Care Home: St Barnabas Residential Home

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What the care home does well The home offers a good level of accommodation, which is domestic in nature, and kept clean and odour free. The management is committed to working in the best interests of the people living at the home, and ensuring staff receive the training and support to be able to provide a good level of care. The St. Barnabas (Charity) management Committee play a very supportive role at the home, which includes spending time with the residents, and asking their views on the service provided. The care plan, which gives staff guidance on how a resident wishes to be looked after. Residents told us that they like the staff, and complimented the friendly atmosphere, "it`s as if it`s my family". Other comments included "treated well", "marvellous here very lucky - well looked after", "very fortunate with our Chef", "allowed to do what you want" and they are "not just carers - their our friends". A relative told us that they are "very happy, satisfied with the care". What has improved since the last inspection? The home has continued with their on-going refurbishment programme, giving residents a larger dining room/lounge area, and new conservatory. The home has addressed the shortfalls we identified during our last inspection with their medication system, by keeping accurate records of all the medications residents are taking. They have also purchased a separate cabinet to store controlled drugs securely. The home has continued to consult with residents to offer a range of social activities and outings to meet people`s individual choices and interests. What the care home could do better: Prior to starting staff in the home, they must ensure that they have obtained all the required recruitment information, to be able to evidence that the person is suitable to look after the residents. Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Barnabas Residential Home The Common Godyll Road Southwold Suffolk IP18 6AJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jill Clarke     Date: 0 9 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: St Barnabas Residential Home The Common Godyll Road Southwold Suffolk IP18 6AJ 01502722264 01502726045 st-barnabas@tiscali.co.uk 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) : St Barnabas Southwold care home 13 Number of places (if applicable): Under 65 Over 65 13 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 St. Barnabas is set in the residential area of Southwold, a short walk from the town centre, with its range of amenities. These include beaches, shops, restaurants, coffee shops, banks and post office. Public transport links include a bus service from Southwold, which connects with the railway station at Halesworth. The large house, built on the site of an old windmill has 3 floors, which residents can access by a very small lift or stairs. Due to the limited space in the passenger lift, not all people who use a wheelchair can be accommodated on the first floor. All 13 bedrooms have their own wash hand basin, 3 also have en-suite toilets. Communal toilets and bathrooms are situated close to bedrooms, which are located on all 3 floors. Communal areas consist of a dining room/lounge, lounge (drawing room), Care Homes for Older People Page 4 of 30 Brief description of the care home conservatory, and enclosed porch area at the front of the home. There is an enclosed courtyard, and gardens which face out to the Common and sea front. There is off road parking at the side of the home, with further public car parking available, a short walk away. The is a non smoking home. Costs per calendar month range from £1,736 to £1,952 depending on size of room, and if it has en-suite facilities. Fees cover accommodation, care and meals. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We (The Commission) visited the home unannounced to carry out a key inspection, where we focused on assessing the outcomes (see bar chart above) for people living at the home, against the Key Lines of Regulatory Assessment (KLORA). In undertaking this, it helps us get an idea, from a residents viewpoint, on what it is like living at the home, and gain feedback on the level of care they receive. The report has been written using accumulated evidence gathered before, and during the inspection. We last inspected the home on the 18 April 2007. A Selection of our surveys were sent to the home in October 2008 to give out. This gives an opportunity for people using, working in, and associated with the service to give their views on how they think it is run. At the time of writing this report we had Care Homes for Older People Page 6 of 30 received surveys back from 3 residents, 2 relatives, 2 health care professionals (Practise Manager and Pharmacist) and 3 staff. Comments from which have been included in this report. Prior to the inspection the home was asked to complete an Annual Quality Assurance Assessment (AQAA). This provides us with information on how the home is meeting/exceeding the National Minimum Standards. It also provides us with any planned work they are intending to undertake during the next 12 months. Comments from which have also been included in this report. We spent time talking to 3 residents in the privacy of their bedrooms, as well as gaining general feedback whilst meeting residents during the day, which included joining in with a reminiscing session. We looked at a sample of records held at the home which included care plans, staff recruitment paperwork, minutes of meetings, training records, menus, incident forms and medication administration records. By doing this we can see whether staff are keeping their records up to date, and reflect current practise, to ensure the safe running of the home. Everyone we met during the day (residents, staff, and visiting relatives) was very helpful and participated in the inspection by giving us feedback and providing information when asked. People living at the home prefer to be described as residents; therefore this report reflects their wishes. