Care Home: The Barn

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What the care home does well People are able to make decisions about their daily life while using the service. People are supported to make choices and take risks during their respite. People are supported to maintain their daily routines and participate in activities which interest them and bring them to The Barn for respite. People are supported to maintain a health diet. People who use the service are able to say how they need and prefer to be supported. There is a system in place for ensuring people are supported in taking their medication. People stay in an environment that can meet their needs. The home is clean. Staff receive the training they need to do the job well. There is a quality assurance system in place which seeks the views of the people who use the service. What has improved since the last inspection? At the last inspection in December 2007 we made four recommendations. The service needed to think about how it stored confidential information and consult with the people who use the service, they did this and the information has been moved. The safeguarding policy needed to be updated, this has been done, so it accurately reflects the action to be taken. Recruitment practice had to be more robust exploring gaps in employment of prospective staff, this has been done. What the care home could do better: At the end of this inspection there are two requirements and one recommendation. It is important that people`s needs are fully assessed before they use the service to ensure that they know the home can meet their needs. People who are using the service must have a care plan in place which they have agreed to and details how their needs will be met. It is important that the registered provider consider the health and safety needs of staff who are lone working in the building at night. Key inspection report Care homes for adults (18-65 years) Name: Address: The Barn Holton Lee East Holton Holton Heath Poole, Dorset BH16 6JN     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Tracey Cockburn     Date: 1 4 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: The Barn Holton Lee East Holton Holton Heath Poole, Dorset BH16 6JN 01202631063 01202631063 barn@holtonlee.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): East Holton Charity Name of registered manager (if applicable) Mr Richard Alexander Fitzpatrick Type of registration: Number of places registered: care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users who can be accommodated is 4 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Physical disability (Code PD) Date of last inspection Brief description of the care home The Barn at Holton Lee offers accommodation for holidays, activities, retreats and relaxation for up to 10 people with a physical disability, although at any one time only 4 will require personal care. 4 rooms are registered with the commission. New accommodation has been built and includes single en-suite rooms. Family members, friends or carers can accompany guests and accommodation is provided to support this. Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 4 Brief description of the care home The Barn is a modern building set within 350 acres of varied landscape with views towards Poole Harbour. The building is fully wheelchair accessible and designed to meet the needs of people who have a physical disability. The house provides single or double room accommodation. Other facilities include adapted bathroom and toilet including overhead hoist in a shower room, mobile hoists, Apollo bath, alarm call systems and electrically operated beds. Communal areas consist of a resource room fitted with computers with internet access, lounge with TV, a sitting room and a large dining room. As well as the main kitchen where staff prepare the meals there is a guest kitchen for snacks and drinks. During the day people can use power chairs and scooters to go around the grounds, for bird and deer watching. At extra cost guests can book additional services such as counselling, reflexology, massage/aromatherapy and carriage driving. The home is not particularly close to community resources being in a rural area, however this is in keeping with the expectations of this service. Fees vary according to support needed. Care Homes for Adults (18-65 years) Page 5 of 27 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We visited the service without warning. We prepared for the key inspection by reviewing information in the annual quality assurance assessment sent to us. We sent survey forms out to people who use the service as well as health and social care professionals and staff who work in the service. We received two survey forms back from people who use the service, one from a member of staff and two from social and health care professionals. We talked to the manager and staff, we spoke to one person who has used the service for respite and we looked at recruitment, training and care files. Care Homes for Adults (18-65 years) Page 6 of 27 What the care home does well: What has improved since the last inspection? What they could do better: At the end of this inspection there are two requirements and one recommendation. It is important that peoples needs are fully assessed before they use the service to ensure that they know the home can meet their needs. People who are using the service must have a care plan in place which they have agreed to and details how their needs will be met. It is important that the registered provider consider the health and safety needs of staff who are lone working in the building at night. Care Homes for Adults (18-65 years) Page 7 of 27 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 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 Adults (18-65 years) Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is not always able to demonstrate that they can meet the assessed needs of individual receiving respite before the service is provided. The process has to be flexible but at the same time comply with regulations. Evidence: The annual quality assurance assessment says: 2. Guests either have a Care Managers assessment and/or an assessment which they complete themselves or are completed with them on or before arrival. 