Care Home: Manor Barn Nursing Home

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What the care home does well The home and grounds are maintained well, and the furnishing and decoration is of a high standard. Most bedrooms have en-suite facilities. Staff are helpful and friendly, and the home has a relaxed atmosphere. The home responds well to concerns and complaints raised by residents or their relatives, friends or advocates. People are receiving the person care and medical care and support they need. The home is well maintained and decorated and furnished to a very good standard, and people are able to personalise their bedroom. What has improved since the last inspection? Care planning is taking more account of how people wish their care to be provided. Care plans which help plan end of life care where appropriate have been put in place so that staff have clear information about the person`s wishes. Staff now work in geographical teams, one team covering each of the three parts of the home, and this helps ensure that more consistent personal care is being provided. Wheelchair reassessments had been carried out to ensure that each wheelchair is set up in a way that continues to meet the individual`s needs. More activities are being provided that meet people`s needs. Because of increased staff numbers meal times are better supported. Improvements to the accommodation have included the redecoration and refurbishment of the main sitting room and conservatory areas and new garden furniture. What the care home could do better: The home needs to better evidence how staff whose first language is not English are being supported with their communication skills. CARE HOMES FOR OLDER PEOPLE Manor Barn Nursing Home 2 Appledram Lane South Fishbourne Chichester West Sussex PO20 7PE Lead Inspector Ed McLeod Unannounced Inspection 9th February 2009 09:45 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 Manor Barn Nursing Home DS0000024175.V373906.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. Manor Barn Nursing Home DS0000024175.V373906.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Manor Barn Nursing Home Address 2 Appledram Lane South Fishbourne Chichester West Sussex PO20 7PE 01243 781490 01243 813713 manorbarn@care-homes.org 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) Rhymecare Ltd Manager post vacant Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability (0) of places Manor Barn Nursing Home DS0000024175.V373906.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with Nursing (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 (OP) 2. Physical Disability (PD) The maximum number of service users to be accommodated is 30. Date of last inspection 3rd March 2008 Brief Description of the Service: Manor Barn is a care home that provides residential and nursing care, and is registered to accommodate up to 30 residents in the category of old age, not falling within any other category. The fees are between £750 and £780 per week. Manor Barn was originally constructed in the sixteenth century, since then it has been extended and converted. The home is situated near the village of Fishbourne. Rhymecare Ltd operates the service. The person registered for the service on behalf of the company is Mrs Sheila Wyatt. At the time of our visit no manager was registered for the service. Manor Barn Nursing Home DS0000024175.V373906.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 star. This means the people who use this service experience good quality outcomes. The inspection visit was arranged to assess compliance with previous requirements and with the key national minimum standards for care homes for older people. We prepared for this visit by obtaining the homes CSCI annual quality assurance audit (the AQAA) which was completed by the manager, and we also received CSCI survey responses from six people living in the home. Some of this information has been included in the writing of this report. In preparing for this visit we took into account other information received on the service and the outcomes of the previous inspection report. During our visit we spoke with six people living in the home, four visiting relatives, the manager, and four members of staff. We looked at four sets of care plans, and three sets of staff recruitment, training and supervision records. Other records, including records relating to health and safety, complaints, and activity provision were also seen. The inspector was on the premises for five hours and forty five minutes. What the service does well: The home and grounds are maintained well, and the furnishing and decoration is of a high standard. Most bedrooms have en-suite facilities. Staff are helpful and friendly, and the home has a relaxed atmosphere. The home responds well to concerns and complaints raised by residents or their relatives, friends or advocates. People are receiving the person care and medical care and support they need. The home is well maintained and decorated and furnished to a very good standard, and people are able to personalise their bedroom. Manor Barn Nursing Home DS0000024175.V373906.R01.S.doc Version 5.2 Page 6 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. Manor Barn Nursing Home DS0000024175.V373906.R01.S.doc Version 5.2 Page 7 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. Manor Barn Nursing Home DS0000024175.V373906.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 Manor Barn Nursing Home DS0000024175.V373906.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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. EVIDENCE: The manager for the home tells us in the homes annual quality assessment audit (the AQAA) that the service undertake an extensive pre-admission assessment to ensure that the persons care needs, wishes and preferences are recorded prior to admission. During this visit we looked at the pre-admission assessments for three people admitted to the home in the past year. Manor Barn Nursing Home DS0000024175.V373906.R01.S.doc Version 5.2 Page 10 We noted in these records that information received during the referral phone call is recorded, then a face to face assessment is carried out and recorded. If the assessment indicates that the home can meet the persons needs, an acceptance letter is sent to them or their relative to advise them of this. The acceptance letter includes information on the room to be occupied and the cost of the placement. A relative we talked to during our visit told us that he had had an opportunity to visit the home and discuss his wifes care before they chose Manor Barn. Manor Barn Nursing Home DS0000024175.V373906.