Care Home: College Of St. Barnabas

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What the care home does well The home provides a relaxed and caring environment, which is well maintained and safe. The standard of care is good and this is reflected in well- maintained care plans. The ethos of the home is reflected in prayer and worship and the activities in the home are arranged with this in mind. The home has two chapels where morning and evening service takes place. The standard of catering is good and meals are provided in two dining rooms. Residents who live in the cloisters (supported living) accommodation also take their meals in the home. Staff training and development is ongoing with all but one staff holding an NVQ level 2 or 2 award. The home is well managed in the best interest of the residents. What has improved since the last inspection? The home is currently being refurbished and the communal areas of the home are being redecorated and new flooring fitted. Two new bedrooms have been commissioned by CSCI Registration Team. The medication storage arrangements have been rearranged and the medication is now stored in a locked room. What the care home could do better: The home continues to work towards meeting the National Minimum Standards. Consideration must be given to the provision of qualified nursing staff to work with the registered manager in order to enable her to undertake her managerial role and delegate some clinical duties. Shortfalls were observed in the recruitment procedures and these must be improved to include all required documentation including written references and an application form. CARE HOMES FOR OLDER PEOPLE College Of St. Barnabas Blackberry Lane Lingfield Surrey RH7 6NJ Lead Inspector Mary Williamson Unannounced Inspection 10:00 3 March 2008 rd X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address College Of St. Barnabas DS0000013310.V359248.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. College Of St. Barnabas DS0000013310.V359248.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service College Of St. Barnabas Address Blackberry Lane Lingfield Surrey RH7 6NJ 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) 01342 870369 01342 871672 matron@collegeofstbarnabas.com The Council of the College of St. Barnabas Heather Bradley Mockler Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (0) of places College Of St. Barnabas DS0000013310.V359248.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 providing nursing - (N) to service users of the following gender: Either Whose primary needs on admission to the home are within the following categories Older Persons, not falling within any other category (OP) The maximum number of service users to be accommodated is 28 2. Date of last inspection 26th July 2006 Brief Description of the Service: The College of St Barnabas is a Charitable Trust providing retirement accommodation in two categories; sheltered accommodation in cloistered dwellings and nursing care in the main part of the house. Service provision is specifically for members of the Clergy of the Church of England or its sister churches. Provision is also extended to the spouses of clergy, retired licensed readers and full time church workers. Other applicants may be accepted as fee paying Service Users dependent on bed availability. This inspection report relates only to the registered care facilities with the nursing provision. A separate report has been issued for the Domiciliary Care provided to the cloisters. The home is situated in a rural location and has extensive grounds near the village of Domansland in Surrey. All rooms are single occupancy with en-suite facilities. There are several communal facilities, including, lounges, dining rooms and an extensive library. The College has two chapels and Eucharist and Evensong are celebrated daily. The fees charged range from £504 to £599 per week, information obtained on 3/3/2008. College Of St. Barnabas DS0000013310.V359248.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 a two star rating. This means that people who use this service experience a good quality outcome. This was the first site visit of a key inspection and was unannounced. Mary Williamson Regulation Inspector undertook the inspection. The registered manager Mrs. Heather Mockler was present for the duration of the inspection. A tour of the premises was undertaken and some residents invited the inspector to view their rooms, and talk about their experience about living in the home. Group discussion with residents also took place. Records relation to the care of the residents and the management of the home examined. These included care plans, needs assessments, medication recording charts, menus, staff training records, and staff employment files. Staff on duty were spoken to and they were able to confirm some of the training they had undertaken. It was possible to meet with the bursar, and the college warden to gain some insight into the administration of the service. The manager completed an Annual Quality Assurance Assessment, which has been used in conjunction with this report. The Commission for Social Care would like to thank the residents, staff and management for their help and hospitality during this inspection visit. What the service does well: The home provides a relaxed and caring environment, which is well maintained and safe. The standard of care is good and this is reflected in well- maintained care plans. The ethos of the home is reflected in prayer and worship and the activities in the home are arranged with this in mind. The home has two chapels where morning and evening service takes place. The standard of catering is good and meals are provided in two dining rooms. Residents who live in the cloisters (supported living) accommodation also take their meals in the home. Staff training and development is ongoing with all but one staff holding an NVQ level 2 or 2 award. College Of St. Barnabas DS0000013310.V359248.R01.S.doc Version 5.2 Page 6 The home is well managed in the best interest of the residents. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. College Of St. Barnabas DS0000013310.V359248.R01.S.doc Version 5.2 Page 7 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 College Of St. Barnabas DS0000013310.V359248.R01.S.doc Version 5.2 Page 8 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, and 6. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective residents have access to appropriate information in order to help them make a choice about living in the home. Contracts of occupancy and needs assessments are in place. The home does not provide intermediate care. EVIDENCE: The home has a statement of purpose and residents guide in place and all prospective residents are provided with this information in order to help them make a choice about moving to the home. The home has specific criteria for admission, and residents must either be retired clergy of The Church of England or a spouse. All prospective residents are invited to spend a two-week trial period in the home during which the manager undertakes time a detailed needs assessment. This will establish if individual and specific needs of prospective residents can be met. Four assessments were seen and are detailed and informative. College Of St. Barnabas DS0000013310.V359248.R01.S.doc Version 5.2 Page 9 Contracts of occupancy are in place and, a selection of these were also seen. These outline the accommodation offered, the care to be provided, and the method and frequency of fees payable. The home does not provide intermediate care. College Of St. Barnabas DS0000013310.V359248.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, and 11. Residents who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Individual care plans outline how care will be provided. There are appropriate arrangements in place to meet the health care needs of residents. The medication policy in place protects residents living in the home. Privacy and dignity are respected particularly around the time of death. EVIDENCE: Individual care plans sampled outline the care to be provided and these are detailed and updated daily by carers. These plans are well written based on the needs assessments. They are well maintained and are usually the responsibility of the deputy manager. The manager is currently overseeing this role. Appropriate arrangements are in place to meet resident’s health care needs. All residents are registered with a GP who visits the home regularly. Residents many also see their GP at the local surgery. The chiropodist, dentist, and optician visit the home or residents can make their own arrangements to visit individual practices. Physiotherapy or consultant input may be accessed on referral by the GP. College Of St. Barnabas DS0000013310.V359248.R01.S.doc Version 5.2 Page 11 The home has a medication policy in place and nurses administer medication according to this policy and The NMC (Nursing and Midwifery Council) Code of Professional Conduct. The medication recording charts (MAR) were seen and are well maintained. Photographic evidence on some MAR charts were not in place, and the manage stated that she would correct this as soon as possible. All medication was stored correctly, and regular audits of medication are undertaken by the chemist and reports retained for information. Residents are supported to self medicate and risk assessments are in place for this procedure. Privacy and dignity are respected and staff were observed to be polite and respectful when addressing residents, for example calling them Fr, or Bishop. The ethos of the home is centred around worship and prayer, and the home is peaceful and calm. This is also extended to residents who are dying and their spiritual needs and rites treated with priority. Family rooms are available to support relatives who wish to spend time with sick and dying relatives. Funerals are facilitated in the home’s chapel, and a garden of remembrance may be used to lay ashes. College Of St. Barnabas DS0000013310.V359248.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, and 15. Residents who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Activities are arranged according to individual needs. Family and friendship groups are maintained. Individual choice is respected, and the nutritional needs of the residents are met. EVIDENCE: Activities are arranged according to resident’s needs and choice. These are mainly centred around worship. There are two chapels in the home and residents attend morning worship and The Holy Eucharist, and evening service. Most of the residents like to spend time in their rooms reading or listening to music. Some residents spend time in the library reading, or in quite discussion. On the morning of the inspection The Friends of the College were holding the regular Monday morning shop in one of the recreation rooms on the ground floor. Residents are able to buy sundries, and order specific items, which they purchase the following week. This was also observed as a social occasion. There are also reading groups, poetry groups, music recitals, organised on a regular basis. Special occasions are also celebrated. College Of St. Barnabas DS0000013310.V359248.R01.S.doc Version 5.2 Page 13 Family contact is maintained and visitors are welcome to visit the home at any reasonable time. A resident stated that his former parishioners visit and facilitate visits to his old parish. One resident stated that he could be as independent as he wants to; another stated that the home was isolated and another stated that she could have a taxi any time to get to the local village. The menus are planned over a four -week period and are seasonal. The choice and variety of meals are good. The chef was off duty and it was possible to talk with the second chef, who had a good understanding of the nutritional needs of the residents including their likes and dislikes. The chef also caters for the residents living in the cloisters who take all their meals in the college. Meals are served in two dining areas the smaller one being mainly for the residents living in the college. There was good feedback provided about the food. One resident stated that “the food is very good here” one said, “ there is no shortage of food” and another resident from the cloisters was most displeased, stating that “the food was tasteless and unpleasant”. The chef was observed to deal with these comments immediately. College Of St. Barnabas DS0000013310.V359248.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, and 18 Residents living in the home experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The complaints procedure and safeguarding procedure in place protect residents living bin the home. EVIDENCE: The home has a complaints procedure in place and all residents and their relatives have access to a copy of this procedure. A complaints log is maintained and the one complaint received since the last inspection has been resolved in a satisfactory manner. The home has a safeguarding procedure in place for the protection of vulnerable adults. All staff undertake training in this procedure on commencement of employment. There is also a copy of Surrey’s Multi Agency Policies and Procedures on Safeguarding Vulnerable Adults in place and the manager has attended this training and has cascaded this throughout the staff team. College Of St. Barnabas DS0000013310.V359248.