Care Home: Barrington Lodge Nursing Home

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What the care home does well The home tells us that it is their aim to provide 24 hour care in a caring and homely environment with high standards of care. They say that they promote a friendly welcoming atmosphere at all times and aim to treat residents with the respect and care that they deserve. When we visited, we found that although the home itself would not meet some of the standards expected of a newer building, residents considered that the atmosphere in the home and the attitude of the manager and staff outweighed the lack of facilities such as en-suite bathrooms. They told us that they felt comfortable and safe and that staff were "lovely" "very kind" and "always there to look after you". The home is run in a way which promotes residents abilities to make choices and to influence the care and support that they receive. Their opinions are sought and taken into consideration, there are activities available for them to join in with if they want to and we saw that mealtimes are an important and enjoyable part of their day. The manager and providers are committed to providing a high standard of care within the home and have a good reputation within the community. What has improved since the last inspection? Since our last inspection the home has gained accreditation in The Gold Standards Framework, receiving a commend status. This has enhanced the care that they are able to provide for residents who are nearing the end of their lives and their families and friends. It has reduced unnecessary hospital admissions and helped residents to have real choices about how they wish to be cared for at the end of their lives. What the care home could do better: We did not issue any requirements at this inspection, judging that the home is still providing excellent care for the people who live there. We did raise some concerns about fire safety and these were addressed promptly by the Registered Providers. We also considered that the home would benefit from some redecoration and refurbishment and we have been assured that a plan to undertake this and replace some of the furniture will be put in place. Key inspection report Care homes for older people Name: Address: Barrington Lodge Nursing Home 9-15 Morland Road Croydon Surrey CR0 6HA     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: Alison Ford     Date: 0 4 0 3 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 26 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 26 Information about the care home Name of care home: Address: Barrington Lodge Nursing Home 9-15 Morland Road Croydon Surrey CR0 6HA 02086549136 02086620060 barrington@lrh-homes.com www.lrh-homes.com London Residential Healthcare Limited care home 44 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: 14 Highly dependent, severely physically disabled clients 30 Elderly Infirm clients of whom a maximum of 13 will be under the care of the Multidisciplinary Rehabilitation Team The number of persons for whom accommodation is provided shall not exceed 44 (fourty-four) in the following categories Date of last inspection Brief description of the care home Barrington Lodge is a home providing nursing care for up to a total of 44 people. There are 33 bedrooms 11 of which are double rooms and 22 are single rooms. The home has two lounges; a large one adjacent to the dining area and a smaller quiet lounge for more private meetings with visitors. The main lounge leads out on to a raised patio with seating which in turn looks out over a large well-maintained garden that is accessible to residents. The dining room is accessed via the lounge through large Care Homes for Older People Page 4 of 26 Over 65 17 0 0 14 Brief description of the care home sliding doors. The bedrooms are located on three floors, which can be accessed either by stairs or a passenger lift. There is limited parking for approximately 8 cars at the front of the building. The home has achieved an Investors in People award. Fees range from £587 - £756 per week. Different rates are applicable to those whose placement is funded through the local authority and people who are privately funded and these would be discussed prior to admission. Care Homes for Older People Page 5 of 26 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 report follows an unannounced visit to the home, undertaken as part of our inspection process. However, when writing the report, we have also taken into other information that we have received since our last inspection in 2007, when we judged that this was an excellent 3 star,service. This included comments that we have received from people who use or visit the service, responses to surveys that we routinely send to the home, and information that the service has sent us about things that have happened there, notifications. When we visited, we walked around the home talking to people who live there and to their relatives about their opinions of the home and what it was like to live there. We spoke with the Registered Manager and some of the staff on duty and we looked at various records and documentation that the home is required to keep as evidence of their commitment to the health and safety of the people who live and work there. Care Homes for Older People Page 6 of 26 In addition, the home sent us their Annual Quality Assurance Assessment ( AQAA). this is a self assessment which tells us how well they believe they are meeting their aims and objectives and about their plans for the future. Care Homes for Older People Page 7 of 26 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 26 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 26 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. No-one is admitted into the home without having an assessment undertaken, to make sure that it will be able to meet their needs. The home does not offer intermediate care, this standard does not apply. Evidence: Before a resident is admitted into the home, a senior member of staff will visit them either at home or in hospital, to make sure that the placement will be suitable and their needs can be met. For those people funded by the local authority there would also be a Care Managers Assessment. These assessments then form the basis of care planning, when the staff work with residents and their families in order to identify the support and care that will be needed. We saw that there is also some information about residents past lives and achievements so that staff can begin to understand more about them. Care Homes for Older People Page 10 of 26 Evidence: Relatives, that we spoke with during our visit, were able to explain how they were helped to make the choice of home. They told us that there had been written information available for them to take away, in the form of a brochure and service user guide although more importantly to them, had been the attitude of the staff. They said that staff, especially the manager, had been very helpful, encouraging