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Inspection on 06/12/07 for Bay View Nursing & Residential Care Home Ltd.

Also see our care home review for Bay View Nursing & Residential Care Home Ltd. for more information

This is the latest available inspection report for this service, carried out on 6th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The staff work well as a team and ensure the well-being and comfort of the residents` and treat them with great respect and kindness. The outcome for the residents is good. For example 4 residents spoken with said, "the home is lovely, the staff are kind and caring, and the food is good." There is a good rapport between staff and residents. The routines in the home are flexible to suit the needs and wishes of people who use the service. Bay View provides a homely and comfortable environment for residents. It is decorated and furnished to a good standard and there are many homely touches. There is a relaxed atmosphere where residents support one another. The home use research based person centred care in their assessment, delivery and evaluation of care. Health and Safety issues are clearly monitored and regular safety checks of all equipment carried out.

What has improved since the last inspection?

What the care home could do better:

The contract or Terms and Conditions of residency document does not provide the prospective resident with certainty of the room to be occupied, as it is not stated. This is recommended for purposes of clarity. Attention to detail in record keeping in relation to staffing levels and training would ensure that residents` best interests are protected.

CARE HOMES FOR OLDER PEOPLE Bay View Nursing & Residential Care Home Ltd. 2-6 Bay Road Walton-St-Mary Clevedon North Somerset BS21 7BT Lead Inspector Patricia Hellier Key Unannounced Inspection 12:00 6th December 2007 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bay View Nursing & Residential Care Home Ltd. DS0000049283.V350764.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bay View Nursing & Residential Care Home Ltd. DS0000049283.V350764.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bay View Nursing & Residential Care Home Ltd. Address 2-6 Bay Road Walton-St-Mary Clevedon North Somerset BS21 7BT 01275 343109 01275 878003 maggiemorris100@hotmail.com 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) Bay View Nursing & Residential Care Home Ltd. Mrs Margaret Morris Mrs Margaret Morris Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Bay View Nursing & Residential Care Home Ltd. DS0000049283.V350764.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. May accommodate up to 40 persons aged 65 years and over. Staffing Notice dated 26th May 1999 applies. Manager must be a RN on part 1 or 12 of the NMC register. Date of last inspection 23rd May 2006 Brief Description of the Service: Bay View is a large Victorian house registered to care for up to 40 service users. The home also cares for 3 elderly people with a learning disability. Bay View is set on the cliffs above the Bristol channel, shops and other facilities can only be accessed by transport from the home. All bedrooms have en-suite facilities or a vanity unit. There are 28 bedrooms, 12 of which may be used as double rooms. All bedrooms meet the new spatial standards and many exceed them. Upper floors and a basement area are served by 2 lifts and the home is flat throughout. The provider makes information available through a brochure and information pack. The information pack contains the Statement of Purpose and Service User guide and all relevant information about the home. The fees range between £537.57 and £650 a week with additional charges being made for hairdressing, chiropody, newspapers, and toiletries. This information was provided in November 2007. Bay View Nursing & Residential Care Home Ltd. DS0000049283.V350764.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place over 10 hours on two days. Manager, Mrs Morris, was present throughout. The Registered Before the inspection the information about the home was received from the file held in the office, surveys received from 19 people who use the service and 10 relatives 3 GP’s and 3 health professionals. The last two inspection reports were reviewed together with the completed Annual Quality Assurance Assessment (AQAA) form, from the provider. We also reviewed all correspondence and regulatory activity since the last inspection. The accumulated evidence for this report comes from the above and also fieldwork that included the following: discussions with 13 residents, 5 relatives, and 7 staff; observation of practices, tour of the premises, review of documents relating to care, recruitment and health and safety; review of policies; inspection of medication records and storage. Of the 20 resident surveys sent 19 were returned. Such a high return rate is due to the staff assisting residents to complete the survey forms. All were satisfied with the care they received. 17 said the home is clean and fresh, and that they would know who to speak to if they were unhappy. Two residents did not feel the home is always fresh and clean, and did not feel the staff are available when needed or that they listen or act on what they say. Comments from residents were “the staff are friendly and kind”, “I am very happy her”; “they are all wonderful”. One or two spoke of their frustration at not being able to go out for walks as often as they would like, while another spoke said “it would be nice to go to my room after meals when I am ready and not have to wait”. All relatives spoken with felt welcomed at the home and that they were consulted regarding their relatives care and needs. Comments included “the staff are very pleasant and friendly”, “the staff’s kindness and care help my relative to settle in”. Of the 14 relatives’ surveys sent 10 were returned and all felt that their relatives were well cared for by competent staff. Comments from relatives were “the home provides very good care and I have every confidence in them”; “the staff are friendly and caring and the building never smells”. All 10 relatives felt they were kept up to date with important issues. Comments of concern were about the number of staff that appear to be trainees, and the overseas staff’s ability to communicate clearly. Two relatives did not know how to complain and had not seen the complaints procedure. Bay View Nursing & Residential Care Home Ltd. DS0000049283.V350764.R01.S.doc Version 5.2 Page 6 All residents and staff spoken with told the inspector that the home was very good and the staff very kind. Comments received were “it is very homely and comfortable”; “my care needs are well met”; “it’s a good staff team and they provide care that takes account of residents wishes and preferences”. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Bay View Nursing & Residential Care Home Ltd. DS0000049283.V350764.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bay View Nursing & Residential Care Home Ltd. DS0000049283.V350764.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5, Standard 6 is not applicable. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents are provided with a comprehensive Residents’ booklet containing the Statement of Purpose and all the information required to ensure they or their relatives have access to the relevant information at all times. Eight of the nineteen residents who returned surveys stated they had not received a contract. In discussion with two relatives they said they were aware of a contract document but could not remember what it said. Five care files inspected contained evidence of either a contractual agreement for residents who are privately funded, or a Terms and Conditions of Residency agreement for those funded by Social Services. Social Services contracts were also present. The resident or their relative had signed the contracts and agreements showing that they had been involved and informed of the arrangements. Bay View Nursing & Residential Care Home Ltd. DS0000049283.V350764.R01.S.doc Version 5.2 Page 9 The manager and administrator told us that all residents / relatives are given a copy of this document. Neither document stated the room to be occupied as recommended in the National Minimum Standard for clarity purposes for residents. Contracts inspected showed clear identification of fees to be charged and how the Registered Nursing Care contribution is used. Care needs are well met through a full assessment process as evidenced in the five care plans inspected. The assessment information is clearly documented in all aspects of physical, mental, social and emotional needs providing staff with a good knowledge base from which to provide person centred care. A plan of care to meet the new residents needs is developed from the assessment information. The assessment includes all the elements listed in the standard. An assessment was seen for a recently admitted resident, which contained the key details for person centred care and the outcome of the assessment, stating that the home could meet the identified needs. The resident when spoken to said ‘they are very kind; know what I need and look after me well’. Care practices observed showed that staff were fully aware of the residents needs as stated in their assessments. Bay View Nursing & Residential Care Home Ltd. DS0000049283.V350764.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from care plans that are well formulated and give clear information to enable staff to meet residents’ health and social care needs. Risks to residents are fully assessed and actions to minimise these planned, for the safeguarding of residents. Respect and dignity are well maintained by kind and caring staff. EVIDENCE: Individual records are kept for each of the residents, which include a social history. Five care plans were inspected and all reflected clearly current identified health and social care needs. All of these records showed clear evidence of Interprofessional working with other Health Care Professionals included providing full, holistic, care to residents. Care plans while identifying actions to meet needs also give scope for residents to be as independent as they are able, which may vary daily. Bay View Nursing & Residential Care Home Ltd. DS0000049283.V350764.R01.S.doc Version 5.2 Page 11 One resident spoken with verified this, as they are aware that their condition can change on a daily basis. Staff spoken with were able to clearly describe the care for this individual and how they adjust the care interventions to encourage the resident’s independence as far as they are able. Clear actions to meet identified needs were recorded and regular evaluation noted. All care plans showed resident or relative involvement. All care plans contained Manual Handling, nutrition, falls and pressure sore risk assessments, with the outcomes being used to inform the provision of care. Other personal and environmental risk assessments were present to ensure the safety of the resident while promoting independence as able. Visits by the dentist, chiropodist and optician were recorded in all of the care plans. Wound care plans are clear and contain all necessary details of the wound and its progress. These good practices are to be commended. Evidence was seen that social and psychological needs are well met through activities and staff interactions with residents being case tracked. One resident was seen assisting and encouraging another resident at coffee time and staff encouraging and supporting both residents with words and actions. Daily records were up to date and written in a respectful manner. All residents were neatly dressed, and attention had been paid to hair and nail care. Detailed conversations with six of the residents confirmed a good standard of nursing and personal care. Comments made were – “the staff are very nice”, “staff are always kind and approachable – nothing is too much bother”; “I’m very happy here”. One relative praised the home for the way in which their mother is cared for, “it’s like the best of