Care Home: Brick Barn Residential Home

What the care home does well The purpose of this random inspection was to follow up the outstanding requirements made at the key inspection of the 11th July 2008, review these requirements following a Safeguarding Alert on 22nd September 2008 and monitor the outstanding requirements found at the random inspection on the 25th September 2008. Since the last random inspections there have been changes in the staff and management group. Brick Barn has taken on a new manager and staff from a home which closed. New management structures with the appointment of two deputy managers and two senior carers have been introduced. Staffing levels have improved and a more cohesive staff group is in place. The Statutory Requirements made at the key inspection and the previous random inspection have now been met. Care planning documentation and record keeping has improved, whilst the management, storage and administration of medication including Controlled Drugs has been complied with. Staff recruitment processes have also improved with the necessary checks and references seen in place. The new laundry is an improvement on the previous arrangements with suitable machines and facilities fitted. Improvements were found in the catering arrangements in the home. Two cooks have been appointed and both have completed Basic Food Hygiene training. Forwardplanning, shopping and menu planning is now in place with records kept of food eaten by residents. What the care home could do better: As stated above the management, storage and administration of medication in the home has improved. Recommendations were made that a list of staff initials and signatures of staff members giving medication, needs to be created. The manager acknowledged that this was missing and agreed to compile this list immediately. A second recommendation was made that on the monitoring and auditing of medication as it comes into the home, the home should re-introduce dating the MAR sheet record as medication is accounted for as it enters the home. The manager and deputy manager agreed to do this as the next supplies entered the home. Catering arrangements in the home have improved. Dedicated catering staff have been appointed. Menu planning has begun and is to be expanded to a four-week menu plan. Fridge and freezer temperature record checks are completed, but no attention had been given to a check identifying that a freezer is possibly running extremely cold. We raised this with the cook and the manager and further temperature checks were to be completed that day to ascertain whether the thermometer or the freezer was faulty. Whilst some environmental issues found at previous inspections namely the management of laundry and infection control have been attended to, other environmental issues such as decoration and the security of a fire door do require attention. A new requirement is to be found in this report and we have requested that the home notifies us of what consultation they have had with the Fire Service and what action they have taken. Staff recruitment practices have improved since the last inspection. However at this inspection, it was noted that there were some shortfalls noteably in the lack of detail found on an employment record inspected. We were told that this had and would be raised with the staff member concerned with the detailed added. This care staff member was an established member of the Brick Barn staff and as with all employees they had been asked to complete staff recruitment paperwork so that the new manager has a clear picture of staff skills, experience and training. Inspecting for better lives Random inspection report Care homes for older people Name: Address: Brick Barn Residential Home 106 Walton Road Kirby Le Soken CO13 0DB one star adequate service The quality rating for this care home is: The rating was made on: 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. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Pauline Dean Date: 0 8 1 2 2 0 0 8 Information about the care home Name of care home: Address: Brick Barn Residential Home 106 Walton Road Kirby Le Soken CO13 0DB 01255673232 01255673232 brickbarn@gmail.com 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) : Brick Barn Care Home Ltd care home 16 Number of places (if applicable): Under 65 Over 65 0 16 dementia old age, not falling within any other category Conditions of registration: 16 0 The registered person may provide the following categories of service only: Care Home only - Code PC 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 The maximum number of service users who can be accommodated is 16 Date of last inspection Brief description of the care home Brick Barn provides care for up to 16 elderly people. People living at the home have a diverse range of needs associated with their age, mental and physical health. The accommodation is provided in a period property located in a small Essex village between Colchester and Clacton-on-Sea. The home has a large well maintained garden area that is easily accessible. The village has a local shop and public house. The entrance to the home leads directly onto the main road through the village making 2 5 0 9 2 0 0 8 Care Homes for Older People Page 2 of 11 Brief description of the care home independent access to the village difficult for most residents. The mobile library service visits the home but there are few other local amenities. Care Homes for Older People Page 3 of 11 What we found: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The reason for this visit was to undertake a random inspection following the key inspection of 11th July 2008 when we made six requirements relating to care planning, the management and storage of Controlled Drugs, the environment and staffing levels and staff recruitment. An Immediate Requirement was issued following this key inspection with regard to staffing levels at the home. The proprietors were required to confirm in writing within 24 hours of receipt of the Immediate Requirement what action they planned to take. A response was received on 17th July 2008. On the 22nd September 2008 a Safeguarding Alert was