them to visit and discussing the facilities available in the home. Some relatives said that they had viewed homes that had been smarter but that they had been impressed by the attitude of the staff and the feeling of homeliness. Care Homes for Older People Page 11 of 26 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. This home provides a high standard of health and personal care and has developed expertise in supporting those who are nearing the end of their lives. Evidence: The people that use the service looked comfortable, happy and well cared for and each of them has an individual care plan, which uses a standardised format. We looked at a sample of them and found them to be well organised and reflective of the care and support that residents needed. We could see that they are reviewed regularly so that any changes are identified and can be addressed. The people that we spoke with told us that generally staff help them to do things in the way that they like and we saw that they spoke very kindly to residents and were gentle in their approach. Those residents who were being nursed in bed looked clean and comfortable. We saw that specialist equipment is in place to help reduce the risk of pressure sores and for people who require enteral feeding. Advice would be sought from other health care professionals where appropriate. The home is judged, by the Primary Care Trust, as being able to offer a high level of care and able to admit those with complex nursing Care Homes for Older People Page 12 of 26 Evidence: needs therefore 10 beds are funded by them. Previous inspections have always found that medication policies and procedures in the home are robust and in line with current guidance. One resident needs to have medication disguised in food, and a framework for this has been drawn up by the home, in conjunction with their relatives, the psychiatrist and pharmacist to ensure safe administration.A complete audit of medication storage, disposal and administration was recently undertaken by the Primary Care Trust and no errors were found. Therefore they were not assessed on this occasion. Since we last inspected the home, they have been working to implement The Gold Standard Framework and have they gained Commend Status in the accreditation process. This initiative is designed to provide the best possible care for people who are nearing the end of their lives and for their families. It includes work with residents and their families with regard to advanced care planning to ensure that wishes and preferences for this time are identified and met. Staff were able to explain how they approached this sensitively and the way that it had changed their practice. Unwanted hospital admissions have been reduced and staff are able to anticipate when they might need to obtain palliative care drugs in order to ensure that residents are comfortable and pain free. The home has produced leaflets which help people to understand the framework and they have also started a memorial book which allows people to reflect on the lives of resident who have died and to write a small tribute. From our own observation and the feedback that we have received both from people who use the service and from other health care professionals we have judged that residents in this home receive a very high standard of health and social care and have assessed this standard as excellent. Care Homes for Older People Page 13 of 26 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. The home provides the opportunity for residents to live their lives as they choose. They are encouraged to maintain their relationships with their families and friends and they tell us how much they enjoy the food that is served to them. Evidence: Residents are able to enjoy their days as they choose. Regular activities are arranged for them, including arts and crafts, board games and exercises to music, although some of them told us that they prefer to sit and watch television or to stay in their rooms. Relatives who were visiting told us that they are always welcomed warmly,and one gentleman often spends the day there visiting his wife and joining her for lunch. There are several sitting areas in the home so that people could meet with their visitors in private if they wanted to. Some residents are able to go out with their families and outings are also arranged when the weather is fine. The homes self assessment tells us that they are aware of the need to try and continue to extend the range of activities that they are able to offer. On the day we we were there the activities coordinator was away however entertainers were coming in the afternoon to sing and play music. Church representatives also visit the home regularly for those who have spiritual needs. Care Homes for Older People Page 14 of 26 Evidence: Mealtimes are regarded as very important and the cook has worked in the home for several years. She is seen as an important member of the staff team and has close contact with residents so that she gets to know about their likes and preferences. Residents make their choices from the menu the day before, both for lunch and supper, although, if they particularly fancy something else entirely that is not a problem and it can be provided. While we were in the home the lunch time meal was served. It was well presented and portions were large. Most residents sit in the dining room where tables were laid with cloths, serviettes and condiments. A copy of the menu was also on each table. Every one was able to have a drink with their meal. People who required help to eat sat on another table so that staff could attend to them. We noted that where a meal was refused, an alternative was swiftly offered and residents all said that the food was always very good. From our own observation and the positive feedback that we have received from residents and their relatives, we have judged this outcome groups as being excellent. Care Homes for Older People Page 15 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a clear complaints policy in place which could be accessed by anyone who uses or visits the service and people are confident that any concerns would be addressed promptly. Policies and procedures are in place to protect them from abuse. Evidence: The home has a clear complaints procedure in place which is available in the Statement of Purpose and the Service User Guide. It could be produced in alternative formats, such as other languages, large print or audio, if necessary to help anyone make a complaint or suggestion. Any concerns are viewed positively as a way to improve the service and are addressed promptly so that they can be resolved. Comprehensive documentation is available to show how they have been managed and the outcomes. Since the last inspection two concerns have been investigated one of which was unsubstantiated. No referrals have been made to the local authority to be addressed according to their safeguarding protocol and no complaints have been received by The Commission. All of the people