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Peoples 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 the home supports them with it in a safe way. Peoples 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. EVIDENCE: Manor Barn Nursing Home DS0000024175.V373906.R01.S.doc Version 5.2 Page 12 During this visit we looked at care plans for three people. We found that since our previous visit the manager has introduced care planning forms which can assist in ensuring people are receiving the care they need. For example a 24 hour care checklist for the individual has been introduced which brings together information previously recorded in separate forms, and a new handover sheet brings together the important information staff need at the beginning of a shift or if they have been on leave or absent. We looked at a checklist being completed for one person with the manager, and discussed with the manager that the section on fluid intake was being filled out by some staff but not by others. The manager said that for the person concerned the staff were not required to complete fluid intake records. The manager accepted that it would be useful if it was recorded for staff which sections they should be filling out for the individual. We talked to a member of staff about the tasks undertaken by each persons key carer, and were told that these would include doing nail care, checking weight, arranging appointments and talking to relatives. The carer said that they discuss peoples care with them such as their mobility support and continence care. The manager told us that staff now work in teams, one team covering each of the three parts of the home, and that this helps ensure that staff are assisting each other in providing manual handling care and that personal care is being provided in a more consistent manner. We talked to a member of staff about how they are ensuring that peoples privacy is observed and their dignity is maintained, and were given good examples of how this is achieved. The AQAA tells us that evening and afternoon baths or showers are offered if this better fits in with the persons preferences or arrangements, and this helps ensure that people are receiving care in the way they prefer. We discussed the personal care and health care needs of one person at length with her and her partner, and discussed her care plan with them. Their view was that the care plan was setting out her needs well, and that her complex day care and night needs were being met by the home – for example her skin care and hygiene needs, as well as emotional support. Manor Barn Nursing Home DS0000024175.V373906.R01.S.doc Version 5.2 Page 13 They felt that it is sometimes difficult to communicate with staff whose first language is not English, and we will refer to this in the Staffing section of the report. They told us that where there has been poor practice they have brought this to the managers attention and that whatever we have talked to the manager about its all been done. They also told us that the manager has arranged for a emergency bell adaptation to be made that the person could use, and that this has been helplful. We also talked to the partner of a person being cared for, and their view was that staff were very good, and that the care including continence care was good. The six people living in the home who responded to our CSCI survey told us that they were receiving the care and support they needed, and that staff listened to them and acted on what they said. They told us they were receiving the medical support they needed. The manager told us that wheelchair reassessments had been carried out to ensure that people still had wheelchairs that were set up in a way that continued to meet their needs. We found evidence that staff are receiving training and advice from nursing experts, for example in the area of the treatment of people in the home with motor neurone disease. We spoke with the nurse with overall responsibility for medication in the home, who told us that only trained nurses are administering medicines in the home, and this was confirmed by a relative and a person receiving care who we spoke to. We found that responsible staff were receiving training and competency assessment in the handling and administration of medicines. We found that homely remedies agreements are now in place, and that two extra medication trolleys have been purchased to ensure medication is brought more directly to the person. We found that there are suitable arrangements in place for the storage and recording of medicines and medicines administered. We were told that once a month the responsible nurse checks the administration records. We discussed this with the manager who agreed more regular checks would be better practice. Manor Barn Nursing Home DS0000024175.V373906.R01.S.doc Version 5.2 Page 14 The AQAA tells us that people receiving palliative care and other people in their final days are now cared for using the Liverpool Care Pathway approach. The AQAA also advises us that care plans which help plan care in their final days or in the event of an emergency are put in place so that staff have clear information about the persons wishes. During our visit we found that the manager is undertaking a diploma in palliative care. We found that the home have received a number of written comments from relatives about the end of life care provided including may I say how impressed we have been with all your care. Thank you for making my mothers last few weeks comfortable through your kindness and attention, and thank you for all looking after my mother so well in her final months of her long life. Manor Barn Nursing Home DS0000024175.V373906.