Care Home: Barrock Court Nursing Home

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What the care home does well What has improved since the last inspection? Since the new manager came into post in March, many improvements had taken place at Barrock Court. The quality of information in peoples care plans had improved. These had been kept up to date, and were detailed and included the individual wishes of the person. Healthcare records were more robust and showed changes in people`s treatment or medical needs. There was evidence that people were receiving more consistent care and this was benefiting their general health and well being. Safer arrangements were now in place for providing medication for family to administer to people during periods of leave. The service also had clear care plans for medication that were followed so that people received safe, effective and consistent treatment. A greater importance was placed on the provision of activities and occupation, and there was more effort being made to take some people out on regular shopping trips. The range of in house activities was gradually being increased. The new manager had changed the culture of how complaints in the home are managed. A number of people now felt comfortable to raise concerns about things that happened in the past, and the manager was looking into these concerns, and trying to put things right for people. Staff had received new training on safeguarding people from abuse, and concerns were now being properly referred to the appropriate authorities for investigation as necessary. Barrock Court Nursing Home DS0000038773.V376203.R01.S.doc Version 5.2 There had been many improvements to the environment, including some redecoration, new lighting and new equipment. A quiet `sensory room` with special lighting effects had been created. People had been involved in the discussions and decision making about what changes should be made in the home, and as a result there were plans to provide a hair salon and an exercise room. Procedures for the recruitment and training of staff had improved and the personnel files had been updated and organised. There was a training plan in place and staff commented that the quality of recent training was much better. Communication between staff had improved and there was a more positive atmosphere in the home. Management and leadership of the home had improved, with the new manager being well supported by Aermid Health Care. There was good consultation ongoing with people living in the home, and staff, about the changes being made. Regular quality checks had been re-introduced to make sure the service was being run as intended, and staff were being supervised more closely. There was a clear commitment to long term improvement. What the care home could do better: The service should ensure that records of the measurement of blood sugar levels and administration of insulin are updated immediately and not completed from memory at a later time, to reduce the risk of errors. The service should also ensure that ordering procedures are reviewed to prevent any prescribed preparation, such as dietary supplements and creams, running out. Key inspection report CARE HOMES FOR OLDER PEOPLE Barrock Court Nursing Home Barrock Park Low Hesket Carlisle Cumbria CA4 0JS Lead Inspector Jenny Donnelly Key Unannounced Inspection 7th July 2009 08:30 DS0000038773.V376203.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Barrock Court Nursing Home DS0000038773.V376203.R01.S.doc Version 5.2 Page 2 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 Barrock Court Nursing Home DS0000038773.V376203.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Barrock Court Nursing Home Address Barrock Park Low Hesket Carlisle Cumbria CA4 0JS 016974 73765 016974 73865 manager.barrockcourt@aermid.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Aermid Health Care Plc Manager post vacant Care Home 28 Category(ies) of Dementia (1), Old age, not falling within any registration, with number other category (28), Physical disability (5) of places Barrock Court Nursing Home DS0000038773.V376203.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code 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 - Code OP Dementia - Code DE (maximum places: 1) Physical disability - Code PD (maximum places: 5) The maximum number of service users who can be accommodated is: 28 There shall be no further admission of service users to Barrock Court Nursing Home without the prior written agreement of the Care Quality Commission. 27th January 2009 2. Date of last inspection Brief Description of the Service: Barrock Court Nursing Home is purpose built and is situated near Low Heskett at the end of a long driveway with fields and trees surrounding it. The home has its own internal courtyard that people are able to enjoy in warmer weather. The building is on one level, divided into three units. These units accommodate people of varying levels of dependency and each unit has its own lounge and bathing facilities. Aermid Health Care Plc operates the home. A new manager, Daniel Cleough, was appointed in March 2009, and is applying for registration with the commission. At the time of this key inspection, the weekly fees ranged from £407.00 to £575.00 according to people needs, plus any registered nursing care contribution people are entitled to receive. Written information was available in the form of a ‘service users guide pack’. The homes’ latest inspection report was also available in the home. Barrock Court Nursing Home DS0000038773.V376203.