Care Home: The Barn

Similar services:

• Clover House
• Parkside
• Park Lodge
• Mere Hall View
• St Bonaventures
• Hudson Road
• Whitewalls
• Home Farm

What the care home does well People were given useful information about how they would be looked after at The Barn; it was easy to read so that everyone could understand the information. All residents had an individual plan that contained lots of useful information about what they liked or disliked and what help they needed to be independent and safe; this would help to make sure they got the care they needed and wanted. Residents said they could make choices and decisions and said staff listened to them and respected their decisions; this made sure that residents could lead the life they wanted. The person in charge made sure residents had a say in how the home was run. Staff made sure that there were lots of different things for residents to enjoy both inside and outside the home; this helped to make their lives more interesting. The residents helped to plan the meals; some residents helped to shop for the food and make the meals. One resident said `the food is good we can have what we want` another said `I really like the meals`. Residents had a member of staff or a `key worker` who would give them special attention and support and make sure they were happy. The Barn DS0000073094.V376068.R01.S.doc Version 5.2 Staff had been told how to look after and protect residents and how to keep them safe from any harm. Residents knew who to speak to if they were upset or angry about something. Residents said they were happy living at the home and would be happy to speak to staff if they were unhappy. One resident said `I am happy here and would tell someone if I wasn`t`. The Barn was bright, clean and well looked after; there were no funny smells around. The furniture was comfortable and residents were able to bring in their own belongings and to choose how their rooms were decorated. Rotas showed that there were enough staff during the day time hours; residents also said there were enough staff, one said `I like the staff, there are enough to look after us properly`. Staff said they worked well together. The person in charge had made sure that new staff were alright to work at The Barn; residents had also helped to decide whether new staff should work there. The person in charge made sure staff knew how to look after residents properly and how to keep people safe. What has improved since the last inspection? This does not apply as The Barn is a new service. What the care home could do better: Residents and staff should be given a contract with the new organisation; they needed this information to make sure they knew what the rules were. There should be records to show what residents had eaten at every meal; this would help to show that residents were getting enough to eat. Rotas showed there was only one care staff to look after everyone during the night; we were worried that one member of staff would not be able to keep everyone safe if anything were to happen. We asked the people in charge to look at this situation to make sure everyone was safe. The person in charge needs to make sure that all new staff were given the training they need when they first start work; this would make sure they knew what to do and how to keep people safe.The BarnDS0000073094.V376068.R01.S.docVersion 5.2 Key inspection report CARE HOME ADULTS 18-65 The Barn 241-243 Leyland Lane Leyland Lancashire PR25 1XL Lead Inspector Mrs Marie Matthews Key Unannounced Inspection 1 September 2009 09:30 st The Barn DS0000073094.V376068.R01.S.doc Version 5.2 Page 1 This report is a review of the 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. 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 home adults 18-65 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. The Barn DS0000073094.V376068.R01.S.doc Version 5.2 Page 2 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 The Barn DS0000073094.V376068.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Barn Address 241-243 Leyland Lane Leyland Lancashire PR25 1XL 0151 651 1716 0151 652 6037 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) Potensial Limited None registered Care Home 12 Category(ies) of Learning disability (12) registration, with number of places The Barn DS0000073094.V376068.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only- Code PC To people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability- Code LD The maximum number of people who can be accommodated is: Date of last inspection New Service 12 Brief Description of the Service: The Barn is a care home providing 24-hour accommodation for up to 12 adults who have learning disabilities. The Barn has recently changed ownership and is now part of a national organisation called Potensial. The Barn, which was originally two houses, is situated in a residential area of Leyland and close to the town centre and all local amenities. Car parking is available on the road to the front of the home and there is an enclosed garden area to the rear. Accommodation is provided on two floors although there is no lift access. All bedrooms are single rooms, one of which has en suite facilities. The home is domestic in character providing comfortable accommodation for the people who live there. Information about the services that the home offers is provided in the form of a service user guide and is available, with a summary of the most recent inspection report, to existing and prospective residents and their relatives. On the day of the inspection the weekly fees ranged from £530.50 to £1183.55. Residents pay additional charges for hairdressing, personal items and some outings. The Barn DS0000073094.V376068.