who use this service experience good quality outcomes. This unannounced inspection was carried out on the 22nd April and included a review of pre admission assessments, care plans, staff records and training, medication records, activities, and menus. There were 18 residents at the home during the inspection. 8 residents were involved in the inspection and six visitors to the home were happy to discuss the support offered. The manager and the staff on duty discussed the care and support they provide at the home. The reader should aware that the Care Standards Act 2000 and the Care Homes Regulations 2001 use the term service user to describe those living in care home Care Homes for Older People Page 6 of 24 settings. However for the purposes of this report those living at Barons Down will be referred to as residents. The Annual Quality Assurance Assessment (AQAA) was completed by the manager within the required timescale. Care Homes for Older People Page 7 of 24 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 24 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 24 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 about the services offered by the home is available for prospective residents in the Statement of Purpose, and assessments are completed to ensure the home can meet the needs of people before they are offered a place. Evidence: The Statement of Purpose and Service Users Guide have been reviewed and updated, as required from the last inspection. However the Statement of Purpose does not clearly identify the needs of the people the home intends to meet, including those with a dementia type illness. The providers and manager agreed that this will be addressed, to ensure that the information available is quite clear, and enables people to decide if the home offers the support they want. The manager confirmed that assessments are completed for all prospective residents, with their and or their representatives involvement, to ensure that the home can meet their individual needs. These assessments are used as the basis of the care plans and Care Homes for Older People Page 10 of 24 Evidence: provide information about about peoples medical, nursing and care needs. Residents involved in the inspection said that their relatives had chosen Barons Down for them, and that they have been able to discuss their needs with the staff to ensure they are offered the care and support they want and need. Care Homes for Older People Page 11 of 24 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. The care planning system provides staff with information about the needs of the people living in the home. Policies and procedures are in place with regard to medication to protect residents. Evidence: Four care plans were viewed and found to contain information about the medical, nursing and care needs of the people living there, including risk assessments for pressure relief, moving and handling, falls and nutrition. However there are a number of areas that need improvement including ensuring that the care plans are consistent throughout; that they can evidence the home meets the specific needs of all the residents, including those with a dementia type illness; that the records of daily care reflect the support that is offered, and that a life history is developed with the people living in the home, and or their representatives, to enable staff to meet their social and psychological needs. A keyworker system is in place and staff were able to discuss their responsibilities with Care Homes for Older People Page 12 of 24 Evidence: regard to providing specific support for particular residents and their relatives and friends. Although residents involved in the inspection were not aware that they had a particular member of the care team offering this support. The manager advised that a considerable amount of work has been done to improve the care plans and this will continue, as identified in the AQAA they intend over the next 12 months to improve the documentation, encourage residents and or their representatives to be involved in reviews of care provided, and training has been arranged for staff with regard to supporting people with dementia and care planning. Therefore a requirement has not been made. Policies and procedures are in place with regard to medication, and the medicine adminstration records viewed were completed appropriately. Medication training has been provided for the nurses, and systems are in place to assess their competence. Palliative care and end of life training is being arranged for staff, and the manager confirmed that the home will be working towards the Liverpool Care Pathway and Gold Standard Framework over the next year. Care Homes for Older People Page 13 of 24 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. A range of activities are available for residents to particpate in if they wish, although they are not offered every day. The food at the home is good, choices are offered at each meal and special dietary needs are met. Evidence: Activities arranged for the people living in the home include group and individual games, craft and art sessions including cake making, as well as external musical entertainers and specific celebrations, Easter being the most recent. During the inspection staff were too busy to offer an acitivity to residents until late afternoon, although one had been planned for the morning. Residents involved in the inspection said that they are able to choose how they spend their time and can join in activities if they wish, although some prefer to spend time in their own rooms. The manager advised that the activity programme will be reviewed following the training in dementia care, to ensure that the home offers a range of activities that all residents can enjoy if they wish. Visitors are welcome at any time and there are links with the local churches, with visits arranged depending on the preferences of the residents. Care Homes for Older People Page 14 of 24 Evidence: Communication between the residents, visitors and staff was relaxed and friendly and feedback was very positive, with residents and visitors stating tha the staff are very good, they give us the support and care we need and they look after my relative very well. The food at the home is good, choices are offered and the cook said that they can really have anything they want. Specific dietary requirements are met, including staff