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This was a main or key inspection of this service. The lead inspector Jenny Donnelly asked the manager to fill out a form called the Annual Quality Assurance Audit (the AQAA). This asks for details of what has improved in the home since the last inspection and for the plans for the coming year. This was fully completed and returned to us by the date we asked. We also sent surveys to some of the people living in the home and the staff group, and we quote from these surveys in this report. Jenny Donnelly made an unannounced visit to the care home on 7th July 2009 between the hours of 08.30 and 16.30. She was accompanied by Angela Branch, a pharmacist inspector. During this visit we (the Care Quality Commission) toured the building, spent time in the lounges, and dining room where we watched lunch being served. We spoke with people living in the care home and their visitors. We also spoke with the manager and the staff on duty. We looked at files and documents that backed up what we were told and what we saw. Following the last key inspection in January 2009, the service was given a poor quality rating for the second time. We issued Aermid Health Care Plc with three statutory notices requiring urgent improvements to be made, and we imposed a condition on the homes’ registration preventing any new people being admitted, until standards had improved. A new home manager was appointed on 16th March 2009. To monitor the homes’ progress in meeting our requirements, we made random inspections to the service on 26th March and again on 21st and 29th April. At these visits we found improvements had taken place in the areas we were most concerned with, and judged that the statutory notices had been met. Copies of all these reports are available on request from us, or from the care home. What the service does well: People living at Barrock Court told us they were happy with the service provided and said they enjoyed living there. They felt well looked after, thought the home was improving under new management and said the staff met all their care needs. • • “I am very settled at Barrock Court” “I have only praise for the attention I receive in this home” DS0000038773.V376203.R01.S.doc Version 5.2 Page 6 Barrock Court Nursing Home • “We are very well looked after here, I wouldn’t go anywhere else” People had been involved in the discussions and decision making about planned changes in the home to the decor and use of space. People felt they had some control over their own lives, and could influence the way the home was managed. • • • “They enable me to remain as independent as possible” “They make my experience at Barrock Court enjoyable and I know I can’t live at home anymore” “Daniel (the manager) is always keen to listen” The planning and delivery of personal and health care was well organised and took into account peoples individual wishes. The manager has done much work to improve the way medicines are handled and to keep people safe from errors. Regular checks, or audits, of medication and care, were being done to identify promptly areas that need improvement. The provision of meals was good, and people felt encouraged to make suggestions for the menus. What has improved since the last inspection? Since the new manager came into post in March, many improvements had taken place at Barrock Court. The quality of information in peoples care plans had improved. These had been kept up to date, and were detailed and included the individual wishes of the person. Healthcare records were more robust and showed changes in people’s treatment or medical needs. There was evidence that people were receiving more consistent care and this was benefiting their general health and well being. Safer arrangements were now in place for providing medication for family to administer to people during periods of leave. The service also had clear care plans for medication that were followed so that people received safe, effective and consistent treatment. A greater importance was placed on the provision of activities and occupation, and there was more effort being made to take some people out on regular shopping trips. The range of in house activities was gradually being increased. The new manager had changed the culture of how complaints in the home are managed. A number of people now felt comfortable to raise concerns about things that happened in the past, and the manager was looking into these concerns, and trying to put things right for people. Staff had received new training on safeguarding people from abuse, and concerns were now being properly referred to the appropriate authorities for investigation as necessary. Barrock Court Nursing Home DS0000038773.V376203.R01.S.doc Version 5.2 Page 7 There had been many improvements to the environment, including some redecoration, new lighting and new equipment. A quiet ‘sensory room’ with special lighting effects had been created. People had been involved in the discussions and decision making about what changes should be made in the home, and as a result there were plans to provide a hair salon and an exercise room. Procedures for the recruitment and training of staff had improved and the personnel files had been updated and organised. There was a training plan in place and staff commented that the quality of recent training was much better. Communication between staff had improved and there was a more positive atmosphere in the home. Management and leadership of the home had improved, with the new manager being well supported by Aermid Health Care. There was good consultation ongoing with people living in the home, and staff, about the changes being made. Regular quality checks had been re-introduced to make sure the service was being run as intended, and staff were being supervised more closely. There was a clear commitment to long term improvement. 