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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. EVIDENCE: It was a requirement made at our previous visit that the provider ensure that people receiving the service are being supported to lead an active lifestyle, have their interests encouraged and activities provided which they enjoy. Manor Barn Nursing Home DS0000024175.V373906.R01.S.doc Version 5.2 Page 16 At this visit we found that outings have begun to take place, including a visit to see Christmas lights and plans for an outing in the Spring. We found that activities are planned twice per week, and that when staff have time they are doing activities such as quizzes and bingo with people. On the day of our visit a student nurse on placement was doing word puzzles with one person. A resident we spoke to suggested that musical exercise would be helpful, and the manager said to us that it was planned to try musical exercise. We talked with the manager about how the individual social needs and interests of three people living in the home were being met. The manager gave us examples of this for each of the three people, and their care plans reflected how their interests were to be supported. The home has purchased satellite TV channels and tell us this has for example allowed one person to watch his relative play in an international football match. We looked at the evaluation records for the activities which had taken place on the 27th and 29th January 2009, and the 3rd and 5th February 2009 which indicated the activities which had taken place, who had participated, and how well the session had gone. The AQAA tells us that the home has a monthly church service and visits from representatives of other churches, and that home play host the local school children in groups at festive times throughout the year. Residents meetings are recorded in the homes newsletter which families and friends can also receive on paper or via email to keep them informed of what is happening and what opportunities are available for them to join in with. The record of the monthly meetings with residents and relatives which took place on 15th January 2009 told us that piano recitals, the Christmas party, and a mobile shop visit had been a success during December, and indicated some of the ways in which people are being supported to maintain contact with their relatives. The manager also advised us that staff read letters received from friends and relatives to one resident, and that during the previous week a wedding anniversary tea for one couple took place which their friends attended. We found that the previous requirement concerning the provision of activities had been met. Manor Barn Nursing Home DS0000024175.V373906.R01.S.doc Version 5.2 Page 17 Since our previous visit the home has changed to having in-house chefs, and staff we spoke to told us the new chef has changed menus to better meet peoples tastes and that the food is always nicely presented. On the day of our visit the main lunch choice was chicken and leek pie or spicy vegetable wrap. Staff told us that people asked to comment on menus. People are asked about their food preferences, likes and dislikes, and these are recorded by the chef to help staff offer food that will need the persons needs. For example, one person who had a restricted diet and weight issues had a menu devised for them with the assistance of a dietician. We spoke to the chef who told us that homemade soups have been introduced, but some people still request packet soups so people are given the individual choice of homemade soups or packet soups. We observed the lunch being served, and found that people who needed assistance with eating were receiving this, and people who needed their food mashed were receiving this. People said they enjoyed the food, and the meal was relaxed and unhurried. Staff we spoke to told us that because of increased staff numbers meal times are better supported. Manor Barn Nursing Home DS0000024175.V373906.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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 home safeguards people from abuse and neglect and takes action to follow up any allegations. EVIDENCE: The AQAA tells us the complaints procedure is clearly displayed in several areas throughout the home, and in the service user’s guide and statement of purpose. Of the six people living in the home who replied to our CSCI survey, five told us they knew how to complain and who to talk to if they had concerns or complaints. During our visit we looked at the records of three complaints received in the previous month, and found that these has been investigated fairly and that the complainant was advised of the outcome of the complaint within the timescale indicated in the complaints procedure. We spoke to one complainant who told us that whenever they brought a complaint or concern to the attention of the manager it was always dealt with. Manor Barn Nursing Home DS0000024175.V373906.R01.S.doc Version 5.2 Page 19 Staff in the home receive training in the protection of vulnerable adults, and notices in the home told us that the next staff training on this was to take place on the 19th February 2009. The AQAA tells us that staff are trained in protecting and safeguarding vulnerable adults by senior staff and by an external training provider, and that the training refers to local multi-agency guidelines for the reporting of incidents. The AQAA advises us that there have been no safeguarding referrals or investigations in the past 12 months. The home has a copy of the most recent local multi-agency safeguarding guidelines and procedures, and the manager advised that she will be attending a briefing session on these with the local authority in April 2009. Manor Barn Nursing Home DS0000024175.V373906.