Care Home: The Old Haybarn

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What the care home does well The home is well maintained and decorated to a very good standard. Thorough pre admission assessments are carried out to ensure that the home can meet the needs of prospective residents and to make sure that prospective residents are compatible with the current residents. Care plans contain a wealth of information to ensure that staff are aware of the abilities and needs of the residents and how they are to be met. Staff feel well supported and find the manager very approachable. A staff member stated `I love working here` and another said that they are `very pleased with the level of training provided`. The extensive training opportunities available ensure that staff remain well equipped to meet the needs of the residents. A resident also said `I like my room and I like living here`. All of the staff team have or are working towards an NVQ (national vocational qualification) at level two or above. In addition a high number of the staff team hold level three and some have also achieved level four. The day centre on site offers residents an extensive range of courses to choose from and they provide residents with opportunities for personal development, skill development, fitness and leisure activities. What has improved since the last inspection? The day centre is currently being extended and residents have been consulted with and kept fully informed of changes and developments as they occur. The fence panel to the front of the building has been removed and is being replaced with a new brick wall which will ensure greater security and privacy for the residents. Residents are involved in staff recruitment and their views are taken into consideration as part of this process. The owner keeps up to date with changes in care practices and ensures that the staff team are trained on any relevant courses both for individual and the home`s development. What the care home could do better: There were no requirements made as a result of this inspection. Key inspection report Care homes for adults (18-65 years) Name: Address: The Old Haybarn London Road Crowborough East Sussex TN6 1TQ     The quality rating for this care home is:   two star good 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: Caroline Johnson     Date: 1 6 0 7 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 25 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 25 Information about the care home Name of care home: Address: The Old Haybarn London Road Crowborough East Sussex TN6 1TQ 01892654057 01892667457 baronsmedehomes@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Baronsmede Family Homes Ltd care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 7 The registered person may provide care to service users in the following category only: Care home only (PC) to service users of the following gender :Either whose primary care needs on admission yto the home are within the following category: Learning disability (LD) Date of last inspection Brief description of the care home The Old Haybarn is registered for a maximum of seven adults with a learning disability. The home is situated in a pleasant semi-rural setting on the outskirts of Crowborough and close to the local shops, banks, public houses, cafes, takeaways and restaurants. The Old Haybarn provides a high standard of accommodation for seven residents. All bedrooms have en-suite facilities with a washbasin, toilet and either a shower or bath. On the ground floor there are three bedrooms, a bathroom, a sitting room, dining room, kitchen, laundry and an office/sleep in room. On the first floor there are four bedrooms. The home is well decorated, furnished and maintained. A day centre which residents attend is on the same site and is facilitated by the same Care Homes for Adults (18-65 years) Page 4 of 25 Over 65 0 7 Brief description of the care home staff team. This day centre is run by the homes provider and is also attended by residents from the providers other home close by. The home aims to provide services to people with learning disabilities, which would provide opportunities for them to develop a greater degree of independence. The current range of fees for The Old Haybarn are from 610 - 983 pounds per week. Care Homes for Adults (18-65 years) Page 5 of 25 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 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: For the purpose of this report the people living at the Old Haybarn will be referred to as residents. As part of the inspection process a site visit was carried out on 16 July 2009 and it lasted from 10.15am until 15.45pm. The registered manager/owner facilitated the majority of the inspection. Over the course of the inspection there was an opportunity to meet with two residents in private and to observe other residents generally in their surroundings. In addition time was spent talking with two staff members in private. Two care plans were examined in detail. A wide range of records were also seen including - staff rotas, staff training, medication, menus, health and safety documentation, quality assurance and leisure activities. Care Homes for Adults (18-65 years) Page 6 of 25 In advance of the inspection the home submitted a very comprehensive AQAA (annual quality assurance assessment) which contained detailed information about the home and how it is run. Care Homes for Adults (18-65 years) Page 7 of 25 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 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 25 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 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are provided with detailed information about the services available within the home. Evidence: There is a detailed statement of purpose in place. The service user guide is available in a range of formats including written, pictorial and as a slide show. There has been one new admission to the home since the last inspection. Records showed that the home had carried out a detailed pre admission assessment which included comprehensive information that was provided by the relatives of the resident. In addition the placement authority also provided a detailed assessment of needs. A transition plan was then put in place to assist the resident in settling into their new home. The resident stated that they really like their home and have settled in very well. When asked what they like best about their home they stated I like my friends and all the staff. Care Homes for Adults (18-65 years) Page 10 of 25 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 