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. Barrock Court Nursing Home DS0000038773.V376203.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Barrock Court Nursing Home DS0000038773.V376203.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Admission procedures help people to know if the home will be suitable to meet their needs, before they moved in. EVIDENCE: Following the last full inspection in January, we imposed a condition on the homes registration preventing any new people being admitted. This was so the company could concentrate on making the improvements needed to meet the needs of people already living there. This meant we could not look at the admission arrangements for new people to see if they were satisfactory. However we did see the information packs that are given to new people and were able to ask about the assessment and admission process. The home uses a standard pre-admission assessment to find out about peoples health, Barrock Court Nursing Home DS0000038773.V376203.R01.S.doc Version 5.2 Page 10 personal and social care needs. This assessment is backed up by information from any other professionals involved with the person, such as their social worker. We looked at the arrangements for people who were admitted to the home last year, and judged that the admission process would help people to know if the home will be suitable for them. The home does not provide an intermediate care service, although they have in the past provided short term respite care. Aermid Health Care Plc will need to make a written request to the commission for the removal of the condition on their registration certificate preventing further admissions. Barrock Court Nursing Home DS0000038773.V376203.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were happy with the quality of health and personal care they received. EVIDENCE: Following the last full inspection in January, we found that the quality of care planning, the arrangements for meeting people’s health care needs, and the management of medicines in the home were very poor. We also thought the delivery of personal care could be much improved. At our random visits in March and April we found that improvements had begun in all these areas. At this visit we found these improvements had been continued and maintained. We looked at a number of care plans for people with different care needs and found they had all been updated and included all relevant information. People with wound care needs had been seen regularly by a visiting wound specialist nurse and staff had followed her care and treatment advice. Records relating to peoples wound management were much improved and ‘stock cupboard’ Barrock Court Nursing Home DS0000038773.V376203.R01.S.doc Version 5.2 Page 12 dressing were no longer being used. Each person had their own prescribed dressings kept in their bedroom, and this helped make sure the correct treatments were being applied. We saw that care plans for people who were ill had been updated to show the outcome of doctor’s visits and any changes in their care needs. There was evidence that people had access to other health care services, such as the dentist and optician. We also saw that social workers had been called in as needed to help people make decisions about their care arrangements. The completed surveys we received, and people we spoke with throughout the day gave very positive feedback about the care they received at Barrock Court. People told us; • “I am very settled at Barrock Court” • “I have only praise for the attention I receive in this home” • “We are very well looked after here, I wouldn’t go anywhere else” People looked well cared for, were properly dressed in clean clothes with their hair tidy. We heard staff talking with people in friendly way with a good use of humour. Staff listened to people and respected their wishes and choices. The pharmacist inspector checked medication and found that overall it had improved and was managed well. There were good systems in place for monitoring medication to make sure it was handled safely but there were still occasional problems that need to be addressed. However, nursing staff who we spoke to were well informed of peoples’ treatments and able to answer all queries without hesitation. Records for administration of medication were good and the treatment received by people was clearly documented. Although most records were preprinted by the pharmacy for name of medication and dosage, some were handwritten or altered by staff. In these cases records were signed and doublechecked to prevent errors occurring that could cause harm. We were concerned that measurements of blood sugar levels and administration of insulin were not documented immediately after they were done. The records for different people were made at a later time from memory with the risk of mix-up. The home had reviewed its arrangements for providing medication for family to administer during periods of leave. Staff had stopped packing down medicines but instead had arranged for the pharmacy to provide properly labelled packs to minimise errors. We saw care plans for the management of medication that were good and records showed that these were followed properly so that people received safe, effective and consistent treatment. We also saw that people were able to have Barrock Court Nursing Home DS0000038773.V376203.R01.S.doc Version 5.2 Page 13 homely remedies so that minor ailments could be treated without delay. However staff that we spoke to had not seen the homes policy on this. We counted a number of medicines and compared them against records to check they were given correctly. These were in order with only occasional discrepancies. However, we saw one recent occasion when a pain-killer patch that needed replacing every three days, was not replaced until the fourth day, leaving the person at risk of inadequate pain relief. We also saw some dietary supplements and a cream that had run out for up to two weeks. We checked medicines liable to misuse, called controlled drugs, and these were in order. We also saw records of regular checks, or audits, of medication that were done by the manager. This makes sure that medication is monitored closely and problems could be identified and managed without delay to minimise risks to residents and to keep them safe. Barrock Court Nursing Home DS0000038773.V376203.