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect to be invited to visit the home, and be given sufficient information, to support them in deciding if St Barnabas is able to offer the level of care, and accommodation they are looking for. Evidence: Feedback from residents surveys, confirmed that they had been given enough information about the home, before they moved in so they could decide if it offered the level of care and environment they were looking for. Comments included my daughter visited other homes in the area and found this to be by far the very best. Time spent speaking with residents, identified that they had either knew of, or had visited the home before, as they came from the area, or their next of kin had visited first on their behalf - especially if they were moving back to the area. The home can also offer Day Care, which supports people in getting to know what the home is like. Care Homes for Older People Page 10 of 30 Evidence: The homes AQAA tells us that trained staff complete a pre-assessment on all prospective residents, which enables them to meet the person and discuss their care needs. By doing this, staff tell us they can get to know the person, make sure they are able to offer the level of care, and environment they are looking for, and if they decide to move in, support them to fit effortlessly into the home, by reducing any anxiety the person may have prior/during the move. They also ensure that they do not accept any new residents unless they fall within their registration category (frail older people), and are confidant their staff have the required skills and training to care for them. Staff surveyed, when asked do they feel they have the right support, experience and knowledge to meet the different needs of the people living at the home, all replied always. We looked at a recently completed pre-assessment, which had been undertaken prior to the person moving in, which gives an overall assessment of their general health and well-being. We spent time talking to a new resident who confirmed that they had visited the home the family brought us, and had spoken with staff, prior to deciding if to move in or not. They were very positive about the move and felt it was like coming to a second home - so thankful to get in. They felt staff treated them well, and their needs were being fully met, telling us that they were getting their strength back since moving in - which they put down to the support they had been receiving. We also met another resident, who was staying at the home, whilst they decided if the time was right, for them to move into residential care permanently. Relatives completing our survey also told us that the home is always able to meet peoples needs. This reflected the feedback we received from visiting health professionals, who told us that staff look after their charges, and residents seem very happy. Care Homes for Older People Page 11 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to be treated with respect, be consulted on how they wish to be looked after, and have their health care needs monitored. Evidence: Residents surveyed, when asked if they received the care and support they need, 2 replied always, and 1 usually (occasionally staff not available to answer questions). Each resident has a care plan, and during this visit we looked at 2 in detail. The care plan gives staff guidance on the level of support and care the resident is requiring, in each aspect of their life. For example information given in the daily living section of the care plan includes, personal care and physical/mental well-being, communication, mobility and dexterity, personal safety and risk assessments, diet, religious observance, daily living and social activities. We identified on 1 of the 2 care plans, although informative, staff could have given more information on what the person is able to do for themselves. By giving more detailed information on what a person can do, to ensure staff do not take over, by Care Homes for Older People Page 12 of 30 Evidence: undertaking tasks for residents, which they are able to do themselves. By doing this, staff are supporting people to maintain their independence. Discussions with the manager, identified that they felt staff do undertake an enabling role, but because they know the residents so well, and that peoples needs vary from day-to-day, it may not always be written in the care plan. We asked a resident, if when staff help them with their personal care, do staff ensure their privacy and dignity during this time, so the resident was not left feeling embarrassed. We were told yes they know what I can do for myself - leave you for 5 minutes (when bathing) so you can have some privacy, theyre very sensitive. We spent time talking with a resident, and with their permission, we went through their care plan with them. This enabled us to identify if the level of information given in the care plan reflected the level of support the resident told us they were receiving, which it did. The use of daily communication sheets also ensures that staff keep each other updated, on any issues arising or affecting the residents welfare. For example the care plan showed when the person had visited/been seen by a health care professional and the outcome of that meeting. Information contained in residents care plans also showed that staff are constantly monitoring residents physical and mental health. Where applicable it showed where they had contacted/liaised with Health Professionals to alert them of the changes, so they could receive the appropriate treatment. When the staff have concerns, relatives told us staff communicate with them and let them know what is going on. Comments from 1 relative who talked to us during the inspection, further evidenced the positive