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24, and 26. Residents living in the home experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a well maintained and comfortable home which is suitable for its stated purpose. The standard of cleanliness and hygiene is good. EVIDENCE: The home provides a good standard of accommodation for the residents living there. It is currently in the process of refurbishment and the communal areas are being redecorated. There are lounge and dining facilities to meet the resident’s individual needs including a large lounge a smaller lounge, and a large and smaller dining area. The home has a library and a reference library, and two chapels on the first and second floors. Individual accommodation is provided mainly in single en-suite rooms, which have been furnished with personal furniture and belongings. All rooms overlook College Of St. Barnabas DS0000013310.V359248.R01.S.doc Version 5.2 Page 16 well-maintained gardens. Residents stated that it was difficult giving up their homes but felt comforted by having their books, and furniture around them. A shared room is provided for married couples. The standard of cleanliness and hygiene is good. The housekeeper was spoken to and outlined her areas of responsibility. She has responsibility for the general cleaning, laundry, and dining room administration and the supervision of these staff. She stated that the ancillary staff receive training in infection control, COSHH, and food hygiene. College Of St. Barnabas DS0000013310.V359248.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, and 30. Residents who live in the home experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents needs are generally met, however more qualified nurse input is required to maintain health care needs. Staff are trained to do their jobs. Minor shortfalls were observed in staff recruitment procedures. EVIDENCE: The staff duty rota was seen and the number and skill mix of care staff on duty was sufficient to meet the personal needs of the residents. The home provides nursing care and the only qualified nurse on duty was the manager. It was evident from her work load for that shift that she was extremely busy and had to undertake all the nursing tasks herself, including taking blood for testing, ordering prescriptions, and undertaking the administration of medication, and managing the home. A discussion took place between the management team regarding the provision of more qualified nursing resources to be allocated to the home to provide support to the manager to enable her to supervise and train staff and undertake her management role. The staff are trained and competent to undertake their roles and responsibilities. All staff undertake induction training, which is recorded and signed on completion. Currently one staff member is undertaking NVQ level 2 and all the other staff hols either an NVQ level 2 or level 3 qualification. College Of St. Barnabas DS0000013310.V359248.R01.S.doc Version 5.2 Page 18 The home has a recruitment policy in place. Three staff recruitment files were seen. Two were well maintained and the third did not have an application form or references in place. A discussion was held with a member of the management on how to resolve this issue. College Of St. Barnabas DS0000013310.V359248.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, and 38. Residents who live in this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is well managed in the best interests of the residents. The health, safety, and welfare of the residents are promoted and protected. EVIDENCE: The home is well managed by the registered manager who has been in post for six years. She is a qualified nurse and also has a degree in nursing administration. There is also a deputy manager in post who is on long- term sick leave. Currently the manager is providing the on call cover and undertaking all the clinical management responsibilities for the home. As previously stated in standard 27 nursing support must be provided to enable the manager to undertake managerial responsibilities. College Of St. Barnabas DS0000013310.V359248.R01.S.doc Version 5.2 Page 20 The warden, bursar, and board of governors share the administration of the home and cloister accommodation. Two secretaries support them. Systems are in place to monitor quality assurance. Regulation 26 visits take place monthly, and are retained in the home for information. Audit tools are used to monitor cleanliness, catering, medication, health and safety, and care plans. Regular residents and staff meetings take place and issues acted upon. A yearly customer satisfaction questionnaire is distributed to residents and relatives and results are published in the newsletter. Investors in people are renewed every three years. The home does not handle personal finances for residents. The health, safety and welfare of the residents and staff are promoted. Health and safety training is undertaken on commencement of employment and renewed on a yearly basis. Risk assessments are in place for all identified risks. Fire safety is observed and there is a contract in pace for the maintenance of fire fighting equipment and emergency lighting. College Of St. Barnabas DS0000013310.V359248.R01.S.doc Version 5.2 Page 21 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 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 X X X 3 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 3 College Of St. Barnabas DS0000013310.V359248.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? 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 OP27 Regulation 18(1)(a) Requirement The registered person must ensure that suitably qualified nurses are employed in the care home in sufficient numbers to meet the health care needs of the residents, and to provide support for the manager to undertake managerial responsibilities. The registered person must ensure that all the required employment documents are in place on commencement of employment including a written application form and two written references. Timescale for action 27/04/08 2 OP29 19(1)(b) 27/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations College Of St. Barnabas DS0000013310.V359248.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection South East Region The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI College Of St. Barnabas DS0000013310.V359248.R01.S.doc Version 5.2 Page 24 - 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. 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