raised by Essex Social Services. The concerns raised were in line with the requirements found at the key inspection, with an additional concern relating to the nutritional needs of the residents. A random inspection was conducted on the 25th September 2008 to consider these concerns. We found outstanding requirements from the previous inspection and a further five statutory requirements were issued at this inspection. At this inspection we looked at these requirements which covered care plans, the management and storage of Controlled Drugs, the environment, with particular attention to the laundry facilities, nutrition, staffing levels and staff recruitment practices. We looked at the care plans of three people living at Brick Barn. A new format had been developed, with each file divided into four colour coded sections. We looked a care plan of a resident who had resided at Brick Barn for some time, a resident who had recently been admitted and a resident who had had recent changes to their care. In the opening section of the care planning file there was detailed information covering general information and identification, a photograph of the resident, their preadmission assessment (as appropriate) and assessment, the persons likes and dislikes, the activities they liked to do, a care plan summary, a personal care log, fluid charts if needed and daily reports. In each of the three care plans sampled there was evidence of detailed care plan objectives with detail of the category, the objective and the action to be taken. Review dates were set, with both long and short term objectives seen in the care plans. All of the three care plans sampled were due for review either later in December or January 2009. Examples of good record keeping were seen in these three sampled files e.g. records relating to a turning programme for one resident and personal care log entries which related to the management of continence as detailed in the care plan. Records were also seen of medication reviews on two of the three care plans sampled. In each case the residents GP had been involved in this. Further information on medication was found in the second section of the care plan where records are kept of a residents weight. The home currently only has weighing scales for residents who are weight bearing, but the manager did tell us that scales are Care Homes for Older People Page 4 of 11 to be purchase which can be used by non-weight bearing persons. At the time of this inspection, this was not a problem, but it is anticipated that these scales will be necessary. Risk assessments and moving and handling assessments were found in the third section of the care plan. These detailed clearly the level of the risk and the action to be taken. An example of this was with regard to the risk of falls for one resident. Records had been kept of falls and a physiotherapist had been contacted and advice sought. Mobility equipment had been ordered and received following this assessment. In the fourth section of the care plan file, records were seen of visits to and from doctors, District Nurses, dentists, Opticans and the hairdresser. Where necessary these were included in the care plan as changes were needed. We looked at the medication records, storage and administration of medication for the three people. One of the deputy managers showed us the storage, record keeping and administration practices. Medication administration records were in good order as was the storage of medication. A recommendation was made i.e. the date of entry of a medicines into the home should be added to the Medication Administration Record (MAR) sheet. The manager said that this would be completed immediately. A further recommendation was made that the home should hold a list of signatures and initials of care staff who administer medication to assist with identification of the member of staff who administered the medication. A Controlled Drug cabinet had been fitted in the homes office and the administration of Controlled Drugs is recorded in a Controlled Drug register. Entries seen were clear and legible with two staff signing the register. On the day of the inspection we were able to meet with one of the two cooks at the home. They told us that they and the other cook had attended a Food Hygiene training course on 4th December 2008. The home had a 2 week planned menu with two options offered at each meal. We were told that the home is planning to increase the menu planning to a 4 week projection. There was a good supply of food in the home. Dried and tinned goods are ordered from a wholesalers and are delivered weekly. Fresh fruit and vegetables were seen in the home and we were told that these are purchased twice a week. Frozen food and meat were seen in the freezers and fridge and we were told that they are ordered and delivered weekly. Records are kept of the food residents eat by catering staff. Entries were clear with detail of the quantity eaten. Records were also kept of the temperatures of the fridges and freezers. These were legible and complete. At this inspection we undertook a partial tour of the premises to see what changes and improvements the proprietor had made since the last inspection. The premises were warm and there were no unpleasant odours at the time of the inspection. Dining arrangements were as found at the last random inspection on 25th September 2008. There were two dining tables and eight chairs. The manager told us Care Homes for Older People Page 5 of 11 that the home is looking to extending the current conservatory dining room, creating a quiet lounge and dining room at the rear of the property, with a TV lounge at the front of the building. This lounge is currently used very rarely by residents. Some alterations had taken place in some of the bedroom accommodation. One bedroom had had blinds fitted and we were told that new curtains are to be added following decoration of the room. On the first floor a resident had been moved into another room whilst their bedroom was being decorated. The manager said that the proprietor is considering the installation of en-suite facilities in this room as they are in a second single