work undertaken in this area telling us they were very happy and satisfied with the care being provided, and the way staff have been able to adapt to their next of kins changing needs well. Staff surveyed confirmed that they are always given up to date information about the residents needs, to support them in knowing the level of assistance to give. Information supplied in the care plans, and discussions with management confirmed that they regularly look at whats written in the care plan - to ensure it reflects residents current needs. We spoke with 3 residents in the privacy of their bedroom, to hear what they felt about the standard of care they receive. Comments included staff are always asking if I am alright, treated well, read some real horror stories about some places - but not here - feel safe with them and marvellous here very lucky - well looked after. In October 2008, the home had a visit from the National Health Service community Care Homes for Older People Page 13 of 30 Evidence: pharmacist, who looked at the homes systems for the safe storage and administration of medications (including controlled drugs). A report of their findings was sent to the home, with information on areas they needed to address. This included storing controlled drugs in a suitable cupboard (which we had also mentioned in our last report), and liaising with their local pharmacist to ensure that they use one system for supplying controlled drugs to the home. The Manager has now addressed the issues brought up in the report, which included buying a new cabinet to safely store controlled drugs in, which we were shown. We checked the amount of controlled drugs held for 1 resident, to ensure that it agreed with the amount that the home said they were holding, which was correct. The inspection of their medication systems by the community pharmacist (which covers the same arise we looked at), showed no other problems in the way the home is handling medications, therefore we did not look at their systems any further. However, we did ask a resident if they always received their medication at the time they should receive it, and where there any occasions that staff had been unable to give them their tablets. They said there was no problem - always have them there and ready - staff are good like that. Care Homes for Older People Page 14 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to be able to choose their life style, social activity and be supported to keep in contact with family and friends. Residents are offered a healthy, varied diet, which meets their individual choices and cultural needs. Evidence: Residents (3) choosing to complete our surveys prior to this inspection, when asked if there are activities arranged by the home that they can take part in, 1 replied always, 1 usually, and 1 sometimes. When we visited (unannounced) there were different activities taking place during the day, which included a communion service and reminiscing. We were invited to join 5 residents during their reminiscing session, which due to our visit, involved retired teachers saying how they felt when their school was being inspected. The session also enabled us to talk about our role, and explain part of it includes writing a report, so people who dont know the home, can gain an insight of what it is like living there. When we asked what they would say to people interesting in moving in, their comments included if you have to be in a home - this is as good as any, allowed to do what you want, quite free to come in and out, food is good, home runs smoothly and can trust staff to help you. Care Homes for Older People Page 15 of 30 Evidence: Further discussions with the residents in the lounge, and during 1 to 1 meetings with residents in their bedrooms, showed that staff organise a range of social activities, which people can join in with, if they wish. Some residents liked joining in with group activities, and others preferred to spend time on their own, in the knowledge that they could always join the others for company if they wish. Discussion with 1 resident showed that they were being supported to continue their artwork, and play their musical instrument. The AQAA informs us that residents feedback shows that they enjoy the social integration and the activities offered. They go onto tell us residents say they like being involved in the choices of activities, such as reminiscence groups, hymns and prayers, musical groups and concerts, social meal times with drinks beforehand to name but a few. Residents are encouraged to be part of the community, which included trying to catch a glimpse of HRH Prince Charles and Camilla during their visit last summer to Southwold, going on a mystery tour to Lowestoft, and attending the local church fete and fund raising events. During the better weather staff are also looking to make more use of a local mini bus, for those residents who would like to get out a little more. Whilst talking individually to residents, we asked their views on the meals provided, and if they are offered plenty of drinks during the day. Comments included reasonable enough, bacon and eggs by special request, very fortunate with our Chef - if someone doesnt like what is on the menu - they will put them-self out . Residents told us that at meal times staff will sit alongside - sit and encourage people to eat as staff wouldnt let people not eat. When we joined residents in the dining room, they had just finished their Sheppards Pie and fresh vegetables, and were being offered a choice of Baked Custard, fruit and ice cream from the dessert trolley which staff were taking round. The atmosphere we found to be relaxed, and unrushed. Care Homes for Older People Page 16 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect their concerns to be listened to, and staff to take appropiate action to resolve them. Evidence: The homes AQAA tells us that their complaints procedure is simple, clear and user