hotels, and they have all the specialist equipment needed to help mum”. Six residents spoken with told us their care needs had been discussed with them and specific arrangements made to meet their individual needs. Care plans and activity records inspected verified this. Care practices observed showed caring interactions and good communication skills from staff. One episode of poor practice was observed with a member of staff wheeling a resident through the home with no footplates on the wheelchair. This potentially put the resident at risk of toe or foot injury. Choices and preferences were observed being discussed and offered. One resident said ‘they always do things the way I like, and if I want to get up later they let me’. The management of medicines is satisfactory and the home has a policy for the receipt, recording and storage of medication. The nursing staff who deal with this were clearly able to describe the process and policy, thus demonstrating that the policy is adhered to for the protection of residents from the mishandling of medications. Bay View Nursing & Residential Care Home Ltd. DS0000049283.V350764.R01.S.doc Version 5.2 Page 12 Regular monthly audits of the medication are undertaken and outcomes satisfactory. Good practice was observed in the dispensing and disposal of medication, during the lunchtime period. Medication Record Sheets (MAR) showed some gaps and no recorded information as to why the medication had not been administered, thus not providing other care staff with full information about the resident’s condition. Hand transcribed prescriptions were seen on three of the MAR sheets. One of these had been signed by two members of staff when written, and two had not. The latter does not provide the recommended safeguards for residents. The medications fridge was locked and temperatures recorded had been within the recommended limits providing safe storage of medicines. One bottle of eye drops seen, did not have the date of opening recorded to ensure safe administration within the limited timescale stated. All residents spoken with felt that kind and caring staff respected their dignity and privacy. One resident stating “they always knock on the door”; and another said, “they are always polite and ask what I would like”. The home has an Equality and Diversity policy that recognises the cultural and social needs and differences that are present in society. In the AQAA returned the manager told us “Our Residents come from different social backgrounds and some have different disabilities such as hearing impairment or sight deficit. The staff understand that some people will need a different level of assistance.” In discussion with the manager and staff issues relating to different cultural backgrounds have not yet arisen within the service provision. Both management and staff demonstrated clear knowledge and desire to meet cultural and diversity needs as and when they should arise. Bay View Nursing & Residential Care Home Ltd. DS0000049283.V350764.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Social activities and meals are both well managed, creative and provide daily variation and interest for people living in the home. Residents right to choice and control over their lives is well respected, and encouraged. Autonomy and personal choice is promoted, helping residents to maintain independence. Friendly staff always welcomes relatives and visitors. EVIDENCE: An excellent range of activities is provided with posters displaying information of forthcoming events throughout the home. Residents spoken with said, “we have plenty of choice and variety”. One resident said, “the activities are marvellous”. Four of the residents spoken with said they would “like more activities that interested them e.g. board games, and speakers”. One resident told us they felt the activities are a “bit old fashioned”. In the AQAA the provider returned we were told, “Activities take place on a daily basis. We have an activities facilitator plus an NVQ Level 3 Carer who has attended a course for activities for older people”. A photo album and display of various activities were seen with different residents seen taking part. Bay View Nursing & Residential Care Home Ltd. DS0000049283.V350764.R01.S.doc Version 5.2 Page 14 During the inspection the activities facilitator was seen preparing residents and one of the lounge areas for a sing a long. A visiting musican came and the residents all appeared to be enjoying it. Also during the inspetion residents were seen being offered the opportunity to watch televisison or to sit quietly and read the newspaper. Some residents wer quite happy listening to the radio in the dining room. Residents when spoken with said “there is always something we can do, or join in with if we want”. Another resident told us “I am very happy here and its down to the girls. They let me do what I want when I want, join in or not depending how I feel. Sometimes they just come and talk to me”. During the inspection staff were observed providing 1:1 attention to residents in the form of nail care, companionship or encouraging communication. One of the staff showed us the work she is doing for, and with, residents to assist in developing their speech and recognition skills. The effects of this work were verified by two relatives who spoke of how it had improved their spouse’s life and given them back some quality. Other members of staff when interviewed knew of this work and how to utilise it for the benefit of residents. The local churches visit regularly to give holy communion to any residents who wish to attend and services are held at Christmas,Easter and harvest Thanksgiving. To ensure meal times are a relaxing social affair the dining room has been recently redecorated. There are 2 sittings at lunch, separating those who require assistance from those who do not. This is commendable and encourages a social atmosphere and ensures staff are able to concentrate and give appropriate time to those that need assistance with their meal. The residents have a