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 key unannounced inspection, including a visit to the home, took place on 1st September 2009. The inspection process included looking at records, a tour of the home, discussions with the manager and a senior manager from the organisation, three care staff and three residents who lived in the home. Information was also included from survey forms filled in by four residents and two care staff. We were also sent the annual quality assurance assessment (AQAA) before the inspection visit; this gave us a good picture of the current situation in the home and where further improvements were needed. There were ten residents living in the home on the day of the inspection. What the service does well: People were given useful information about how they would be looked after at The Barn; it was easy to read so that everyone could understand the information. All residents had an individual plan that contained lots of useful information about what they liked or disliked and what help they needed to be independent and safe; this would help to make sure they got the care they needed and wanted. Residents said they could make choices and decisions and said staff listened to them and respected their decisions; this made sure that residents could lead the life they wanted. The person in charge made sure residents had a say in how the home was run. Staff made sure that there were lots of different things for residents to enjoy both inside and outside the home; this helped to make their lives more interesting. The residents helped to plan the meals; some residents helped to shop for the food and make the meals. One resident said ‘the food is good we can have what we want’ another said ‘I really like the meals’. Residents had a member of staff or a ‘key worker’ who would give them special attention and support and make sure they were happy. The Barn DS0000073094.V376068.R01.S.doc Version 5.2 Page 6 Staff had been told how to look after and protect residents and how to keep them safe from any harm. Residents knew who to speak to if they were upset or angry about something. Residents said they were happy living at the home and would be happy to speak to staff if they were unhappy. One resident said ‘I am happy here and would tell someone if I wasn’t’. The Barn was bright, clean and well looked after; there were no funny smells around. The furniture was comfortable and residents were able to bring in their own belongings and to choose how their rooms were decorated. Rotas showed that there were enough staff during the day time hours; residents also said there were enough staff, one said ‘I like the staff, there are enough to look after us properly’. Staff said they worked well together. The person in charge had made sure that new staff were alright to work at The Barn; residents had also helped to decide whether new staff should work there. The person in charge made sure staff knew how to look after residents properly and how to keep people safe. What has improved since the last inspection? What they could do better: Residents and staff should be given a contract with the new organisation; they needed this information to make sure they knew what the rules were. There should be records to show what residents had eaten at every meal; this would help to show that residents were getting enough to eat. Rotas showed there was only one care staff to look after everyone during the night; we were worried that one member of staff would not be able to keep everyone safe if anything were to happen. We asked the people in charge to look at this situation to make sure everyone was safe. The person in charge needs to make sure that all new staff were given the training they need when they first start work; this would make sure they knew what to do and how to keep people safe. The Barn DS0000073094.V376068.R01.S.doc Version 5.2 Page 7 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. The Barn DS0000073094.V376068.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Barn DS0000073094.V376068.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5. 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 and their representatives were given enough information to help them determine whether their needs would be met. EVIDENCE: The information about services available at The Barn was clear, made available to residents and their relatives and in alternative formats; this would ensure everyone could understand the information. Residents said they were given enough information about the service. The use of advocates to support residents was encouraged; advocates could help residents with decisions in the absence of relatives or friends. There had been no new service users since the last inspection but it was clear that assessments were ongoing and kept under review. There was evidence that residents and people important to them were involved in the ongoing assessment of their needs; this would ensure they received the care they both needed and wanted. The Barn DS0000073094.V376068.R01.S.doc Version 5.2 Page 10 Records showed that a range of training had been provided for staff to ensure they had the skills to meet the needs of the residents. There were some gaps in the provision of training but these had been identified and further training was being planned. Residents had not been issued with contracts or statements of terms and conditions with the new organisation; residents and their relatives needed this information to ensure they were aware of their rights and obligations whilst living at The Barn. The Barn DS0000073094.V376068.