friendly. They also told us that the complaints procedure is displayed for all to see in many areas of the home and that it is given to all new residents and updated and circulated as necessary. Residents surveyed, told us that they knew who to speak to if they are unhappy with the level of service they receive. This reflected our findings during the inspection, with 1 resident telling us that they will go and tell Wendy (Registered Manager), she listens - she would hate to think anyone being unhappy. A relative also told us they knew who to complain to, then adding but not applicable, as the situation hasnt arisen. Information given in the AQAA showed that the home had dealt with 2 complaints during the last 12 months, 1 concerning the Sunday tea-time service, and another over communication, where a resident said they had not been informed that an activity was taking place. Both had been responded to quickly and appropriately. The home records any concerns they receive in a complaints and niggles book, which gives Care Homes for Older People Page 17 of 30 Evidence: detailed information on when the complaints were received and action taken by staff. Positive practice undertaken at the home to ensure residents voices are being heard, is by having a member of the committee undertaking the role of residents advocate. Their role is to visit residents, to gain their views on the level of care being provided, and if any residents raise any issue, with their permission pass these onto the management to deal with. They can also help with any other issues that require an advocate. The AQAA tells us new staff members receive POVA (Protection of Vulnerable Adults) when they first start working at the home, as part of their induction. Then to ensure staffs knowledge on safeguarding, to protect the welfare of the people they care for is kept up to date, they also undertake refresher training each year. Staff surveyed all replied yes when asked if they know what actions to take if a resident or visitor has any concerns about the home. Discussions with the manager and information given in the AQAA, showed that they are aware of the Mental Capacity Act and Deprivation of Liberty safeguards, and are still at a point of organising training within the home, and looking to see how it will be incorporated into their care plans and practises. This will further ensure that staff are always working in the best interests of the residents, and when needed, knowing who to contact to advocate on a residents behalf. Care Homes for Older People Page 18 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect a homely, comfortable, clean environment which is well maintained, and set in a pleasant location. Evidence: The AQAA tells us that St. Barnabas is a very friendly, warm, cosy looking home with an ambiance to match, they go on to tell us that the home is free from offensive odours and policies are in place to control any possible infection. This matched the feedback we received from residents who we surveyed (who told us the home is always kept fresh and clean), and met during the inspection. Since we last visited the home, a lot of work has been undertaken, to enhance the residents living areas. This includes new carpets, refurbishment of the dining room /lounge, and a new conservatory, which offers a more space (especially for communal activities) and light. During our visit these areas were in constant use, as residents met up for lunch, took part in communion and reminiscing activities, or watched the new large flat screen television before tea. The conservatory offered a quiet place where residents could spend time with their visitors. Residents and staff told us about further work happening at the home, which would be starting within the next few weeks - to make their existing lift bigger so it will accommodate a wheelchair user, and a member of staff. The home is also looking to Care Homes for Older People Page 19 of 30 Evidence: see if they can increase the number of en-suite rooms as part of their refurbishment plan. Staff have worked hard to ensure that any disruption to the residents whilst the work is being carried out, will be kept to a minimum. This is by consulting fully with the residents, and keeping them up to date with the work timetables. The home has also purchased a stair climber, which staff have been trained to use, to support residents getting up and down stairs, if needed during this time. It will also be used as part of their fire safety procedure, if they ever needed to evacuate residents in the case of a fire. The AQAA tells us that all fire risks and checks are made routinely. Whilst walking around the home, the contract maintenance labels on fire extinguishers (3/09), showed that they are being regularly serviced to keep them in good working order. The manager also told us that on-going fire risk assessment which involves looking at the whole home yearly, then in between this as needed, for example in preparation for the lift being out of action. Time spent talking to residents in their bedrooms, confirmed that they found their rooms comfortable, and met their individual needs. A new resident had been supported by staff to personalise their bedroom, which included lots of family photographs on the walls, and other items of memorabilia, which led to interesting discussions about the persons life and hobbies. When we asked a resident if the temperature of their bedroom was alright, they replied yes and that they were quite warm enough. We also asked if they had anywhere in their room, where they could lock their valuables away, and were informed that staff were going to give me a little safe. The manager confirmed as part of their infection control policy, soiled continence pads are put into trade waste, and any soiled dressings are taken away by the district nurses. They went on to say that they have had a lot of contact lately with the Waveney PCT, regarding infection control