plans provide detailed information about the needs and abilities of residents and how they are to be met. Evidence: Two care plans were examined in detail and they included very detailed advice and guidance for staff to ensure that individual needs are met. In each there is a statement of care needs and a plan for delivery of care. It was noted in each case that the manager and the keyworker had signed each section but not the resident. A staff member spoken with stated that the residents concerned would be able to sign the documents and understand what they were signing. There were a range of risk assessments in place ensuring that where there is a perceived risk there is advice for staff to follow. In addition to the care plans a daily record is kept all personal care provided, to record all professional visits and healthcare appointments and to record any activities that Care Homes for Adults (18-65 years) Page 11 of 25 Evidence: residents have participated in. All records are reviewed on a regular basis. In addition there are regular care plan audits carried out. Staff spoken with were clear about the needs of the residents and how they were to be met. A staff member spoken with stated that they are introducing new goals for residents. An example given was that a resident would like to learn how to make their own drinks so time has been set aside in the evenings to enable them to carry out this task with staff supervision. Examination of residents meetings showed that a wide range of issues are discussed and a number of actions are then taken as a result. It was also noted that a joint meeting with the residents and staff from the sister home was held in May where residents were consulted on in relation to the building works at their day centre. Ideas for new courses were also discussed. Care Homes for Adults (18-65 years) Page 12 of 25 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. Residents have opportunities to participate in a wide range of interesting and stimulating activities. Evidence: All of the residents have an individually tailored programme of activities based at the Haybarn, which is a day centre run by the owners of the home. Tutors from local colleges along with a number of private tutors run the courses from the day centre. There they have opportunities to spend time with friends from another home owned by the directors and with residents from another local care home. At the time of this inspection there were building works underway to extend the day centre by providing additional rooms for activities. In addition the owner will have an office on site. An official opening ceremony will be held late August/early September. Outside the day centre there is a large patio area with comfortable seating and very Care Homes for Adults (18-65 years) Page 13 of 25 Evidence: pleasant surroundings. A small vegetable patch is situated to the side of the seating area. The owner advised that once the building works are complete they will be growing more organic vegetables on a three acre site within the grounds of the home. Programmes seen included activities such as yoga, arts and crafts, music all-sorts, animal care, sensory, computer skills, communication skills, numeracy and literacy, performing arts, gardening and independent living skills. This year the annual holiday will be to the New Forest. Regular day trips are also planned to places of interest. Some of the residents enjoy using the local shops to buy magazines and one resident stated that he goes every week to buy his tv guide. The majority of residents like spending time in their individual rooms watching television in the evenings. Staff stated that some choose to take a walk and occasionally they have pub trips. There is a club night one evening a week at the day centre. One resident stated that he enjoys watching DVDs and videos and his play station. A resident was also keen to show folders of the work that they have undertaken at their day centre. This was in both a written and pictorial format and showed extensive evidence of the resident having opportunities to make drinks, cook, use local facilities and share their views on a wide range of topics. One resident stated that they are encouraged to keep their bedrooms clean and tidy and that staff remind them when this task needs to be carried out. A newsletter is produced bi-annually. The January 2009 edition includes photos of the residents in various activities throughout 2008. Photos were of residents at their day centre, weekend activities, holidays, theatre outings and shows and birthday parties. The owner advised that the intention is to increase the frequency of this publication and at the time of inspection she had almost completed the next edition. Menu sheets were seen and showed that residents receive a varied and well balanced diet. Staff advised that residents choose what they would like for breakfast and lunch and the majority can make their own breakfast independently although they would always be supervised in the kitchen area. There is a set meal in evenings. Desserts are decided on the day and are more fruit/yogurt based. A cooked breakfast is provided on Saturdays. Care Homes for Adults (18-65 years) Page 14 of 25 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. The systems in place ensure that residents healthcare needs are met. Evidence: Records showed that residents are supported to attend a wide range of healthcare appointments such as the dentist, opticians and chiropodist. The owner advised that they are continuing to liaise with their local gp surgery about introducing health action plans. A staff member advised that medication is ordered via their sister home. A monitored dosage system is in place. There is very little medication in use in the home and the arrangements in place for the storage and handling of medication were in order and all records seen were up to date. All staff received training on the medication in use in the home. It was reported that a senior staff member has recently completed an assessors course on medication. A format for carrying out staff competency assessments has been drawn up and they will ensure that all staff are assessed using this format in the near future. Care Homes for Adults (18-65 years) Page 15 of 25 Evidence: Where residents require specialist advice and support to meet their healthcare needs the home is proactive in ensuring that arrangements are made for this to happen. Residents wishes in relation to dying and death have yet to be assessed. The manager advised that the local CLDS did some work with residents around this subject some time ago and that