that we spoke with were confident that should they have any concerns they would just tell the manager and she would sort it out. Care Homes for Older People Page 16 of 26 Evidence: Staff have all received training in recognising suspected abuse and they were able to tell us how they would report it. They all had clearance from The Criminal Records Bureau before they stared work in the home so that residents are protected from those who have been judged as being unsuitable to be working with vulnerable adults. The homes attitude to complaints and their ability to produce documentation in alternative formats in order to help residents and relatives has lead us to judge this outcome group as excellent. Care Homes for Older People Page 17 of 26 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 home is clean, comfortable and generally well maintained and people tell us that it suits them and they enjoy living there. Evidence: The home was originally 4 older style houses which have been adapted to provide accommodation for up to 44 people. Originally, their registration included provision for some younger people with physical disabilities however the majority of the residents now are older people. The expertise of the nursing staff means that the home can take residents with quite complex nursing needs. The home has all of the specialist adaptations that are needed to care for the people that live there, it is always clean and generally well maintained. A variety of communal areas provide opportunities for residents to meet with their relatives in private if they wish and they have been able to bring possessions from home in order to personalise their rooms. There are sufficient bathroom, shower and toilet facilities throughout the home, fitted with adaptations to help those people with limited mobility. Residents enjoy the well maintained gardens to the rear of the property in the warm weather. It must be noted that Barrington Lodge would not meet the standards expected from a newer home. Eleven of the bedrooms are for shared occupancy and few of them Care Homes for Older People Page 18 of 26 Evidence: benefit from en-suite facilities. We also consider that some areas would benefit from redecoration and refurbishment. However, residents tell us that they like the homely, friendly atmosphere and this outweighs the lack of facilities. We raised some concerns about the safety of residents in the event of a fire. Many of them prefer to have their bedroom doors left open; where this is the case they must be fitted with a device which ensures that they close when the fire alarm operates. We also saw that fire doors at the top of the stairs had been wedged open. These doors should always be closed unless they have been fitted with automatic closers. We were able to meet with the homes Registered Provider during the inspection and he has agreed to fit these devices to the doors. He will also be instigating a redecoration and refurbishment plan which will include replacing some bedroom furniture. As the concerns we raised are to be addressed we have rated this outcome group as good. Care Homes for Older People Page 19 of 26 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. Residents can be confident that there will always be enough appropriately trained staff in the home to support them and meet their health care needs. Evidence: People told us that the staff that care for them in the home are kind and caring. Many of them particularly mentioned the manager and how much they appreciated her always being there for them to talk to. On the day that we visited there were sufficient numbers of staff on duty to meet the needs of the residents, who told us that they never had to wait too long if they needed some help. Many of the staff have been in the home for some time and this provides familiarity for residents who told us that they always felt quite safe there. The home does not use temporary or agency staff. The home has confirmed that no new staff members are employed without thorough checks being made, to ensure that they are suitable to be working with vulnerable people. Staff we spoke with were able to confirm this and tell us about the documentation that they had needed to supply. Staff were also able to tell us about the training that they had received since our last inspection. Some of this is delivered by appropriately skilled people within the Care Homes for Older People Page 20 of 26 Evidence: organisation and external providers are also used. On the day we visited, training in moving and handling procedures was being undertaken. Most of the care staff have achieved an NVQ qualification to at least level 2. Care Homes for Older People Page 21 of 26 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. We have always judged this to be a well managed care home. It is run with residents best interests in mind and allows them the opportunity to influence the care and services that they receive. Evidence: The Registered Manager, Veronica Raynor, is a nurse with considerable experience and works continuously to improve services and provide good quality care and support for the people who use the service. This was repeatedly confirmed by residents who told us she is always around and will always get things done. Relatives also commented on how much they appreciated being able to just pop in and see her whenever they wanted to. We were also pleased that, having raised some issues with the provider, they were addressed promptly. The Commission has always found them committed to providing a high standard of service for residents. There is an ethos of transparency within the home with residents confident that they can voice their opinions and views about the service. There are regular residents Care Homes for Older People Page 22 of 26 Evidence: meetings and quality assurance surveys are distributed twice a year. Results are collated by head office and then displayed in the home. Policies and procedures relating to the health and safety of people who live or work in the home are all in place and regular internal audits take place. We are always notified of any incidents that happen in the home. Although fire drills take place in the home we did recommend that, in line with current guidance, their frequency should be increased especially for staff working at night. Some money is kept for a few of the residents. We were able to see the records of this and checks that they were accurate. We consider that the overall management of the home remains excellent, as at the last inspection. Care Homes for Older People Page 23 of 26 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 24 of 26 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 1 37 It is recommended that the frequency of fire drills held in the home should be increased, in line with good practice guidance from the fire safety regulations. Care Homes for Older People Page 25 of 26 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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