choice of two main courses, the cook goes to each resident discussing menus and discussing their choice - this is recorded on the daily record. The home has developed a special colourful photographic menu which assists residents with dementia to be able to choose their food. This is based on recent research from the developing wealth of knowledge in this area. The home has four lounges and a dining room, one lounge has a TV. This gives flexibility for residents who choose to be in a quiet room and to be with the people they choose. Several visitors were seen coming and going during the inspection. Relatives spoken with said they could come any time and felt that their relatives were well looked after by friendly staff. One relative said, “the staff are so patient and residents never look untidy or uncomfortable”. Bay View Nursing & Residential Care Home Ltd. DS0000049283.V350764.R01.S.doc Version 5.2 Page 15 Choice and preference is well respected. There was evidence of a good rapport between residents and staff, with lots of laughter and encouragement. Care records contained clear information about their likes and dislikes and residents’ preferred daily routine. The kitchen is clean, tidy and well organised. The lunch served during the inspection looked appetising and well presented. Good practice was seen in the manner in which care staff were helping residents with their meal. All residents spoken with about the food said ‘it is good’. Many said they “ like the meals, and the choices offered”. Bay View Nursing & Residential Care Home Ltd. DS0000049283.V350764.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are confident that they are listened to and their requests acted upon. Knowledgeable and competent staff protect residents. EVIDENCE: The home has a comprehensive complaints procedure and all residents receive a copy on admission. One relative and two residents in the survey responses told us they did not know how to make a complaint. All residents and relatives spoken with during the inspection were aware of the complaints policy. The complaints policy and procedure is displayed in the hallway of the home providing information to all. There have been no complaints since the last inspection. All residents stated that if they were not happy about anything they would speak to the manager. Staff and residents spoken to, say the manager is very approachable and understanding. Three residents said ‘I’ve nothing to complain about, it’s a lovely home”. A record of complaints received, with actions taken and outcomes is kept to show residents are responded to, and the information used to inform the running of the home for the residents’ benefit. Residents are on the polling list and are facilitated to make use of their of postal vote if they so wish. Bay View Nursing & Residential Care Home Ltd. DS0000049283.V350764.R01.S.doc Version 5.2 Page 17 A comprehensive policy and procedure for responding to allegations of abuse is available, together with the Local Adult Protection (No Secrets in North Somerset) guidelines. It is recommended that the local policy be crossreferenced with the ‘No Secrets in North Somerset’ document to ensure consistency of information for the protection of residents. . The home also has a Whislteblowing policy and staff said they would report any concerns to the manager. Staff said they had never seen any signs of abuse in the home and demonstrated a good understanding of what abuse is. Staff said they have received training in the recognition and handling of abusive situations for the safeguarding of residents. This was verified during inspection of training records. It is recommended that both the above policies include the details of CSCI and Care Connect to ensure all staff know where, and how, to report incidents should they witness anything they think that may be abusive. In the AQAA the provider told us “To encourage people to feel free to complain or whistleblow we have a locked post box situated in the hallway where staff or relatives can discreetly give anonymous information”. Staff and relatives interviewed confirmed thay knew about this and wouldf have no hesitation in using it if necessary. Care plans inspected showed that consent for the use of bedrails had been obtained from residents or relatives thus safeguarding choice. Issues of consent were discussed in relation to the Mental Capacity Act 2005 and the need to protect residents, who we think lack capacity, through the process outlined in the Act. While the manager has some understanding of the implications of this, and she and some of the staff have received training, the implications and implementation of the issues in practice, are being developed for the protection of residents. All residents spoken with said ‘the staff are very kind’; ‘they take time to help me’; ‘I can’t fault them’. Bay View Nursing & Residential Care Home Ltd. DS0000049283.V350764.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with homely, safe and comfortable surroundings. The home has suitable equipment to maximise resident independence. Robust Infection Control practices are followed. EVIDENCE: The property is well maintained, with homely and comfortable communal spaces. The living accommodation is well decorated and homely. Residents’ rooms are personalised and comfortable. All rooms are provided with vanity units. Shared rooms have screening to ensure privacy is maintained. Residents, in shared rooms, spoken with confirmed that screening is always used when they are being assisted with personal care. The décor, fixtures and fittings are in good order. Bay View Nursing & Residential Care Home Ltd. DS0000049283.V350764.R01.S.doc Version 5.2 Page 19 Each room has non-slip flooring around the bed area, reducing unpleasant odours and enabling easy cleaning. The remainder of the room is carpeted to give the feel of a homely environment. Two of the lounges and the dining room have recently been redcorated. In the AQAA we were told that “advice was sought from residents who assisted in chosing the