they were producing a video to assist staff in discussing the subject. This will be followed up. Care Homes for Adults (18-65 years) Page 16 of 25 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 are clear procedures in place to enable anyone wanting to make a complaint to do so. Evidence: There is a detailed complaint procedure in place and a simplified version of the procedure is included in the service user guide. The owner advised that there have been no complaints received since the last inspection of the home. It was reported that there is a detailed procedure in place on adult protection and prevention of abuse. A copy of multi-agency guidelines on adult protection are also available for staff to read. All of the staff team have completed training on the protection of vulnerable adults. The arrangements in place for the management of residents finances were discussed and records were seen in relation to one resident. All records seen were in order. It was reported that as a relative is the designated appointee they also keep a close eye on records. The procedure in place is recorded well but could potentially be open to abuse so it was recommended that this be discussed at the next review and agreement reached on the best procedure to be followed. Care Homes for Adults (18-65 years) Page 17 of 25 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. The Old Haybarn is well maintained and decorated to a very good standard. Evidence: The home continues to be well maintained and decorated to a good standard. There is a comfortable lounge area and dining room. At the time of inspection a fence panel around the front of the building had been taken down and was being replaced with a new brick built wall. There are also plans to improve the whole area around the home with paved areas all around which will enhance the site. There is a surveillance system in place with four cameras installed around the property and a monitor in the office. Three of the bedrooms were seen and they had been decorated to a good standard and personalised by the individual residents. All areas seen were clean. Regular maintenance checks are carried out and fire drills are undertaken on a monthly basis. Staff have had training on infection control. Care Homes for Adults (18-65 years) Page 18 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff team and well trained and equipped to meet the needs of the residents accommodated. Evidence: It was reported that eighteen staff are employed and contracted to work in either of the two homes owned by the directors. The majority of the staff team work in both settings. Some have set shifts in both homes and some work predominantly in one with occasional shifts in the other. There is also a regular team of bank staff which means that the home does not have to use agency staff to cover annual leave or sickness. There are two care staff on duty throughout the day. In addition the manager is also on duty working office hours. A staff member also does a sleep-in duty at night. Staff have access to an extensive list of staff training. In addition to updates on mandatory training, courses attended by staff in the past year included bereavement and loss, deprivation of liberty, mouth care, supervision and appraisal, overseeing care plans, communication passports, extend update, good nutrition and epilepsy. It was also noted that further training has been planned to be held throughout the year. Care Homes for Adults (18-65 years) Page 19 of 25 Evidence: Recruitment procedures were examined and were found to be thorough including a wide ranges of checks. There was also evidence that the views of the residents had been sought in relation to individual applicants. All new staff complete a level two induction award in supporting people with learning disabilities. All of the staff have or are studying for NVQ (national vocational qualification). A high percentage of the staff team have completed NVQs at level three and four and a number also hold the Assessors Award. A supervision chart on display in the home showed that staff receive regular supervision. Both staff spoken with stated that they find supervision very helpful. They stated that the manager is very supportive and approachable. One staff member stated I love working here and another said that they are very pleased with the level of training provided. Care Homes for Adults (18-65 years) Page 20 of 25 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 home is run well and the systems in place ensure that the health, welfare and safety of residents is protected. Evidence: The registered manager who is also the owner is a qualified nurse in learning disabilities (RNMH) and in addition she has completed the RMA (registered managers award). She continues to keep abreast of changes in care practices and attends regular training courses. The company has accreditation with Investors in People status and this was reassessed this year and maintained. Staff meetings are held regularly and there was evidence that issues raised at a recent inspection at the sister home had been raised with staff and were being acted upon. There was also evidence that the company listens to the views of the staff. As part of the homes quality assurance system a range of satisfaction questionnaires were distributed to residents and their relatives. Residents complete a pictorial Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: questionnaire which includes a range of questions seeking views about now and the future. The responses were collated and feedback was given to all who participated. In addition to questionnaires the home owner carries out a number of audits to monitor and measure the homes performance at any one time. There are a range of measures in place to ensure the health, safety and welfare of residents and staff. Amongst other audits a health and safety audit was carried out in May 2009 and a fire risk assessment was carried out in August 2008. There was detailed information in the home on swine flu and the action to be taken should a case be suspected. In advance of the inspection the manager completed an AQAA (annual quality assurance assessment). This was a comprehensive document and information contained has been used throughout this report. Care Homes for Adults (18-65 years) Page 22 of 25 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 23 of 25 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 Adults (18-65 years) Page 24 of 25 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 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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