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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. Their room feels like their own, it is comfortable and they feel safe when they use it. EVIDENCE: The premises are a listed building with new wings offering living accommodation with en-suite toilets and wet rooms. We visited the main communal areas in the home and five bedrooms. Manor Barn Nursing Home DS0000024175.V373906.R01.S.doc Version 5.2 Page 21 We found that improvements to the accommodation have included the redecoration and refurbishment of the main sitting room and conservatory areas, new pictures, and a piano has been donated. New garden furniture and satellite television have also been provided. There are arrangements for regular maintenance work to be carried out in the home and for staff to report maintenance issues. The fault is recorded, together with the action taken and the result. The AQAA tells us that managers regularly review the maintenance records. The home is decorated and furnished to a very good standard, and bedrooms we visited had been personalised by the person. Most bedrooms in the home have en-suite toilets, with the exception of three of the rooms in the main building which are close to a communal wet room, a toilet and bathroom. The AQAA tells us that equipment purchased since the previous visit has included two new hoists, four new slings and new slide sheets. We are advised in the AQAA that all beds are full hospital electric beds, and that pressure relieving mattresses are provided for all clients. The AQAA tells us that people with limited mobility and needing additional pressure relief have overlay mattresses provided and people with high dependency needs have full replacement mattresses offering a high level of pressure relief. The first floor is accessed by a passenger lift, which has adequate space for wheelchairs. The AQAA tells us that hand washing is provided in all areas of the home, including wash basins and alcohol cleansing solutions by the entrance and in communal areas for visitors and staff to use. The AQAA tells us that twenty one staff have undertaken training in the prevention and control of infection, and that staff are supervised with specific reference to hand washing and infection control. The six people living in the home who responded to our CSCI survey told us that the home is kept fresh and clean. One person wrote the home is always very clean. It always smells fresh ie no bad smells or lingering smells. All parts of the home which we visited were found to be fresh and clean. Manor Barn Nursing Home DS0000024175.V373906.R01.S.doc Version 5.2 Page 22 Manor Barn Nursing Home DS0000024175.V373906.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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. EVIDENCE: Four people living in the home who responded to our CSCI survey told us that staff were usually available when they needed them, and two people living in the home told us that staff were always available when they needed them. On the day of our visit the staff team was augmented by trainee nurses on placement in the home. One of the trainee nurses was talking to a resident and supporting him to do a puzzle. During our visit there were sufficient numbers of staff available to assist people with eating or cutting their food if they required that help. One member of staff we spoke to said a recent increase in staff numbers was helping ensure that people were receiving the help they needed with eating. Manor Barn Nursing Home DS0000024175.V373906.R01.S.doc Version 5.2 Page 24 While the home has a number of vacancies, it was evident during our visit that some of the people accommodated have very complex care needs which had necessitated the review of staff numbers which had been carried out. It was a requirement made at the previous inspection that the provider maintain a record of all persons employed at the care home (including temporary staff. The AQAA tells us that staff are only commenced after a POVA register check and two references have been obtained, and that until receipt of their CRB (with a clear record) the new staff member will be supervised in all their duties and not left with any client during this time. We looked at the staff recruitment records for three staff employed within the past year. We found that the required checks were being carried out and the required references were being obtained to ensure that staff are safe to work with the people accommodated. The AQAA tells us that if the home employs agency or temporary staff a profile with their training record, POVA and CRB certification is obtained before they commence work. The manager advised us that at present no agency or temporary staff are being employed in the home. The previous requirement concerning staff recruitment records was found to have been met. Staff records seen indicated that new staff were undergoing induction training to familiarise themselves with the care tasks and the home. We are told in the AQAA that the induction programme for new staff includes training in fire procedures, moving and handling, health and safety, and safeguarding vulnerable adults. During the induction period the service assesses the skills, experience and competencies of the new staff member and identify additional support and training they may need during their induction. During our visit one resident and a relative told us that it can be very difficult to communicate care needs to some staff due to their language difficulties, and that some staff have difficulty in communicating with each other. One example given was that when the person asked for their head rest to be adjusted a member of staff started moving the persons feet. We asked the manager what support was being provided for staff whose first language was not English. Manor Barn Nursing Home DS0000024175.V373906.R01.S.doc Version 5.2 Page 25 The manager advised us that some staff were undertaking English language courses. The manager acknowledged that some staff were not always able to follow instructions due to language difficulties and so the manager had been doing on the spot training such as manual handling with the staff concerned. We have made a requirement that staff who are in need of improving their communication skills have their needs assessed and that the provider puts in place arrangements to support them with these needs. Staff records seen during visit indicated that core training such as manual handling and protection of vulnerable adults was being undertaken by staff, as well as training in some