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were pleased with the increase in activities and the plans for more outings. People were very happy with the choice and quality of meals provided. EVIDENCE: People told us they were able to spend the day as liked, get up and go to bed as suited them, and use the lounges or stay in the bedroom as they pleased. The service employed a part time activity organiser and a part time occupational therapist. The activity organiser was on duty on the day of inspection and we were able to talk with her and look at the records she keeps. New files had been set up to record what activity or occupation each person had been involved in, these showed people had been engaged in reminiscence activities using photographs and picture books to generate discussions, arts and crafts, dominoes, bingo and hand massage. There had been a lot of time spent outside in the courtyard in the recent good weather, with people enjoying lunch and afternoon tea outside. The activity organiser visits each Barrock Court Nursing Home DS0000038773.V376203.R01.S.doc Version 5.2 Page 15 person in turn throughout the week and spends individual time doing what they want, even if this just having a chat. Some of the younger and more able people like to go out and the manager had recently been taking one or two people shopping on a regular basis. One person was disappointed that her previous arrangements for swimming were no longer in place and the manager was looking into re-starting this for a small group. There were plans to book the local community minibus and go for a day trip. Funds for such outings were limited and were raised through fundraising events in the home such as a recent bingo evening with a pie and pea supper. The home holds a church service once a month and the hairdresser visits every two weeks. Plans were moving ahead to provide a proper hair salon and an exercise room with basic equipment. People we spoke with were quite excited about these plans. One member of staff was going to provide a hen house and bring a few of her own hens to keep in the grounds. People had said they would enjoy watching the hens and thought they could sell the eggs to raise money for the activity fund. People told us they were very happy at Barrock Court and said life there suited them. People said; • “They enable me to remain as independent as possible” • “They make my experience at Barrock Court enjoyable and I know I can’t live at home anymore” • “I would like more activities that get me out” • “I enjoy the freedom I have being able to walk up the long lane” We saw people enjoying their breakfast and lunch in the dining rooms. Breakfast is advertised to take place between 9.15 and 10.30 am and we did see people being served a cooked breakfast at 10 am. The menus were on display and showed two choices at each meal, with people being asked to order in advance. The cook told us she talked with people about the menus and had recently included more traditional steamed puddings as requested. Lunch was chicken curry and rice or fish cake with potatoes and vegetables followed by cherry pie and cream. There were always alternative desserts of fruit, yoghurts or ice cream. The evening meal was jacket potatoes with a number of different fillings, sandwiches and cakes. Everyone we spoke with said they enjoyed their food and told us the meals were always good. The surveys we received told us people were happy with food and one person had written: • “The food is excellent” There were plenty of staff around at meal times to offer assistance and we saw that people were able to choose where to sit and have their meal. Hot and cold drinks were offered throughout the day along with biscuits and homemade cakes. Barrock Court Nursing Home DS0000038773.V376203.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People felt safe in the home, knew how to raise concerns and complaints and were confident that staff would listen and act on what they said. EVIDENCE: Following the last full inspection in January, we found that the management of complaints and staff knowledge about how to safeguard people from abuse was poor. We saw improvements in these areas at our random visit in April, and these improvements had been maintained. The new manager had put a copy of the complaints procedure on display along with a personal statement assuring people that he would manage complaints in a constructive way and was happy for people to raise concerns with him. The manager was very visible around the home, taking the time to talk with people and their visitors. We saw people knew him by name and were comfortable calling out to him for a chat. Since our visit in April people had started to come to the manager with complaints about things that had happened before he came into post. The manager has kept us informed of three complaints and has told us what he is doing about them. We saw that he had kept good records of these complaints and concerns outlining his actions and responses to people. The commission Barrock