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 and 10. People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals were involved in decisions about their lives and played an active role in planning the care and support they received. EVIDENCE: Each resident had an individual plan that had been developed from the information obtained about him or her before they were admitted to the home. Two individual plans were looked at in detail; they were not as yet available in any other format but the manager advised the format was being changed to become more user-friendly. The Barn DS0000073094.V376068.R01.S.doc Version 5.2 Page 12 The plans included details about how each resident was to be looked after, their likes, dislikes and preferences and what support was needed to help them to maintain their independence and keep them safe from harm. Residents and people who were important to them, had been involved in the development and ongoing review of the individual plan and had been involved in decisions about changes to their care; this would ensure they received the care they both needed and wanted. However reviews were not always dated; a senior manager advised this would be improved with the introduction of the new care plan format. Each resident had been allocated a member of staff or ‘key worker’ who were actively involved in the review and update of the individual plan; this ensured all staff were aware of the residents’ current needs and wishes. Residents said they were able to make choices and decisions and said staff listened to them and respected their decisions. Any limitations to freedom and choice were fully risk assessed; risks were managed positively and residents were generally able to lead the life they wanted. Residents were encouraged to manage their own finances with the support of staff. Records supported that resident’s finances were managed safely. Residents were consulted about how the home was run and were involved in key decisions such as staff selection, development of policies and procedures and day to day life in the home. From discussions with staff and residents it was clear that The Barn was run in the best interest of the people who lived there. Some procedures such as information about confidentiality were available in easy read and picture format; this ensured service users understood their rights. The Barn DS0000073094.V376068.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 11, 12, 13, 14, 15, 16 and 17. People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were able to make decisions and choices about their lives. Social, educational and recreational activities met individual needs and expectations. Residents were provided with nutritious meals that met their dietary needs and preferences. EVIDENCE: From discussion with staff and residents and looking at records it was clear that residents were able to enjoy a full and stimulating lifestyle with a variety of options to choose from. Residents’ views had been sought when planning activities both in the home and in the local community; this would ensure they participated in activities that they enjoyed. Activities were provided in small groups or one to one and included music lessons, cookery, shopping, pub The Barn DS0000073094.V376068.R01.S.doc Version 5.2 Page 14 lunches, crafts, visits to the local church, local library and other areas of interest and luncheon clubs. None of the residents were employed although some residents attended the local colleges of education; one resident said she was looking forward to going back to college to ‘meet new friends and learn new things’. A number of residents visited their family and friends at the week end; they said staff gave them the support they needed. Residents and staff said the routines of the home were flexible and tailored to meet individual needs and that they were able to make choices in all areas of their lives. Residents were supported to be independent and they were involved in decisions about how the home was run. Residents said routines were flexible and they could do what they liked; this was confirmed by staff and observed during the inspection visit. Meals were well balanced and nutritional and were cooked by staff with occasional help from residents. Some residents were involved with the weekly shopping, preparation of food and clearing away after meals; all residents were involved in menu planning. One resident said ‘the food is good we can have what we want’ another said ‘I really like the meals’. Records of food served needed to include lunchtime meals; this would help to support that residents were offered choices and nutritious meals. Residents’ food likes and dislikes were considered when planning the menus and special diets were catered for. Mealtimes were relaxed and staff gave support and encouragement where needed. The Barn DS0000073094.V376068.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. 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 received health and personal care that was based on their individual needs. EVIDENCE: It was clear from observation, discussion with staff and residents and looking at records that care and support was provided flexibly and residents were able to make decisions and choices about their daily lives. There was clear information regarding how individual residents communicated and some staff had received specialist training to help them to understand residents’ needs. There was a range of equipment to meet resident’s individual needs and to help them maintain their independence. The Barn DS0000073094.V376068.R01.S.doc Version 5.2 Page 16 Each resident had a ‘health action plan’ indicating the level of support they needed. Records showed resident’s health was monitored and advice from health care professionals had been sought if there had been any changes. Most staff had received training in health care matters; this ensured they had the skills and competencies to look after people properly. Residents had been allocated an individual member of staff or a ‘key worker’ to provide them with special attention and support. Residents and staff were able to describe what was required of a key worker; one resident said ‘my key worker helps me to keep my room tidy’ another said ‘we go shopping’. Medication procedures were clear although would need to be reviewed later this month when the medication system was changed. Medicines were stored securely and accurate records showed that safe procedures had been followed to ensure there was no mishandling. There were audit systems to monitor whether staff were following safe procedures. The Barn DS0000073094.V376068.