Care Home: Baronsmede

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What the care home does well Prospective residents receive detailed information about the home to assist them in making an informed decision about accommodation. Care plans provide detailed information about the abilities and needs of the residents and how staff can best support each resident. Each resident has an individually tailored programme of activities, which ensures that they are given opportunities to participate in a variety of interesting and stimulating activities. Residents spoken with stated that they are very happy living at Baronsmede. Staff are provided with extensive opportunities to update their knowledge and skills to ensure that they remain equipped to meet the needs of the residents. All of the staff team have or are working towards an NVQ (national vocational qualification) at level two or above. A high number of the staff team hold level three and some have achieved level four. Staff receive regular supervision and appraisal. Those spoken with stated that they felt well supported. One staff member stated `I don`t need to wait for supervision if I have a problem, the door is always open`. The organisation has accreditation with Investors in People status and this has recently been reviewed and maintained. What has improved since the last inspection? The ongoing reviewing of the way the home operates ensures that the home is run well in the interests of those accommodated. The systems in place are also set up to ensure the smooth running of the service and to make it easier to keep record keeping up to date, to ensure that staff training remains updated and that staff remain supervised. The organisation is also looking at ways in which they could develop in the future and have started a consultation exercise with residents, relatives and staff to seek their views of how this could happen. In the interim they are continuing to keep up to date with ongoing maintenance and redecoration and since the last inspection a new roof has been fitted to the large conservatory and a kitchen has been fitted in the flat. What the care home could do better: There were no requirements made as a result of this inspection. Key inspection report Care homes for adults (18-65 years) Name: Address: Baronsmede Queens Road Crowborough East Sussex TN6 1EJ     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: Caroline Johnson     Date: 2 9 0 6 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 Adults (18-65 years) 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 Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 Adults (18-65 years) Page 3 of 25 Information about the care home Name of care home: Address: Baronsmede Queens Road Crowborough East Sussex TN6 1EJ 01892654057 01892667457 baronsmedehomes@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Baronsmede Family Homes Ltd care home 9 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of people to be accommodated is 9 The registered person may provide care to service users in the following category only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admisssion to th home are within the following category : Learning disability (LD) Date of last inspection Brief description of the care home Baronsmede is a large detached house in a residential part of Crowborough near to the shops and other amenities. The house provides care for up to 9 adults with a learning disability. Seven of the nine rooms have en-suite facilities. Communal facilities include a lounge, dining room/lounge and a conservatory. There is a large garden with a patio to the rear of the house. Baronsmede is one of two homes owned by Baronsmede Family Homes Limited. Day care services are provided at the organisations day centre known as the Barn Centre which is situated nearby. At the time of inspection the fees for the service ranged from 785 to 1,160 pounds per week and the fees include a full daycare package. Care Homes for Adults (18-65 years) Page 4 of 25 Over 65 0 9 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: For the purpose of this report the people living at Baronsmede will be referred to as residents. As part of the inspection process a site visit was carried out on 29th June 2009 and it lasted from 4.00pm until 9.45pm. A previous visit was carried out to the service on 24th June but there was no one at the home as residents were at their day centre. Both the registered manager and the owner facilitated the inspection on 29th June. Over the course of the inspection there was an opportunity to meet all the residents and to spend time with two of the residents in private. In addition time was spent with two members of staff in private. Two care plans were examined in detail and one other parly examined. In addition records seen included; staff rotas, training, medication, menus, health and safety, quality assurance and leisure activities. In advance of the inspection the home submitted a very comprehensive AQAA (annual Care Homes for Adults (18-65 years) Page 5 of 25 quality assurance assessment) which contained detailed information about the home and how it is run. Care Homes for Adults (18-65 years) Page 6 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 Adults (18-65 years) Page 7 of 25 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are provided with detailed information about the services available within the home. Evidence: There is a detailed statement of purpose in place. The service user guide is available in a range of formats including written, pictorial and as a slide show. Records held in relation to one resident showed that the home obtained detailed information from the placement authority prior to making a decision about providing accommodation. In addition they also carried out a detailed assessment of the prospective residents needs and abilities. Over a period of months the prospective resident had several planned visits to the home for meals and overnight stays to enable them to make an informed decision about moving in and also for the home to assess their compatibility with the other residents. Care Homes for Adults (18-65 years) Page 9 of 25 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans provide detailed information about the abilities and needs of the residents. They could be enhanced further by ensuring that goals and aspirations are clearly stated with advice for staff on how to support residents in achieving