Care Home: Barton House

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What the care home does well Barton House provides a clean, homely environment for older people in need of twenty-four hour care. Relatives commented that the home is always clean, fresh and homely. Staff are caring and work well as a team for the benefit of the people who live there. The staff take an obvious pride in the work they do saying that `the residents care is the top priority` and `we put the residents first`. They also said that they treat the people living in the home with respect, that their privacy, dignity, confidentiality and independence are key considerations and that they encourage them to exercise choice. People living in the home said that they liked living there, that the staff looked after them well, that they usually had things to do and that the food was good. The registered manager has an open and approachable style of management. This encourages good interaction with those living in the home, their relatives and the staff. Staff said that they felt well supported and looked after by the manager. The home is run for the benefit of those living there. There is a very positive attitude towards people with dementia and efforts are made to maintain their levels of independence and to encourage choice for as long as possible. People are treated as individuals which is encouraged by each person having their own key worker. Relatives of people living in the home were complimentary about Barton House. One said that their family member had been resident in another home but moved to Barton House as the manager clearly understood their relatives problems. Several said that they had peace of mind knowing that those living in the home were well cared for. They said that the staff were kind and caring, that they were always made welcome and their questions were readily answered. One person said that when their relative first moved into Barton House they were very anxious about how well they were settling in. As a result they made several phone calls to check on their well being and were always well received and never made to feel that they were being a nuisance. Some said that they had also been provided with support by the manager and the staff. Good assessments are carried out prior to anyone moving into Barton House and from these detailed care plans and risk assessments are compiled. Information about their past lives and their preferences are used to provide individualised care. What has improved since the last inspection? A hoist has been purchased to assist the staff in caring for some of the more frail people living in the home. The programme of activities has been extended to include participation in more events in the local community. Staff training regarding the protection of vulnerable adults is provided more frequently thus ensuring that all staff are aware of what constitutes abuse and the action they should take if they suspect abuse has taken place.More staff are undertaking NVQ levels 2 and 3 in Care. Many of the carpets and curtains have been replaced and some areas have been redecorated. This is part of an ongoing programme of maintenance and refurbishment. What the care home could do better: Cleaning materials and other hazardous substances must be stored in a locked cupboard. All fire doors that need to be left open at any time must be fitted with an appropriate device that will close the door in the event of a fire. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Barton House 1 Barton Terrace Dawlish Devon EX7 9QH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susan Samways     Date: 2 5 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 28 Information about the care home Name of care home: Address: Barton House 1 Barton Terrace Dawlish Devon EX7 9QH 01626864474 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Glen Russell Child,Mrs Sally Ann Child Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 15 Number of places (if applicable): Under 65 Over 65 0 15 15 15 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: 15 0 0 0 The maximum number of service users who can be accommodated is 15. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category Dementia (Code DE) Mental Disorder, excluding learning disability or dementia - over 65 years of age (Code MD(E)) Physical disability over 65 years of age (Code PD(E)) Old age, not falling within any other category (Code OP) Date of last inspection Care Homes for Older People Page 4 of 28 Brief description of the care home Barton House is a care home now providing personal care and accommodation for 15 Older People with additional physical and mental problems associated with increasing age. Mr Glen Child and Mrs Sally Child took over the home in May 2005. The home is a grade II listed building situated in a prominent end position of Barton Terrace in Dawlish. It is close to shops, a library, churches, doctors surgery, a hospital, pharmacies, communal gardens, public houses, a post office and a railway station. There is easy access into the city of Exeter by a regular bus or train service. The house has three floors plus a large attic. The attic is currently used as two offices, for the owners and for the manager (who has yet to be registered). The second floor has recently been transformed from the owners office, together with accommodation for staff from overseas, into 4 new en-suite bedrooms plus a reading area in the room which houses the new lift. This lift was recently specially purchased to serve all three floor which now contain bedrooms for people who live at the home. However, owing to installation problems, which are subject to litigation, this lift cannot now be used. There are 6 single bedrooms on the first floor. The ground floor consists of 5 single bedrooms, a lounge, separate dining room and the kitchen. Bathrooms and toilets are located on both floors. All the homes bedrooms are for single occupancy. At the side and rear of the property the garden and patio has level access from the house. The rear patio benefits from shaded seating. The home provides many varied social activities in and out of the home. Fees range between #305 and #425 depending on care needs. The inspection report can be read at the home and copies can be obtained via the CSCI website. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection for this service was completed on 15th December 2007. This was an unannounced inspection which took place over two consecutive days and lasted for 13 hours. The registered manager was present for the majority of the inspection and one of the registered providers called in for part of the first day. Time was spent in discussion with the registered provider and the registered manager. Files for residents and staff and other documents were examined. The inspection included a tour of the premises, chats with several residents, private interviews with some of the relatives visiting and with four of the staff. In addition completed surveys had been received from four people living in the home, who had been assisted by family or friends to fill them in, and from four of the staff. Care Homes for Older People Page 6 of 28 Prior to the inspection the Annual Quality Assurance Assessment, completed by the registered manager, had been received. This provided information about how the national minimum standards had been met, what had improved since the last inspection and what future plans there were for Barton House. What the care home does well: What has improved since the last inspection? A hoist has been purchased to assist the staff in caring for some of the more frail people living in the home. The programme of activities has been extended to include participation in more events in the local community. Staff training regarding the protection of vulnerable adults is provided more frequently thus ensuring that all staff are aware of what constitutes abuse and the action they should take if they suspect abuse has taken place. Care Homes for Older People Page 8 of 28 More staff are undertaking NVQ levels 2 and 3 in Care. Many of the carpets and curtains have been replaced and some areas have been redecorated. This is part of an ongoing programme of maintenance and refurbishment. 