décor”. This was confirmed by three residents spoken with during the inspection. Maintenance and refurbishment plans and records are kept, to ensure the homes’ environment is maintained at a high standard. A hearing loop system has been fitted to assist some residents with communication. Around the outside of the home is a pleasant garden to which all residents can have access. Two residents needing assistance to access this area told us in their survey responses, that they would like to be able to have greater acces to this area. The home has sufficient bathrooms and lavatories to meet the needs of the residents. The home has grab rails situated at relevant points and a shaft lift that is easily used to assist resident mobility, and aid independence within the home. All resident rooms are provided with a lockable space for securing personal possessions, if desired, and door locks that are accessible to staff in an emergency. In the AQAA the provider told us “Each nursing bed has a high risk mattress and there are a number of electrically operated high risk mattresses”. These were observed to be in use during the inspection, and staff interviewed spoke of the use of these when asked about specific residents’ care. The home has five hoists and each resident who requires turning has their own sliding sheet. Other equipment is available to assist in moving and handling. The home was clean and free from offensive odours throughout. The laundry facilities were well organised. Staff interviewed and observed demonstrated good understanding of Infection Control procedures and practices and maintained a clean and hygienic environment. The home has good facilities for ensuring that staff can maintain good hand washing practices, between caring for residents. Bay View Nursing & Residential Care Home Ltd. DS0000049283.V350764.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s staffing levels are sufficient to manage the care needs of residents. The procedures for the recruitment of staff are robust and provide the safeguards required for residents’ protection. Evidence that staff access training to ensure training is matched to the residents needs is limited. EVIDENCE: Staff went about their duties in an unhurried manner and were observed spending time talking with residents. Residents reported, “staff make time for a chat when they can.” Staff approached residents with directness, openness and consideration. Each of the resident’s with whom the inspector spoke said, “ the staff are very good”. Copies of two weeks staffing rosters were supplied to the inspector. These documents were not labelled and did not have the managers duties recorded, thus not giving a comprehensive record of staff on duty to meet residents’ needs. Where there are gaps in the staffing levels due to unexpected absence records should be kept of the process to fill those gaps, to demonstrate appropriate management for the benefit of residents. . Staffing levels rostered are sufficient to meet the needs of residents. Bay View Nursing & Residential Care Home Ltd. DS0000049283.V350764.R01.S.doc Version 5.2 Page 21 A sufficient team of ancillary workers supports care and nursing staff to ensure the smooth running of the service. Residents spoken with told the inspector “staff are always there when you need them”; “ you only have to ring the bell and they come”. Staff interviewed said that they were kept busy, but still had time to chat with the residents. Call bells were answered promptly during the inspection. The home has a Primary Nurse system in place for all residents. Relatives and residents were aware of the role and said, “it worked well”. A few of the staff team employed at the home are from overseas. Residents and staff said, “they fit into the team well”. Comments of concern were received from two relatives surveys in which they told us that communication with overseas staff could be a problem. None of the residents or relatives spoken with during the inspection found this to be a problem. Recruitment procedures are robust and all three files inspected contained the required documentation. Gaps in employment had not been fully recorded on the interview notes, this is recommended to ensure all safeguards are fully completed for the protection of residents. All staff interviewed stated they had contracts of employment and job descriptions. Newly appointed staff confirmed they had completed an induction programme and evidence of this was seen for all staff in their personnel files. For accountability purposes it is recommended that induction records are signed and dated by both the employer and the new employee, to ensure the employee has understood and feels able to work safely in providing care for residents. The home provides in house mandatory training however records of attendance are not clear and renewal dates not identified. The home does not have a training plan and there was no evidence that training is matched to meet staff needs following supervision or appraisal. This is required to ensure staff have current skills and knowledge to meet residents needs in a safe manner. Records inspected showed that staff had not received abuse, infection control or food handling training in the last year. The manager, and administrator who maintains the records, told us that staff had received training in all mandatory areas in the last year. In the four files inspected two did not have any evidence of fire training, food handling training or abuse training, and one did not have evidence of infection control training. Staff when interviewed confirmed that they had received training in all mandatory topics and demonstrated a good knowledge and understanding of these areas, for the safety of residents. Staff spoke of the high priority given to training and gave examples of specialist training undertaken e.g. training in helping people with Learning Disabilities from the Brandon Trust; Palliative care from the local hospice. Bay View Nursing & Residential Care Home Ltd. DS0000049283.V350764.R01.S.doc Version 5.2 Page 22 The home views training as very important and all but one of the care staff have an NVQ qualification. Interviews with staff verified they had undertaken a wide range of training and had good knowledge with which to meet residents’ needs. The Home is accredited by the University of the West of England and provides a placement for two student nurses at any one time. They are supernumerary to the workforce and staff told us that their presence ensures they maintain a wider focus than the home, thus ensuring current good practice guidelines are known. Bay View Nursing & Residential Care Home Ltd. DS0000049283.V350764.