Court Nursing Home DS0000038773.V376203.R01.S.doc Version 5.2 Page 17 had recently received one written complaint, about something that took place last year, and we asked the manager to investigate and respond to this. We saw that he had already contacted the person concerned to arrange a meeting. We felt the manager was listening to people and doing his best to rectify problems that occurred in the past. People we surveyed and spoke with, told us; • “Daniel (the manager) is always keen to listen” • “Barrock Court is very good at trying to improve itself, lately it is succeeding well” Staff training about how to safeguard people from abuse, had in the past been very poor. Since coming into post the new manager had started to re-train all staff on this, and a programme of sessions was planned. Staff who had completed this new training told us they were much better informed about behaviours and actions that could be seen as abusive, and knew how and who to report any concerns to. They also felt much more confident that any concerns they did raise with the new manager would be taken seriously and looked into. There have been two safeguarding referrals since the manager came into post. Both have been properly reported to social services and to ourselves. One related to an alleged incident between two residents, which was immediately reported, resulting in a social worker visiting to speak with the people involved on the same day, and swiftly resolving the matter. The second safeguarding referral was made when a member of staff reported a historical concern to a person’s social worker. At the time of this inspection the manager was cooperating fully with the investigation team. We judged that the manager was listening to people, and acting in their best interests to put things right where they had gone wrong. Barrock Court Nursing Home DS0000038773.V376203.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 25 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People lived in clean and comfortable home and were benefiting from the decoration and improvements that were taking place. EVIDENCE: Barrock Court is a purpose built care home, all on one level with bedrooms, bathrooms and lounges set out in three separate units. There are 28 single bedrooms, three bathrooms and a shower room. There are two dining rooms and an enclosed courtyard where people can sit outside. Since the new manager came into post there had been a number of changes and improvements made to the environment of the home, with several more planned. Barrock Court Nursing Home DS0000038773.V376203.R01.S.doc Version 5.2 Page 19 The kitchen flooring had been replaced, and a new cooker, food mixer and liquidiser had been purchased. A new fridge was delivered on the day of our inspection to replace one that broke down. The chest freezer had been moved away for the staff toilet area and sited in one of the dining rooms. The reception area had been painted and made to look more welcoming with fresh flowers and a table lamp, and there were new notice boards to let visitors know about things happening in the home. New white lighting had been provided throughout the corridors and bedroom light bulbs were being changed for ones with a brighter output. People were especially pleased with this. The quiet lounge had been made into a ‘sensory’ room with a fish tank, lava lamps and some lighting equipment that projected coloured lights and patterns on the ceiling or walls. Staff found that one person really benefited from using this room, and ate better while watching the lights. Picture signs were in place on toilet, bathroom, lounge and dining room doors to help people find their way around. The manager was talking with people about painting the corridors in the three units with different colours, both to make the place more homely, and to help people recognise which is their unit. The activity organiser had ideas for working with people to make pictures or notices to help them recognise their own bedroom door. Plans were in place, and rooms identified to provide a hairdressing salon, an exercise room, a sluice and a staff resource room. All these spaces had been cleared out and were being decorated ready for their new use. We had previously noted that people in wheelchairs had difficulty using the door out to the courtyard. A door bell had now been fitted, so people could more easily summon staff to help them. Further to past problems with the hot water supply and the boiler, we checked water temperatures around the building, and found them satisfactory. The manager told us there had been a couple of occasions where the boiler had ‘tripped out’ and an engineer had rectified the problem and shown staff how to re-set the boiler should this happen again. People told us the hot water supply was much more reliable now. One of the two washing machines had malfunctioned the previous week, and we were told the contractor was getting a replacement part. In the meantime staff said they were managing alright with one washing. We found the whole home was clean, fresh and tidy and peoples clothing and the table linens had been nicely laundered. There were good interim arrangements in place to for the cleaning and disinfecting of equipment, whilst a sluice room was being created. Twenty one staff had completed infection control training. Barrock Court Nursing Home DS0000038773.V376203.