assisting residents with their meals. Those involved in the inspection said that the food is tasty, and we can have what we want really. Visitors were equally positive saying that the meals are excellent, and they are able to join the residents for meals if they wish. Care Homes for Older People Page 15 of 24 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. Policies and procedures are in place to enable people to raise any concerns they may have, and training in adult protection is provided for staff to protect residents. Evidence: The homes complaints procedure is available to residents and visitors in the Statement of Purpose and is also on display in the home. Residents involved in the inspection said that they would talk to the staff or the nurses if they had any concerns, although they also said that they did not have anything to complain about. Training in protecting vulnerable people has been arranged for staff and those involved in the inspection said that they have attended this or will be attending the next training session. The manager advised that adult protection is included in the induction programme and all staff are required to complete this. Care Homes for Older People Page 16 of 24 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. Barons Down offers residents a comfortable and homely environment. Training in the control of infection is provided for staff to protect residents. Evidence: The home offer residents a large lounge dining room on the ground floor and bedrooms, three double and eighteen single rooms some with en suite facilities, on three floors, and residents are encouraged to personalise them with their own possessions. A shaft lift enables residents to access all parts of the home, hoists and moving and handling aids are provided, two of the bathrooms have been refurbished and are now wet rooms, which staff said the residents prefer. There is ongoing maintenance of the home, and there are plans to make further improvements to the interior, to include a separate room for visiting health professionals and hairdresser. Training in the control of infection is provided for staff, those spoken with have attended this and are aware of the procedure to follow to protect residents, by using gloves and aprons appropriately. Care Homes for Older People Page 17 of 24 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. Training is provided for staff with regard to their roles and responsibilities. Robust recruiment procedures are in place to protect residents. Evidence: The manager and staff said the staffing levels at the home were appropriate. However two staff were attending college on the day of the inspection and this may have had an affect on the level of support and care provided for residents. The feedback from staff was that they did not have much time to spend with residents in addition to offering personal care and support, and that new staff are allocated to work together at times instead of with experienced staff. The manager and providers said that they would be reviewing the staffing levels and skill mix, to ensure that residents are offered the support they need and want. Therefore a requirement has not been made at this time. Four recruitment files were examined and found to contain relevant information including application forms, two references, as well Criminal Records Bureau CRB checks. All staff are required to complete induction training in line with Skills for Care, and there are opportunities to continue with National Vocational Qualifications (NVQs) when they have completed this. The home exceeds the requirement that over 50 of staff should have NVQ level Care Homes for Older People Page 18 of 24 Evidence: 2 or equivalent, with all but one member of staff having completed or working towards a NVQ qualification. Mandatory training, as well as specific training including dementia care and learning disabilities is provided for staff, and a training matrix is used to ensure that there is a clear record of the training attended by staff. Moving and handling training has been provided for some staff, but a number of new staff have yet to attend although they have been using the moving and handling aids provided including the hoists. The nurse and manager advised that new staff work with experienced staff when using the hoists, and are supported to use them safely. However as already noted feedback from staff was that new staff work together at times. Care Homes for Older People Page 19 of 24 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 management style at the home aims to encourage residents, visitors and staff to be involved in decisions about the services provided. The health and safety or residents is protected through ongoin maintenance and staff training. Evidence: The manager has been responsible for the day to day management of Barons Down for just under a year, she is a registered nurse with a management qualification, has experience of supporting people living in nursing homes and has applied to register as manage with the Commission. The manager advised that residents, visitors and staff meetings are encouraged to be involved in how services provided are developed, through day to day discussions, surveys and ongoing audits of all aspects of the support and care offered. The providers visit the home on a regular basis in addition to the Regulation 26 visits that are required, and are actively involved in how the service developes. Staff spoken with said they can provide the support the residents need and feel they Care Homes for Older People Page 20 of 24 Evidence: offer a good service. Residents comments were also very positive some said the staff are very good and will do anything for me. A supervision programme is currently being developed, and the expectation is that senior staff attend training so that they can offer appropriate supervision for all staff. The health and safety of residents is protected through ongoing maintenance of the home and a training programme ensures that staff attend the required mandatory training, including fire training, infection control, first aid and moving and handling. Care Homes for Older People Page 21 of 24 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 22 of 24 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 23 of 24 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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