them. Evidence: Two care plans were examined in detail and another was partly examined. They contained a wealth of information, advice and guidance for staff to follow to ensure that residents needs are met. In each case there is a statement of care needs and a plan for the delivery of care. Where risks are identified or perceived there is a detailed risk assessment in place. It was noted that following a recent incident in the home the risk assessment had been updated and the manager advised that in the light of further information it would now need to be updated again. The amendments to the risk assessment were easily visible for all staff to take note of the changes. In respect of each resident there are a number of goals identified. The goals described Care Homes for Adults (18-65 years) Page 10 of 25 Evidence: are broad and therefore not easily measured. For example a goal might be to encourage to develop independence as far as is able to or to monitor behaviour, minimising its effects on quality of life. There is no reference to how these goals are to be achieved. Staff spoken with although very knowledgeable of the needs and abilities of the residents were not clear about residents individual goals. In relation to one resident there were guidelines in place for the management of challenging behaviour. The guidelines referred to the use of a secure cuddle. Staff spoken with stated that the guidelines have not been needed for a number of years. The owner stated that all staff are trained in the management of challenging behaviour and that the guidelines were approved by the community learning disability service and the residents care manager. As the guidelines have not been necessary for a long time they should be reviewed at each external review and if there is agreement that the they need to be kept in place then a record should be kept that this is a multi-disciplinary decision. In addition to the care plans the home uses the standex system to record all daily records, to keep a record of all personal care provided, to record all professional visits and healthcare appointments and to record any activities that residents have participated in. Care Homes for Adults (18-65 years) Page 11 of 25 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have opportunities to participate in a wide range of interesting and stimulating activities throughout the week. Evidence: All of the residents have an individually tailored programme of activities based at the Barn Centre, which is a day centre run by the owners. Tutors from local colleges along with a number of private tutors run the courses from the day centre. There they have opportunities to spend time with friends from another home owned by the directors and with residents from another local care home. Programmes seen included activities such as yoga, arts and crafts, music all-sorts, animal care, sensory, computer, performing arts, gardening independent living skills and extend. Care Homes for Adults (18-65 years) Page 12 of 25 Evidence: Residents stated that they went to London a few weeks ago for the Sister Act play. They also said that they were looking forward to going to see the Lion King. This year the annual holiday is to the New Forest. Staff stated that generally residents are too tired in the evenings to go out preferring instead to have a leisurely evening watching the soaps. At weekends some of the residents choose to go shopping and picnics and outings are on offer throughout the year. A newsletter is produced bi-annually. The January 2009 edition includes photos of the residents in various activities throughout 2008. Photos were of residents at their day centre, weekend activities, holidays, theatre outings and shows and birthday parties. One resident was keen to show folders displaying work achieved as part of one of the courses they had attended. The folders were very comprehensive showing the tasks achieved such as making drinks and snacks, contributing to group activities and sharing their views on a wide range of topics. The details provided were very impressive particularly showing how well the resident contributed to the course and the resident was very proud of their work. There was one section showing the resident making a drink. When asked the resident stated that they do not make drinks at home. The manager stated that this resident can make cold drinks and makes hot drinks under supervision only. Staff stated that residents are supported to maintain contact with their relatives and friends. Opportunities are also provided for residents to meet up occasionally with a resident who moved on to alternative accommodation. Menus are planned on a weekly to two weekly basis. The menus seen were varied and well balanced. A staff member stated that they speak with residents individually to seek their food choices. Residents spoken with said that the food is good. It was reported that green beans and tomatoes are grown at the Barn Centre for use at the home. When building works at the Barn Centre are completed there are plans to increase the growing of vegetables for use in both homes. Care Homes for Adults (18-65 years) Page 13 of 25 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems in place ensure that residents healthcare needs are met. Evidence: The home seeks specialist advice and support when needed in relation to meeting the needs of the residents accommodated. The home is about to introduce nutrition screening. Some residents are on weight reduction and some weight increasing diets. Where this is the case this is monitored by the local surgery and if necessary additional food supplements are provided. Records showed that residents are supported to attend a wide range of healthcare appointments such as the dentist, opticians and chiropodist. The owner advised that they are continuing to liaise with their local gp surgery about introducing health action plans. Staff observed in the course of their duties were courteous and treated residents with respect. The home uses a monitored dosage system and arrangements in place for the storage and handling of medication were in order and all records seen were up to date. It was reported that one resident is prescribed a particular medication for Care Homes for Adults (18-65 years) Page 14 of 25 Evidence: epilepsy, however this was not included on the MAR (medication administration record) chart. The manager stated that she was sure she would have the