room on the first floor which was vacant. A new laundry room has been created in a former first floor bathroom. A new industrial washer and condensor dryer have been fitted and the Red bag system for managing laundry is being used. We were told that the washer has both high temperature wash programmes and a sluicing facility. A butler sink has been installed for hand washing. Within the laundry room there were shelving and storage for clean clothing before they are returned to each resident. The manager told us that the home had purchased new towels, flannels and bedlinen. These were evident in the laundry room and in a laundry cupboard. Within the laundry a new staff toilet has been installed. The ground laundry room was no longer in use. Since the last inspection the newly installed wet/shower room has had a shelf for toiletries installed, a towel rail and a shower curtain fitted. Some touching up of the paintwork is required however. The stair chair lift was in operation as were the two hoists in the home. On the first floor there was a manual operated lift and on the ground floor there was an electric hoist. The manager said that currently only the electric hoist is in use and they are looking to acquire a Stand Aid hoist also. The security of a first floor door at the top of back stairs to the ground floor needs to be considered. This is a matter that has been considered by Essex Social Services within their safeguarding monitoring visits. We were told that this is an issue which the proprietor is considering and one option is to install a key pad system. The manager told us that they would need to consider this with the Fire Service as this is a Fire exit. The manager has made some changes to the staffing structure within the home. In addition to the manager there are two deputy managers and two senior care staff. The manager told us and the staffing rotas confirmed that the manager works five days a week, with the two deputy managers working shifts from 07:00 hours - 14:00 hours and 14:00 hours - 21:00 hours daily. Staffing rotas were in place for the three weeks beginning 29th November 2008 and the manager said that she was working on the rotas for the following three weeks covering the Christmas and New Year period. The manager said that they had considered the dependency levels of the residents and estimated them to be between low to medium dependency. They said that they were planning to have three carers on duty throughout the day Care Homes for Older People Page 6 of 11 with a fourth person on duty one day a week to enable the manager and deputy managers to update care plans and complete management tasks. At night the home has two awake carers. This was evidenced on the prepared rotas and confirmed by two care staff. The manager said that they are in the process of recruiting night carers and a domestic worker. Staff recruitment paperwork for three people were sampled and inspected at the inspection. Good recruitment practices are being followed with evidence seen of application for a position, written references, POVA (Protection of Vulnerable Adults) 1st checks and CRB (Criminal Record Bureau) checks, identification documents, a photograph of the applicant and letters offering appointment with contracts in place. A recruitment check listed aided the home to ensure that all of these documents were in place. The manager said that the home had introduced in-house induction training incorporating Common Induction Standards 1-6. New staff were employed working a probation period. Evidence of this training was seen on staff files. In addition we were able to see evidence of further training completed by care staff since the last inspection. In October and November 2008, care staff had completed training in Safeguarding Vulnerable Adults POVA, Basic Fire Safety, Food Hygiene, Caring Positively for People with Dementia, Moving and Handling of Inanimate Objects, Infection Control, Safe Handling and Administration of Medication, Developing an Activities Programme, Supervision in a Care Setting and Writing and Reviewing Care Plans. What the care home does well: The purpose of this random inspection was to follow up the outstanding requirements made at the key inspection of the 11th July 2008, review these requirements following a Safeguarding Alert on 22nd September 2008 and monitor the outstanding requirements found at the random inspection on the 25th September 2008. Since the last random inspections there have been changes in the staff and management group. Brick Barn has taken on a new manager and staff from a home which closed. New management structures with the appointment of two deputy managers and two senior carers have been introduced. Staffing levels have improved and a more cohesive staff group is in place. The Statutory Requirements made at the key inspection and the previous random inspection have now been met. Care planning documentation and record keeping has improved, whilst the management, storage and administration of medication including Controlled Drugs has been complied with. Staff recruitment processes have also improved with the necessary checks and references seen in place. The new laundry is an improvement on the previous arrangements with suitable machines and facilities fitted. Improvements were found in the catering arrangements in the home. Two cooks have been appointed and both have completed Basic Food Hygiene training. Forward Care Homes for Older People Page 7 of 11 planning, shopping and menu planning is now in place with records kept of food eaten by residents. 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 2. Care Homes for Older People Page 8 of 11 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 9 of 11 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 16 People living in the home 15/02/2009 must be assured that they are safe and secure, namely of a first floor door leading to a fire exit. So that people living at the home are assured they are safe and secure at all times. 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 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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