procedures within the home, as they want consistency across the region. The way the Primary Care Trust (PCT) group want to ensure this is happening, is by providing/ funding training for 5 members of staff from St Barnabas. They are hoping by offering this training across the region, staff will be following the same safe practise across all the care homes. Residents told us that they are spoilt by the location of the home, with having the common on their doorstep, and the beach and shops located a short walk away. Care Homes for Older People Page 20 of 30 Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to fill the aims of the home, and meet the changing needs of the current residents. The home is not always following safe recruitment procedures, which could potentially put people at risk. Evidence: Residents surveyed in response to being asked are the staff available when they need them, 2 replied always, and 1 usually. This reflected exactly (2 always and 1 usually) the staffs response when we asked them if they felt there is enough staff on duty to meet the needs of all the people living at the home. A member of staff told us very occasionally a short lived event occurs where an extra person to help would be good. But such an event lasts less than half an hour and so rarely therefore extra staff could hardly be justified. Residents we met, felt staff work hard and can be very busy at times, but no residents we spoke with, or surveyed, raised any concerns that their care and social needs were not being fulfilled. The manager said that when they foresee extra auxiliary care may be required to support a resident returning from a stay in hospital, to undertake an activities session, or if they have a planned outing (1 to 1 or group), they will arrange for extra people to come in for a short period of time to give the extra staffing cover needed. They felt this arrangement offered more flexibility to support individual residents needs. Care Homes for Older People Page 22 of 30 Evidence: In their AQAA the home had not provided us with any information (in the staff section), on how they are ensuring residents are being protected by the homes recruitment policy and practises. To check that the home is following safe recruitment procedures, we looked at 2 new staffs personnel files. We found that the home had not fully addressed a shortfall we identified during our last visit, as there was a gap in 1 of the staffs employment history. We also noted that the home had started a carer before they had checked to ensure that the person was allowed to work with vulnerable people. The staff rota identified that they had worked 4 shifts (2 supervised as part of their induction, 2 unsupervised) prior to the home receiving confirmation that the person is able to work with vulnerable people. We also pointed out to the manager, that due to only having 1 member of staff on nights (as the second sleeps in on-call), they would be unable to evidence that they are appropriately supervising staff, whilst awaiting their CRB clearance. The manager confirmed that it was their policy not to start staff before the required checks had been undertaken, and gave assurance it would not happen again. For the second member of staffs file we looked at, all the checks on the persons identity to confirm that they are who they say they are, and allowed to work with vulnerable people - had been carried out. The management had taken steps to validate some of the staffs previous employment, working in care settings, but not all. We discussed with the manager that could have difficulties why staff had left previous jobs working with vulnerable people, because the application did not ask for this information. The manager said that they would be reviewing their application form, so they can ensure that prospective staff are given sufficient space, to list all their previous employment and give the reason why they left. The home had obtained written references for both staff prior to them starting work, and they had also been given a Job Description, so they know what is expected of them. When we asked in our staff survey, did your employer carry out checks, such as your CRB and references, before you started work, all 3 had replied yes. Staff also told us that their induction mostly (1) or very well (2) covered everything they needed to know to do the job when they started. New care staff undertake the Skills for Care induction, which includes how to assist residents safely with their mobility, and following hygienic practises to reduce the chance of any infections being passed on. All new staff as part of their induction also undertakes shadow shifts, where they work extra to the normal staffing level alongside an experience carer. During this time they are asked to complete a work booklet, which helps them develop their knowledge of the running of the home, and where essential equipment and paper work is stored/held. For example staff are asked Care Homes for Older People Page 23 of 30 Evidence: to walk around the home, locating and listing the location of all the fire extinguishers, call points and exits, so they can be quickly found in an emergency. A carer told us when I started I was new to care so it took several weeks to absorb all the information. Staff surveyed also told us that they are being given training which is relevant to their role, helps them understand and meet the needs of the residents, and keeps them up to date with new ways of working. The AQAA tells us (at the time of completing March 2009), out of the 13 care staff, 10 hold a National Vocational Award (NVQ) at level 2 or above, with a further 2 staff working to-wards obtaining the qualification. They also told us that domestic and kitchen staff are afforded the same opportunities of training in the appropriate areas. The staff files we looked at showed that they are being supported by the home to develop their knowledge, by being able to access a range of training courses. When we asked a resident if they felt the staff had the right skills and knowledge to support them, they said yes and that staff always seem to be updating their skills. A relative also praised staffs abilities, saying they are very happy and satisfied with the care and felt staff have been able to adapt to (their next of kins) changing needs well. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Manager, staff and the St. Barnabas committee members are committed to working in the best interests of the residents, to ensure they receive a good standard of care, within a safe environment. Evidence: The Registered Manager Mrs Wendy Clack, as with previous inspections, was very helpful throughout the day, providing information when asked. When we fed back the shortfalls we had identified in recruitment (see staffing section) they reacted positively, looking at ways they could ensure it did not happen again. Residents described the manager as approachable, and a good listener and felt confident in her abilities to manage the service. Staff told us that they meet regularly with the manager, and feel supported. Paperwork held on file showed that staff are receiving regularly 1 to 1 supervision, which enables them to discuss any practise issues, and gain feedback on their performance. Care Homes for Older People Page 25 of 30 Evidence: During our inspection we did identify 1 management shortfall in-respect of starting a new member of staff on nights, without undertaking the required checks to confirm they are able to work with vulnerable people, and that they are supervised on shifts until their full CRB clearance comes back. Reassurances were given by the manager that the the incident of starting the person without the appropriate checks was a mistake, which they will ensure does not happen again. New staff on night shifts will also not work unsupervised, until their full CRB clearance is through. Residents told us they liked the friendly and family atmosphere. Health professionals surveyed, when asked what the home does well replied very homely residents seem very happy, and that it is an excellent caring facility. Time spent talking and sitting with residents and staff through the day, showed that people interacted well together, in a relaxed happy atmosphere, summed up well by 1 resident who told us we can have a giggle here. Residents also commented on the good work undertaken by the St Barnabas charity trustees management committee who are closely involved with the running of the home. Residents told us that the committee members will come round and get to know you. A nominated committee member undertakes the regulatory role of Responsible Individual, whose duties include visiting once a month, unannounced, to gain a view of the day-to-day service being provided, and write a report of their observations. We have always found the information given in the regulation 26 reports very informative, and gives a good pen picture of what is happening in the home at the time of their visit. This includes feedback from the residents (normally everyone in the home at the time) and staff they have spoken with, records they have looked at, state of the environment and any matters arising which could affect the welfare of the people living and working in the home. Discussions with the manager, residents, and looking at records (minutes of meetings, regulation 26 reports) held at the home, shows that residents are being regularly consulted over the running of the home. For example, if not handled right the refurbishment work could have caused a great deal of upset to the residents daily lives. Instead, by ensuring good communication, there has been minimal disturbance to the residents well-being. Minutes of a residents meeting held in October 2007, following the first major phase of the building work, it states that residents congratulated the team of builders who had worked with the minimal noise and fuss. Information supplied in the AQAA shows that the home is always running to full occupancy, and that they have a waiting list of the towns residents who would prefer to come here if ever the need arises. As a registered charity, the AQAA tells us that they plough all monies back into the business to make necessary improvements. Care Homes for Older People Page 26 of 30 Evidence: Discussions with the manager, and minutes of a committee meeting also evidenced that they are financially viable, and have built up monies through fund raising. Discussions with the manager confirmed that they have not changed their procedures, which we looked at last time, for the recording, and storage of money residents have asked them to hold in safe-keeping. Due to not finding any problems last time, and confirmation that they are using the same system, we did not individually check any monies held against the homes records during this visit. The home has policies and procedures in place, which gives staff guidelines on safe ways of working, which the AQAA shows are being kept updated. The AQAA informs us that all legislation is checked, up-dated and complied with when necessary. However, we found that not all policies and procedures are being checked yearly, with 2 having not been reviewed for 3 years. By doing this the home is evidencing that they are checking that the guidance they are giving to staff is up to date. The home is ensuring that any equipment used (such as hoists and fire alarm systems) are being serviced and kept in good working order. They have also identified a located close by, where they could evacuate residents to safety, if ever a serious incident such as a flood or fire happens at the home. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 30 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 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 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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