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 set out 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 9 of 28 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 10 of 28 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. Prospective residents and their families can feel confident that their needs will be assessed to ensure that they can be met before moving into the home. Evidence: The files for three people living in the home were examined. Each had an assessment completed by the home and, in the case of those placed by social services, an assessment by their care manager. This ensures, prior to admission that the home can meet the persons needs. The registered manager stated that wherever possible she makes two visits to prospective residents where they are currently living in order to carry out an assessment. She also contacts any professionals involved with the person to gain as clear a picture as possible of the care and support they are going to need. She also stated that the prospective resident and their relatives were welcome to visit the home Care Homes for Older People Page 11 of 28 Evidence: as many times as they felt necessary in order to decide whether Barton House is the right home. They are encouraged to stay for a meal and have a chat with other people living there, meet some of the staff and have a good look round the building. This was confirmed by relatives spoken to who said how welcome they felt and how helpful the visits had been. Evidence was seen that assessments are periodically reviewed to ensure that they are up to date and record changes in the persons condition. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Those living in the home can be confident that their care needs will be met and that they will be treated with respect. Evidence: Three care plans were examined. Each one was detailed and had been regularly reviewed. They included risk assessments, manual handling assessments and information sheets ready for if someone had to be admitted to hospital. The registered manager also agreed to modify the body map system they are currently using to record any bruising,rashes or other marks on the skin, to make them easier and clearer to use. Daily records had been completed using appropriate language and terminology and had recorded any significant events including hospital appointments or visits by the GP. Each persons preferences were recorded such as times for getting up and going to bed, where they liked to have their meals and food preferences. Staff were observed to treat people with respect, to approach them with courtesy and to give, wherever possible, individual attention. The registered manager expressed a Care Homes for Older People Page 13 of 28 Evidence: very positive attitude towards people who have dementia and that was seen to be followed by the staff. A relative commented that they had learned more about dementia from the registered manager than anyone else they had had contact with and that they now had a much better understanding of their mothers behaviour which had improved their relationship. Medication was seen to be stored and administered appropriately. The MAR sheets were all seen to be up to date and signed accordingly. The manager stated that they have good support from their local pharmacist who answers any queries they might have. They have also been able to acquire patient information leaflets for all the medication prescribed for the people living in the home. The residents medication is regularly reviewed by a nurse specialist in elderly care. The staff who administer medication are undertaking training through the local pharmacy. The registered manager stated that all staff have had training regarding the Liverpool Care Pathway which is a multi-disciplinary approach to the care of people coming to the end of their lives. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are encouraged to participate in activities, make choices and to remain as independent as possible for as long as possible. Evidence: The registered manager stated that they encourage the people living in the home to continue to make choices about their daily lives and to maintain their level of independence for as long as possible. As part of the assessment process they ascertain how the person likes to spend their time and what sort of activities they enjoy. Wherever possible this information is used to plan appropriate activities. This is also one of the topics for the residents meetings which are held twice a year. People are encouraged to maintain contact with the local community and actvities include going shopping, going out for walks, attending dress rehearsals at the local theatre and going to other local events. Activities within the home include games, quizzes, art and music depending on the preferences of the people living there at the time. There has also been a visit from a donkey from the local sanctuary which resulted in the home raising money to adopt a donkey. The donkeys photograph is displayed in the home and was commented on with obvious pleasure by several of the residents during the inspection. Care Homes for Older People Page 15 of 28 Evidence: Relatives and friends are encouraged to visit and are supported to take the person out if they wish. Several commented on how welcome they feel when visiting and others said that the home provided support to them as well as the person living in the home. The registered manager stated that they encourage those living in the home to make choices about all aspects of their life in the home for as long as they are able. This includes the time they get up and go to bed, the clothes they wear, the food they eat and the way they spend their time. Gentle guidance is given when needed to ensure that safe choices are made, but at all times the residents are recognised as being individuals and treated as such. Several of the relatives contacted commented on the meals. All praised the food, one described the meals as excellent. Meals were seen to be unhurried with staff providing assistance when required in an unobtrusive way. Meals are well balanced and take into account individuals preferences whenever possible. Second helpings were offered and accepted by several people. Special diets are catered for. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can be confident that any concerns or complaints they might have will be taken seriously and acted upon. People living in the home are safeguarded by staff training in the protection of vulnerable adults. Evidence: The registered manager stated that any complaints or concerns brought to her attention are taken seriously, are investigated and the complainant given feedback regarding the outcome. The home had received two complaints since the last inspection which had been satisfactorily resolved. No complaints about this home have been received by the Commission for Social Care Inspection. The registered manager also stated that they ensure that all residents and their relatives are aware of the complaints procedure and this was confirmed by those who completed surveys and those spoken to during the inspection. All the staff have had training regarding the protection of vulnerable adults. This is updated every three months and is included in other training when relevant. Staff confirmed that they knew about different forms of abuse and what to do should they be made aware of abuse having taken place. Care Homes for Older People Page 17 of 28 Care Homes for Older People Page 18 of 28 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. Barton House provides a clean, comfortable and homely environment in which to live. Evidence: The inspection included a tour of the premises. The home was found to be fit for its stated purpose. It was clean and hygienic and much of the home had been redecorated and re-carpeted since the last inspection. The new lift is now functioning so all areas of the home are now accessible by the people living there. The decor and furnishings are homely in nature and bedrooms have been personalised. The small upstairs lounge is used for residents to entertain their relatives for lunch or afternoon tea, for birthday celebrations and other family occasions or just for meeting friends and relatives in private. At other times it is used by people who want somewhere quiet to go other than their bedroom. There is an ongoing programme of maintenance and refurbishment. The home employs a housekeeper who has devised a cleaning schedule which she and the care staff follow which is also flexible to allow for unexpected requirements. A record of all cleaning duties undertaken is kept for quality monitoring purposes. Unfortunately, during the inspection, a container full of cleaning materials was found in the staff toilet which was not locked and therefore could be accessed by the people Care Homes for Older People Page 19 of 28 Evidence: living in the home. This clearly presented a potential risk to the safety of the residents and was therefore brought to the attention of the registered manager. She undertook to have it removed and placed in a locked cupboard. In addition it was noted that some doors were being held open by door stops or wedges which could prevent doors from closing in the event of a fire. This was also discussed with the registered manager who contacted the registered providers. They gave assurances that proper devices would be ordered immediately and fitted as soon as possible. The registered manager stated that staff have had training in infection control and health and safety. Relatives who commented said that Barton House is homely and not institutional. They said that it is always clean, fresh and tidy. Care Homes for Older People Page 20 of 28 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. Staff recruitment procedures and staff training safeguard people living in the home. Evidence: This was an unannounced inspection and on arrival sufficient staff were found to be on duty. The rotas seen showed that this was the norm and residents, relatives and staff said that there are usually sufficient staff on duty. At night there are two staff on duty. A cook and a housekeeper are employed so care staff can spend most of their time directly caring for the people living in the home. The files for three members of staff were examined. These showed that an adequate recruitment procedure had been followed including taking up references, checking identities and carrying out police checks. This was confirmed by the staff spoken to. Each member of staff has an individual training record and plan. A range of training is arranged for staff during the course of a year. All new staff follow an induction training programme. Of the 10 care staff four have NVQ level 2 in Care and two others are undertaking it. Three staff are working towards NVQ level 3. Other training includes fire safety, medication, basic food hygiene, manual handling and dementia care. Those living in the home and their relatives were complimentary about the staff. They Care Homes for Older People Page 21 of 28 Evidence: described them as being skilled and caring and said that they provide excellent care with nothing being too much trouble. The home operates a key worker system which ensures that each resident has a member of staff who focuses on their particular needs. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management style is open and receptive to the views of the residents and others involved with the home. The home is well managed and run in the best interests of those living there. Evidence: The registered manager clearly cares very much about the way people with dementia are looked after. She was seen to have an open style of management and staff, residents and visitors approached her with confidence. The registered manager said that she is in frequent contact with the friends and relatives of those living in the home so is always receiving feedback about the home. A newsletter is produced to ensure that all those interested are kept in touch with what is happening in the home. Relatives confirmed that any comments or suggestions they might make are well received and questions readily answered. Care Homes for Older People Page 23 of 28 Evidence: Staff have opportunities on a daily basis to discuss with the registered manager any concerns or difficulties they might have. In addition to this staff supervision has been placed on a formal and regular footing. Staff meetings are held twice a year. Staff spoken to said that they felt well supported and looked after by the manager. They also said that they worked well together as a team. The registered manager stated that all the necessary environmental checks and equipment servicing are carried out at the required intervals. Staff have training in safe working practices including fire safety. Accidents and other incidents are recorded. Care Homes for Older People Page 24 of 28 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 25 of 28 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 1 19 13 The registered provider must ensure that the home is free from hazards to the safety of the people living there. All hazardous substances, including cleaning materials must be stored safely under lock and key. 31/08/2009 2 19 23 The registered provider 31/08/2009 must ensure that there are adequate arrangements in the event of a fire to contain the fire and to minimise the risk to the people living in the home. The use of door stops and wedges must cease as these could prevent doors being closed if there was a fire. Suitable devices that would close the door in the event of a fire must be fitted to all doors that need to be held open. Care Homes for Older People Page 26 of 28 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!