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager provides clear leadership and guidance to staff to ensure residents receive consistent care in a safe environment. Quality assurance processes in the home are formal demonstrating that the home consults with residents, families and visiting professionals. The management of resident’s monies in the home are well managed. Staff are appropriately supervised. Health and safety issues are monitored in the home to ensure that issues are identified and addressed where they arise. EVIDENCE: The registered manager is qualified and competent to run the home. She is a qualified and experienced nurse manager who is familiar with the conditions diseases of old age. Bay View Nursing & Residential Care Home Ltd. DS0000049283.V350764.R01.S.doc Version 5.2 Page 24 The manager gives clear leadership, guidance and direction to staff. Residents feel she is approachable, available, and seeks to ensure all their needs are met. Staff interviewed stated that they felt well supported by an approachable manager. A formal quality assurance tool was available for inspection in order to demonstrate that the home consults with residents, and that comments from them are acted upon. Regular audits of various aspects of the home are carried out each month. The results of these audits are not formally collated and reported to residents and staff to demonstrate the good practice of the home and provide a forum for ideas for the development of service provision. Residents and relatives told the inspector that they were always encouraged to express their view and “to air any grumbles”. One resident said, “the manager is very proactive and helpful in many ways”. The management of resident monies by the home were inspected. No cash is held by the home as all residents have an account for extras for which they are billed monthly. Supervision for staff takes place on an informal basis during the year culminating in an appraisal. Staff interviewed said ‘supervision does take place regularly and when needed’. Records inspected showed that issues relating to resident care, personal and professional development had been discussed and actions planned to address issues raised. The manager has implemented a new system in which supervision is cascaded down through the organisational structure, thus ensuring no one person is overburdened. Records inspected indicated regular safety and fire checks are carried out. Staff spoken to confirmed that regular fire instruction and drills had taken place. During the inspection a number of fire doors were observed not shutting flush to the frame, thus not providing the necessary safety mechanism for residents. When we raised this with the manager the maintenance man was requested to check and adjust the doors immediately. Later in the inspection he was seen doing this. A number of staff have received First Aid training. All accidents and incidents are well recorded and audited by the manager monthly for any trends. There is a visitor’s booklet on display in the hall giving information for visitors regarding their safety in the home. Records indicating regular maintenance to gas and water systems were seen, together with servicing records for all equipment. Bay View Nursing & Residential Care Home Ltd. DS0000049283.V350764.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 4 2 4 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 1 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Bay View Nursing & Residential Care Home Ltd. DS0000049283.V350764.R01.S.doc Version 5.2 Page 26 NO 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 OP27 Regulation 17.2 Schedule 4.7 Requirement You must keep in the home an accurate and clearly labelled record of persons rostered to work in the home, and whether they were actually worked. This must include the registered manager. The registered person must ensure that staff receive training appropriate to the work they are to perform and evidence that this is provided through records. Timescale for action 21/01/08 2. OP30 18.1 (c) 21/01/08 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. 2. Refer to Standard OP2 OP9 Good Practice Recommendations The contract or Terms and Conditions of residency agreement to include the room to be occupied for clarity and assurance for prospective residents. To ensure two members of staff sign hand written entries on Medication Administration Records for the safeguarding of residents. DS0000049283.V350764.R01.S.doc Version 5.2 Page 27 Bay View Nursing & Residential Care Home Ltd. 3. OP9 That clear records are kept of medication received, and administered or not, for the protection and welfare of residents. All staff to receive training in the Mental Capacity Act and its implications for practice, for the protection of residents. All gaps in employment are explored at interview and recorded on interview notes to ensure all required safeguards are completed for the protection of residents. The collation of all audit results and feedback to staff and residents for information and participation in the ongoing service provision. 3. 4. OP18 OP29 5. OP33 Bay View Nursing & Residential Care Home Ltd. DS0000049283.V350764.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bay View Nursing & Residential Care Home Ltd. DS0000049283.V350764.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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