of the conditions people in the home were suffering from such as Parkinsons disease. The manager advised us that specialist nurses in motor neurone diseases and Parkinsons had been offering support and guidance to the staff team. The AQAA advises us that the skills and experience of the staff team have been assessed, and that training in such areas as pressure relief, mouth care, eye care, infection control, making of beds, and safe moving techniques has been subsequently undertaken. The AQAA tells us that all staff are asked to undertake the National Vocational Qualification (NVQ) in care as part of their interview and recruitment selection process, and that once induction is completed they receive funding support for NVQ training. We are told in the AQAA that more than 50 of care staff have achieved NVQ in care at least at level 2 or an equivalent qualification, and that two care staff are commencing NVQ training. Manor Barn Nursing Home DS0000024175.V373906.R01.S.doc Version 5.2 Page 26 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have confidence in the care home because it is led and managed appropriately. 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. EVIDENCE: At the time of our visit, there had not been a manager registered with CSCI Manor Barn Nursing Home DS0000024175.V373906.R01.S.doc Version 5.2 Page 27 for the service since June 2008. The present manager has been in post since August 2008 and has applied for registration. During our visit the manager told us she renews her nursing registration annually and has been undertaking a diploma in palliative care. During this visit we found that improvements to the service introduced by the manager have included higher staffing levels, more people participating in activities, and the Liverpool Care Pathway has been introduced to support the palliative care being undertaken in the home. We also found that care plans are clearer in setting out how the persons needs are to be met and risk assessment procedures have been updated. One of the people living in the home wrote in their CSCI survey that the atmosphere in the home seems relaxed and pleasant and staff helpful. It was a requirement made at the previous inspection that the registered person establish and maintain a system for reviewing and improving the quality of care. The AQAA tells us that quality assurance is monitored by questionnaires being sent out six monthly as well as relatives and health care professionals who visit being asked to complete them during their visit. There are questionnaires available to fill in displayed in the foyer. During our visit we looked at the summary and conclusions after the most recent surveys had been carried out. The record of the residents and relatives meeting held on the 15th January 2009 indicates that the conclusions of the survey were advised and discussed in that meeting. One of the results of the survey was that 84 of people responding said that the service provided was good to excellent. The manager tells us that suggestions books in the foyer are checked monthly, and family and friends are welcome at the monthly residents meetings and feedback is given showing what has been done as a result of the meetings. The AQAA tells us that following comments from residents in the residents meetings the dining area and lounge have been refurbished with more dining furniture and new furniture has been purchased for the lounge. Manor Barn Nursing Home DS0000024175.V373906.R01.S.doc Version 5.2 Page 28 Menu changes have been made to meet clients wishes and preferences following residents meetings and general feedback from clients during meal times and family members commenting to both care, nursing and kitchen staff on issues relating to individual needs and preferences. We found that the previous requirement concerning quality assurance arrangements in the home had been met. The AQAA tells us that staff have regular supervision and are supported in their NVQ courses and assessments by senior staff. We looked at three sets of staff records and found that arrangements were in place for regular staff supervision to be provided. Staff supervision records we looked at indicate that these are assisting to review the member of staffs skills, abilities and training needs. The AQAA tells us that audits are carried out on accidents, pressure relieving equipment, and surveys, and that these are available to anyone who wishes to read them. The manager told us that environmental risk assessments in the home are carried out by the manager at the same time that domestic cleaning checks are being undertaken, and any hazards or risks identified are recorded in the maintenance book. Staff training records we looked at indicated that staff are receiving training in health and safety topics such as fire safety and infection control. The AQAA tells us that the home does not hold any money on behalf of people living there, and that relatives are invoiced to send payments for hair dressing, chiropody, and shopping. Manor Barn Nursing Home DS0000024175.V373906.R01.S.doc Version 5.2 Page 29 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 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 3 X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 X 3 Manor Barn Nursing Home DS0000024175.V373906.R01.S.doc Version 5.2 Page 30 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 OP30 Regulation 18.1(c) Requirement The provider must ensure that people employed to work in the care home receive training and support appropriate to the work they are to perform. This to include that staff who are in need of improving their communication skills have their communication needs assessed and that the provider puts in place arrangements to support them with these needs. Timescale for action 29/06/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Manor Barn Nursing Home DS0000024175.V373906.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone 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 Manor Barn Nursing Home DS0000024175.V373906.R01.S.doc Version 5.2 Page 32 - 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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