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were being cared for by sufficient numbers of trained and caring staff, who were well organised. EVIDENCE: We looked at the staff rotas over a four week period and these showed staffing levels were fairly stable. There was a registered nurse on duty at all times supported by four care assistants throughout the day, and two at night. They were supported by the home manager, along with sufficient administrative, domestic, catering and maintenance staff for the home to run smoothly. We did not find any staff members working excessive numbers of hours as had previously been the case. A staff training programme was in place and over 80 of the care staff employed had achieved a National Vocational Qualification in care at level 2 or above. Training held this year included infection control, safeguarding people, dental hygiene, food hygiene, and fire safety. Moving and handling and safe use of chemicals was covered at the end of last year. Two staff had completed a thirteen week dementia care course with the local mental health team. Barrock Court Nursing Home DS0000038773.V376203.R01.S.doc Version 5.2 Page 21 Staff we spoke with and the staff surveys we received were positive about working at Barrock Court, saying things were getting much better under the new management. We were told there had been the occasional shortfall in staffing levels due to sickness, but this now seemed to be the exception, rather than the norm. There were no vacant posts although the manager had advertised for a ‘bank’ carer to cover holiday leave. Staff said the home was more organised now, and their work routine was structured to help them manage the work better, and be more responsive to people’s needs. We looked at staff files and saw they had been re-organised into recruitment, training and supervision sections, and had been checked through and updated. There had been one new staff member since our last inspection and we saw evidence that full pre-employment checks including references and a criminal records bureau check had been carried out. People living in the home spoke highly of the staff, saying; • “They are wonderful” • “The staff are really nice and kind” Barrock Court Nursing Home DS0000038773.V376203.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 36 and 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Leadership in the service had greatly improved and people were benefiting from a new management structure that listened to and acted on their views. EVIDENCE: Following a series of acting and temporary managers, a new experienced home manager, Daniel Cleough, took up post on 16th March, and is in the process of applying for registration with the commission. Since the last full inspection in January, the area manager for Aermid Health Care who oversaw Barrock Court left the company. Mr Lewis who is the responsible individual for Aermid Health Care is now overseeing the home himself. Mr Lewis was at Barrock Court on Barrock Court Nursing Home DS0000038773.V376203.R01.S.doc Version 5.2 Page 23 the day we visited, conducting his monthly monitoring visit and supervising the new manager. Since coming into post the new manager has spent a lot of time meeting informally with people to talk about the home and what changes they would like to see. We saw that people knew the manager by name, were pleased to see him and happy to stop and ask him things. There had been informal discussions with people about the change of use for some of the rooms, and about the colour schemes for the planned decorating. The manager had put notices advertising two monthly ‘residents and relatives meetings’, starting this week, to formalise these consultations. Regular quality checks had been re-introduced, and the manager was doing monthly audits on the quality of care plans, management of medicines and the environment. We saw the maintenance man completed a programme of bedroom checks and building audits, as well as monitoring the water delivery temperatures. The fire warden (one of the care staff) had completed the fire log and made sure all alarm and fire equipment checks were kept up to date. He also instructed staff on fire safety. Any accidents were recorded and the manager looked into each incident to see if any changes were needed to make people safer. Staff were now having individual supervision meetings with their line manager every two months, where their job role and training needs were discussed. There were also regular staff meetings. Staff spoke very positively about the new management both during the inspection and in our staff surveys, saying; • “It has improved since the new manager took place” • “Since new management there is evidence of improvement, we are a lot happier and feel more secure” • “It is a welcoming friendly well run home now” • “We had issues recently, but these have resolved with the new manager” People living in the home and visitors we spoke with during the inspection echoed these views. Barrock Court Nursing Home DS0000038773.V376203.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X X X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 X 3 Barrock Court Nursing Home DS0000038773.V376203.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP31 Regulation 8 Requirement The service must have a manager in day-to-day charge, who is registered with the commission. Timescale extended to allow the newly appointed manager to complete the application process. Timescale for action 01/09/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP9 OP9 Good Practice Recommendations It is strongly recommended that ordering procedures are followed to prevent all prescribed preparations running out. It is strongly recommended that records of measurements of blood sugar levels and insulin administration are made immediately to reduce the risk of errors. Barrock Court Nursing Home DS0000038773.V376203.R01.S.doc Version 5.2 Page 26 Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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