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. 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 were able to express their concerns and had access to a clear and effective complaints procedure; they were protected from abuse by staff awareness and policies and procedures. EVIDENCE: The complaints procedure was clear and available in formats (including words and pictures) that were understood by residents. Residents said they were happy living at the home and would be happy to speak to staff if they were unhappy. One resident said ‘I am happy here and would tell someone if I wasn’t’. Staff knew how to listen to and respond to complaints which would ensure residents views would be taken seriously. Residents had pre addressed postcards with smiley or sad faces on them; these could be used to request a contact from the Care Quality Commission. The complaints procedure included the contact information of other agencies if they needed help from someone other than staff or relatives; some residents had used this service. The records showed there had been no complaints since the new organisation had taken charge; residents said they had not noticed any changes to their routines or the care they received. The Barn DS0000073094.V376068.R01.S.doc Version 5.2 Page 18 The Safeguarding Adults procedure had been reviewed and provided staff with clear guidance in the event of any suspicions of abuse or neglect. It was recommended that the contact information for local agencies should be attached to the procedure; this would provide staff with the correct information and prevent any delay in reporting. The safeguarding procedures were also provided in a format suitable for residents to understand; this would ensure they knew what abuse and neglect was and how to report it. Most staff had received safeguarding training and further sessions had been booked for any new staff or those needing update; staff needed the training to help them to recognise and respond to any abuse or neglect. Staff were aware of the action to be taken to protect residents from harm. There were clear procedures in place to support staff with reporting any poor practice; this would ensure residents were safe. There had been one safeguarding referral made to the local authority (social services); this had been referred promptly and appropriately which showed staff had a good understanding of the procedures. Records and practices showed that staff were aware of and respected residents’ rights and involved residents in decisions about the care they needed and wanted. There were no procedures or training to support staff with the Deprivation of Liberty Safeguards or the Mental Capacity Act; staff needed this training to help them to understand their responsibilities when making decisions for residents. There had been a concern raised that staff were being put at risk as they had not been provided with specific training to help them deal with verbal and physical aggression and that there had been a number of incidents involving challenging behaviour. The manager advised that the number of incidents had decreased and appropriate training had been provided, with more sessions planned, for staff. One member of staff said they had a better understanding of how to respond to challenging behaviour and felt that residents were not at risk; another member of staff said they would not like to work alone at night as they thought this may be a risk (see standard 33 - staffing). Records showed that some staff had been provided with training in this area and further training had been requested. The Barn DS0000073094.V376068.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28, 29 and 30 People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. s People were provided with a safe, clean and homely environment with evidence of ongoing planned refurbishment to the home. EVIDENCE: From a tour of all areas it was clear that the home was well maintained, comfortable and attractive and had good access to the local community facilities and services. There was a plan for ongoing improvement and residents were able to discuss some of the plans for improving the home; this showed that residents had been kept up to date and involved in decisions about the day to day running of the home. The Barn DS0000073094.V376068.R01.S.doc Version 5.2 Page 20 There was a maintenance request book which showed that minor repairs and maintenance had been completed by the organisations handyman; it was recommended that the date of completion of the work should be recorded to help to determine whether repairs were done promptly. The manager and staff said the response to any requests for repairs were prompt. Residents and their visitors had access to attractive and safe garden and patio areas; suitable garden furniture had been provided for residents to sit out in the warmer weather. Communal areas were bright, comfortable and accessible. The manager said front door keys were available for residents and this was supported by agreements in their care plan. Specialist aids and adaptations were provided that