prescription on another MAR chart and would ensure that it was added in. Following the inspection the manager confirmed that the MAR sheet had temporarily been removed by a staff member who had left it in the office to discuss one of the entries with the manager. There was a procedure in place for the returning of unused or out of date medication. Care Homes for Adults (18-65 years) Page 15 of 25 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to enable anyone wishing to make a complaint to do so. Evidence: There is a detailed complaint procedure in place and a simplified version of the procedure is included in the service user guide. The owner advised that there have been no complaints received since the last inspection of the home. It was reported that there is a detailed procedure in place on adult protection and prevention of abuse. A copy of multi-agency guidelines on adult protection are also available for staff to read. All of the staff team have completed training on the protection of vulnerable adults. Care Homes for Adults (18-65 years) 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, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a home that is well maintained and decorated to a very good standard. Evidence: At the time of inspection the owners were going through a consultation process with residents, relatives and staff about plans to redevelop the service provided. It is thought that the plans will involve the creation of smaller units within the same home but no definite plans have been made yet. In the interim the home continues to be well maintained and is decorated to a good standard. Since the last inspection a new roof has been fitted to the large conservatory and a kitchen has been added to the small flatlet on the first floor. This now means that the home can only physically accommodate eight residents. Residents have access to a choice of communal areas in which to spend their time. In addition to the main lounge there is a conservatory and a small lounge area off the dining room. There is also a large well maintained garden to the rear of the property with seating provided for use during the summer months. All areas seen during the inspection were clean. All of the staff team have completed Care Homes for Adults (18-65 years) Page 17 of 25 Evidence: training on infection control. Care Homes for Adults (18-65 years) 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, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from the support of a dedicated and well trained staff team. Evidence: It was reported that eighteen staff are employed and contracted to work in either of the two homes owned by the company. The majority of the staff work in both settings. Some have set shifts in both homes and some work predominantly in one with occasional shifts in the other. There is also a regular team of bank staff which means that the home does not have to use agency staff to cover annual leave or sickness. There are two care staff on duty throughout the day. In addition the manager is also on duty working office hours. A staff member also does a sleep-in duty at night. Staff have access to an extensive list of staff training. In addition to updates on mandatory training courses attended by staff in the past year included bereavement and loss, deprivation of liberty, mouth care, supervision and appraisal, overseeing care plans, communication passports, extend update, good nutrition and epilepsy. The manager has also completed attachment issues, new types of workers in health and social care, assessors workshop for medication, equality and diversity, developing your staff, health and safety, managing changes and total communication. Care Homes for Adults (18-65 years) Page 19 of 25 Evidence: Recruitment procedures were examined and were found to be thorough including a wide range of checks. There was also evidence that the views of the residents had been sought in relation to individual applicants. All new staff complete a level two induction award in supporting people with learning disabilities. All of the staff have or are studying for NVQ (national vocational qualification). A high percentage of the staff team have completed NVQ at level three and four and a number also hold the Assessors Award. Records showed that staff staff receive regular supervision and staff spoken with stated that they find this very helpful. Staff also stated that they value the training opportunities made available to them. Care Homes for Adults (18-65 years) Page 20 of 25 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run well in the interest of the residents accommodated. Evidence: The registered manager has been in post for several years and she holds the Registered Managers Award. As seen in the previous section she has attended numerous courses to ensure that she is keeping up to date with changes in care. Staff spoken with stated that the owner and manager are both very approachable. One staff member stated I dont need to wait for supervision if I have a problem, the door is always open. The company has accreditation with Investors in People and this was recently reviewed and maintained. The owner carries out a monthly visit to the home unannounced to check on the running of the home. A detailed record is kept of the findings. Staff meetings are held regularly and records seen were detailed and showed that staff are encouraged to Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: share their views on the running of the home. As part of the homes quality assurance system a range of satisfaction questionnaires are sent to residents and their relatives. The last questionnaires sent out were in June 2008. The responses to the questionnaires were collated and feedback was given to all who participated. The policies and procedures manual was completely updated in 2008/09. In advance of the inspection the owner completed an AQAA (annual quality assurance assessment). This was comprehensive providing detailed information which has been used throughout this report and also showing that appropriate measures are taken to ensure the health, safety and welfare of residents and staff. Care Homes for Adults (18-65 years) 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 Adults (18-65 years) 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 Adults (18-65 years) 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. 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