3. Guests are only accepted if their care needs can be adequately met, for example we do not provide a waking night service, so guests would not be accepted if they required assistance during the night. As we are registered only for 4 full assistance needs, no guest would be accepted if our quota was already full. People who use the service complete an assessment of their needs usually before they come into the home for respite but sometimes on the day they arrive. The manager told us that the assessment is not usually done on a visit to the prospective user of Care Homes for Adults (18-65 years) Page 10 of 27 Evidence: the service. The user or guest completes the assessment themselves, whilst this is very person centred giving the guest responsibility for stating their needs and how they must be met, it means the manager cannot be sure that a guests needs can be met until they come to the service for their respite. We looked at assessments for two people who use the registered rooms and receive support with personal care. One person had completed their own assessment which had arrived before they had respite. This assessment was very person centred written by the individual them selves and detailing how they prefer to be supported in some detail. there was no evidence that they had been sent a letter confirming the service could meet their needs. We looked at another assessment and it was unclear when it had been completed, possibly on the day the person came for respite, which would be too late to tell someone they could not meet their needs. The manager told us that most but not all guests come for a visit before they decide to have respite at the service. The manager also told us where people are using the service and are on direct payments there is no care management information. Care Homes for Adults (18-65 years) Page 11 of 27 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. Care planning is weak and does not provide information for staff on how people will be supported. Evidence: We looked at the care files of two people who have respite at the service in the registered rooms. We could not find an identifiable care plan, we could find assessment information which covers the areas of support a person needs and is signed by the person, so there is information for staff on how they need to provide support. However this was not a separate plan of their care needs. We acknowledge that there is information which is updated before a person uses the service which covers how their care needs are met and people are very positive about the care and support they receive, it is still important that a clearly defined care plan is in place. The manager told us that he reviews the information in the guests files before they come in. We looked at one risk assessment but this was not completed fully. However risk Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: assessments are completed before guests use any of the equipment in the service such as the golf buggies to move around the grounds. One person who uses the service wrote in their survey form under the heading, what does the home do well?: respect my privacy, dignity and I feel as it is my second home Care Homes for Adults (18-65 years) Page 13 of 27 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 are supported to participate in activities which interest them. Evidence: A health and social care professional wrote on a survey form under the heading what could the service do better? : offer guests more choice of activities and the support they might need to access them One person who uses the service wrote under the heading, what does the home do well?: allows us to do our own thing in a care free environment, within thew limits of my disability. This is exactly what I want! The annual quality assurance assessment says that they have listened to people who use the service and made the following changes to improve their experience: Menu changes are constantly reviewed to accommodate dietary and cultural requirements. Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: Provided mechanical devices such as golf buggies,Trampas to enable guests with disabilities to explore the 350 acre site safely. Enabled guests to make use of existing facilities such as print making,stone carving, artist studios, disabled carriage driving so that their visit may be enhanced and their abilities can be maximised. They tell us they are planning the following improvements: Further improvements such as landscaping and decking to existing Barn garden area to create wheelchair friendly seating space. One person who uses the facilities and was there were we visited found the service a very positive experience, we observed the staff making lunch for this person and fully involving them in making their own choices about what they ate as well as being mindful of their likes and dislikes. Care Homes for Adults (18-65 years) Page 15 of 27 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. There is information on individual health care needs but not clearly recorded in care plans. Evidence: The annual quality assurance assessment says: 18. All guests are treated as individuals and are in charge of their care routines which are documented before or on arrival. 19. Details regarding health care needs and concerns are recorded as part of the assessment, together with details of preferred action in the event of an emergency. 20. Medication is recorded for each guest, staff are trained in the care and handling of medicines and each guest room has a lockable medicine cabinet. There is a system in place for ensuring that when each guest comes in for respite their current medical situation is detailed including what medication they are currently on and whether or not they have enough for the duration of their stay this is then clearly documented with the amount brought in and the amount they leave with. Each guest who uses a wheelchair has an assessment on arrival of their skin and this is documented and signed by the guest and the staff. Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: Although this information is clearly recorded in each persons file there is no clear care plan containing all this information for staff. It should be noted that people who use the service are able to inform staff of their needs and preferences Care Homes for Adults (18-65 years) Page 17 of 27 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. There is a system in place for listening to peoples concerns which should always be followed to ensure that people can be confident they will be heard and their concerns acted upon. Evidence: A survey returned by a social and health care professional said under the heading what could the service do better?: listen and act on feedback from guests and staff When guests complete a stay at The Barn they complete a comments book and are asked for feedback on an evaluation form. The manager told us that if there are any concerns raised in the evaluation form he writes to guests. The manager should consider that these worries and concerns should be handled as complaints and use the services own procedures. There has been a safeguarding investigation since the last key inspection and recommendations were made for the service to act on. The manager said that one issue they did get wrong and would ensure it did not happen again. Guest wrote in the comment book: Staff helpful and friendly wonderful restful week being so well looked after I have had yet another brilliant respite at Holton Lee Care Homes for Adults (18-65 years) Page 18 of 27 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 are supported by a service which is equipped to meet their needs. The home is clean. Evidence: A member of staff wrote in a returned survey form under the heading what could the home do better?: it could be better by upkeeping of the building and have a handyman to keep up with the little jobs that go by the way side We looked round the building and found the rooms to be spacious with en suite facilities. There is a seating area by patio doors and there are sculptures around the building for people to appreciate. The building was warm and clean. The respite rooms are neutrally decorated. All four respite rooms which are registered with the commission have over head tracking hoists in place. Care Homes for Adults (18-65 years) Page 19 of 27 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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 who work in the service are properly recruited and training to ensure people using the service are protected. Evidence: Training in January 2010 for all staff covers the mandatory training. Manager attends learning hub meetings and is introducing other training for staff. The annual quality assurance assessment tells us that: Cleaner employed to concentrate on excellence in house keeping. We looked at the recruitment file for one person employed since the last inspection. the Criminal Records Bureau check was satisfactory and returned before they started work in the service. The ISA vulnerable adults barred list had also been checked and was clear. We found one written reference and on verbal with the written one following after. Both written references were date stamped when they came into the office. Induction training had been completed. The manager told us that there is an information file for staff on medical conditions which gives them additional information on the needs of people who use the service. Seven of the eight permanent staff have NVQ at level 2 or above. Care Homes for Adults (18-65 years) Page 20 of 27 Evidence: We were told by staff that they have expressed their concerns a number of times about lone working late at night in such an isolated spot, there have been occasions when people possibly poachers have been near the building. Staff tell us this worries them. Care Homes for Adults (18-65 years) Page 21 of 27 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 service has the potential to be well managed by someone experienced in the health needs of people who use the service. Evidence: The new manager has completed the registration process and is now the registered manager,he has management experience in the health care service and clear understanding of the short falls in the service particularly around care planning and assessments. All staff who work in the home have received and are receiving training in safe working practices such as moving and handling, infection control, first aid, fire safety and food hygiene. One person who uses the respite service is on oxygen during the night. The manager told us there is not a warning sign that can be put on the door of their room. We looked at fire records and found they were up to date. There is a fire risk Care Homes for Adults (18-65 years) Page 22 of 27 Evidence: assessment in place. The lift and hoists have been serviced in the last two months. Care Homes for Adults (18-65 years) Page 23 of 27 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 Adults (18-65 years) Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 2 14 The registered person shall 31/03/2010 not provide accommodation to a service user at the care home unless so far as it shall have been practicable to do so there has been appropriate consultation regarding the assessment with the service user or a representative. the registered person has confirmed in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the service users needs in respect of his health and welfare. People must only be offered a service once the home is sure through the assessment that their needs can be fully met. 2 6 15 The registered person shall after consultation with the 26/02/2010 Care Homes for Adults (18-65 years) Page 25 of 27 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 service user prepare a written plan as to how the service users needs in respect of his health and welfare are to be met. To ensure that peoples needs are met according to the information in their assessment there must be a record of how this will be done. It is also necessary to ensure that staff are clear on the support each individual needs. The person themselves must be in agreement with the plan. 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 1 42 The registered provider should consider how staff are protected when working alone at night. Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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