ensured residents’ comfort and safety and helped them to maximise their independence. Bedrooms were clean, individually decorated and personalised with treasured possessions and furnishings to enhance the homely feel; residents said they were happy with their rooms. Bedrooms had been provided with lockable storage and suitable locks to doors; this ensured that resident’s privacy and dignity could be respected. Alarm call facilities were not provided unless a risk assessment supported the need for one; the manager said staff were available at all times and all residents were checked regularly during the night dependant on any risk factors. One resident had been provided with a ‘monitor’ as she sometimes had disturbed nights; this was included as part of a risk assessment. One bedroom was fitted with en suite facilities and all other rooms were located near to bathroom and toilet facilities which were clean, homely and included the necessary aids and adaptations to meet the needs of the residents. The home did not have a lift to access the first floor or offices in the attic; some residents were able to access these areas and others with limited mobility were provided with ground floor rooms. One resident was seen using his wheelchair around the home without difficulty. The laundry was well equipped, clean and organised; there was a big step from the laundry door to the patio areas which could be a risk to residents although grab rails had been provided since the last visit. Staff had received training to help them to understand the action needed to reduce the risk of infection. The Barn DS0000073094.V376068.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. 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. Staff were competent, suitable and generally provided in sufficient numbers to provide support for residents in the home. EVIDENCE: Residents said there were enough staff to give them the support they needed; one said ‘I like the staff, there are enough to look after us properly’. Staff said there had been some recent changes to the staff team, two said there were sufficient staff and one said there was never enough staff; two staff said the currently the team was stable, worked well together and staff numbers had improved. One resident said ‘I get on well with everyone at the home there are different staff but they are nice and another said ‘the staff are very good, we miss them when they leave but they sometimes come back and see us which is nice’. Rotas showed sufficient staffing during the day-time hours although there was only one care staff on duty during the night; there were concerns regarding The Barn DS0000073094.V376068.R01.S.doc Version 5.2 Page 22 how this would be managed in the event of an incident such as a fire or injury or illness to residents (these concerns had also been raised with the previous owners). The day time staffing numbers allowed for one to one support for residents with their key workers. There had been a concern raised regarding the night time staffing numbers; it was reported that lone night staff were placed at risk of injury during incidents of challenging behaviour. This was discussed with the manager and regional manager who said the on call rota would provide a prompt response and staff and residents would not be put at risk; however not all on-call staff lived nearby and staff may need immediate assistance. Staff said that although the risk of injury from challenging behaviour had reduced it still remained a risk and they were concerned about the night time staffing situation. It was therefore strongly recommended that night-time staffing should be reviewed to ensure the numbers reflected current residents’ needs and to ensure staff and resident safety was not compromised. Most of the staff had completed a recognised qualification in care (NVQ) to help them to meet the resident’s needs. Care staff had access to a range of information about the residents and staff had read the individual plans each month to ensure they had up to date information about each residents needs. There were clear recruitment procedures. Four staff files were looked at in detail. Recruitment practices were safe and all checks were in place prior to employment; this ensured that residents were protected from being cared for by unsuitable people. It was noted that criminal record checks (CRB) and protection of vulnerable adults checks (POVA) were recorded but not available for inspection as these were stored at head office and destroyed after six months; the manager was advised that all records relating to staff must be stored in the home unless there was a formal agreement with the Care Quality Commission (CQC) and CRB and POVA checks must be maintained in the home until the CQC has inspected the service and sampled staff records. There were records of the interview process and residents had been asked for their opinions regarding the applicants; this ensured they were involved in making decisions about how the home was run. It was noted that two recently employed staff had not received any induction training; staff needed this training to familiarise themselves with the routines of the home and to ensure they were safe to practice. Staff met regularly as a team and were kept up to date; staff said they were able to raise any issues for discussion. Not all staff had been issued with a copy of their terms and conditions which would advise them of their roles and responsibilities. The Barn DS0000073094.V376068.R01.S.doc Version 5.2 Page 23 Records showed that care staff were regularly supervised by senior staff to ensure they had the right skills to be able to look after the residents in their care and to identify the need for additional support and training. The Barn DS0000073094.V376068.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41 and 42. 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 home was run in the best interests of people living and working there. People’s health, safety and welfare were protected EVIDENCE: A new manager had been employed since the last key inspection; she has the required qualifications and experience and is competent to manage the home. We were advised that she would register with the Care Quality Commission on completion of her probationary period. The Barn DS0000073094.V376068.R01.S.doc Version 5.2 Page 25 The manager was supported by the senior management team and from other home managers within the group. The manager was involved in managing the budgets and ensuring residents were provided with value for money and high standards of care. Staff said ‘I can talk to her and would be able to raise any issues’; they also said she often worked with staff and residents which helped to monitor whether residents were being looked after properly and whether staff were following policies and procedures. The manager was clear about where improvements were needed and had kept residents and staff up to date and involved them in decisions about the day to day running of the home. A number of audit systems were in place which would help the manager to monitor whether staff were following procedures and to decide whether residents’ needs were being met. Feedback was sought from residents at regular meetings and during informal discussion groups; residents knew what was happening in the home. The minutes from residents meetings were provided in a format suitable for everyone to understand. Annual surveys had not yet been completed although the manager said resident’s relatives were kept up to date and consulted on an individual basis. The annual quality assurance assessment (AQAA), provided prior to the inspection visit, contained clear and relevant information. It showed us what the current situation in the home was and where further improvements were needed. Any concerns with records had been referred to under the relevant standard; records were accurate and stored securely and residents were able to access their records whenever they wished. Staff had access to clear policies and procedures that provided them with safe guidance in all aspects of their work. Some procedures were also available in suitable formats to help residents to understand the content. A senior manager from the organisation regularly visited the home to monitor the day to day management of the home; a record had been made and this was used to improve the service. There was a clear health and safety policy and staff were given training to ensure they and others were safe. Equipment had been serviced regularly to ensure it was safe to use. The Barn DS0000073094.V376068.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 4 2 3 3 3 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 4 33 2 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 4 3 4 LIFESTYLES Standard No Score 11 3 12 4 13 3 14 4 15 4 16 4 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 3 X 2 3 2 3 3 3 X Version 5.2 Page 27 The Barn DS0000073094.V376068.R01.S.doc N/A 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 YA33 Regulation 18 Requirement The night-time staffing should be reviewed to ensure staff numbers reflect current residents’ needs and to ensure staff and resident safety is not compromised. Timescale for action 12/10/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA3 Good Practice Recommendations Each resident should be issued with a copy of their contract with the new organisation; this will ensure they are aware of their rights and responsibilities whilst living at The Barn. Reviews and updates of individual plans should be dated; this will ensure the information reflects the resident’s current needs. There should be records of all food served; this will support that all residents are provided with a choice of nutritious diet at all times. The contact information of local agencies should be included with the safeguarding procedures; this will ensure staff have the correct information and are able to report DS0000073094.V376068.R01.S.doc Version 5.2 Page 28 2. 3. 4. YA6 YA17 YA23 The Barn 5. YA23 6. 7. 8. YA24 YA34 YA34 9. 10. 11. YA35 YA37 YA39 their concerns without delay. Staff should be provided with procedures and training to support them with the Mental Capacity Act and the Deprivation of Liberty Safeguards; this will help them to understand their responsibilities when making or supporting residents with their decisions. The repairs and maintenance record should include the date that work has been completed. Records relating to staff (CRB and POVA) should be available at the home for inspection unless alternative arrangements have been agreed with the CQC. All staff should be issued with a copy of their contract or terms of employment; this will ensure they are aware of their rights and responsibilities whilst working at the home. All new staff should receive structured induction training within six weeks of employment; this will ensure they have the skills to understand their role and to keep people safe. An application to register the manager with the Care Quality Commission should be forwarded on completion of the probationary period. The service should consider developing their quality assurance and monitoring systems; this will help to develop and improve outcomes for people. The Barn DS0000073094.V376068.R01.S.doc Version 5.2 Page 29 Care Quality Commission North West Region Citygate Gallowgate Newcastle upon Tyne NE1 4WH National Enquiry Line: 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. 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