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Inspection on 13/11/07 for Bay Court Nursing and Residential Home

Also see our care home review for Bay Court Nursing and Residential Home for more information

This inspection was carried out on 13th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 home is managed well with an atmosphere that is welcoming and caring. The environment is homely and furnished to a satisfactory standard. The people who were able said they liked living in the home and said staff are caring, helpful, hardworking and kind. This was observed throughout the inspection. The admission procedure at the home is good. Staff at the home gather enough information to decide whether the home can meet their needs. The person and their family also receive enough information and have time to decide whether the home is the right place for them to be.Care Plans at the home have enough information to identify each person`s basic needs and highlight any health care needs. Staff have an in depth knowledge and understanding of the needs of people who use the service. Personal care is provided in a caring way. Verbal and informal communication is very good at the home, which means that information about people in the home is passed on to all staff. People who use the service are encouraged to maintain links with their friends and family and have access to advocacy services. Promotion of the persons spirituality is respected and supported well by the home. Some meals are good at the home with balanced and varied meals being provided. Discreet help and specialist equipment are provided where required to promote independence. Access to a full range of health care is maintained at the home and the medication systems are managed well. Specialist advice is sought where necessary. The environment is generally a clean and safe place for people to live and work. The management of fire safety and specialist equipment is managed well at the home. A stable and dedicated staff group care for people who use the service. The induction process is thorough which means that staff are provided with enough information to perform their roles safely. Staff have opportunities to attend formal training (NVQ-National vocational qualification training) which ensures they have the skills and knowledge to perform their roles. The quality of the service is kept under review informally on a day-to-day basis with the presence of the manager and more formally through questionnaires and audits. This means that the service changes to reflect the changing needs of people in the home.

What has improved since the last inspection?

Feedback from relatives and people who use the service has prompted the purchase of new chairs for their rooms. Smaller tables for the lounge has made the room appear less cluttered Changes to the way medications are stored have been introduced with the introduction of a new drugs fridge. A formal system for the disposal of medications has also been commenced by the home. Allergies and photos are also recorded on the medication administration chart. The promotion of spirituality continues at the home with the introduction of a specific religious service occurring at the home. Questionnaires on front table provide an opportunity for people who use the service, their families and other parties to provide anonymous feedback.

What the care home could do better:

Maintaining the safety of people who use the service must be a priority of the staff at the home. This can be done in a number of ways. Staff must receive formal training in the protection of vulnerable adults. This will ensure they are aware of the different types of abuse, how they can be prevented and how staff can report allegations correctly and promptly. Staff should also be provided with local contact details where abuse can be reported in the absence of the manager. Staff must also be made aware of what restraint is, and understand that inappropriate use of equipment can be classed as restraint. Staff must also be aware that the use of some equipment is discouraged unless an assessment has highlighted this as a need for safety and not just for the convenience of the home. The home must also consider issues about capacity to consent to this decision and show that discussions have been made with health care professionals and care managers. Staff must also develop robust risk assessment processes to show that checks have been performed and equipment is safe and appropriate to use. Records and care plans must also be improved to show how decisions have been made and must reflect the care that has been given. People must also be safeguarded from financial abuse. The manager must improve systems at the home to ensure the storage and management of personal money is secure and protects the person. Improvements to the recruitment process will also protect people by providing evidence that staff have received all the checks. This will show they are suitable to work with vulnerable adults. The manager must ensure the information required is provided and kept within the care home. Safety can also be improved by simple measures that prevent risks. Bath temperatures should be recorded formally to show checks are performed. This will reduce the risk of a person being scalded in the bath. Warning signs should also be placed where oxygen cylinders are stored. This will provide warnings in the event of a fire.Improvements to staffing levels would mean that care is not rushed and will show the home are responding to the changing needs of people who use the service. Sufficient staff should be available so care can be given at an appropriate rate that does not out pace the person. This will also mean that people who use the service have time to understand what is happening to them. Nutrition can be improved at the home with a review of the supper menu. The manager should look at the food provided to ensure it is wholesome, nutritious and sufficient for the needs of the people who use the service. The manager should also improve the management of nutrition risks by considering how people can be weighed if they are unable to stand unaided. The manager should look at the programme of replacing divan beds for the people who receive nursing care. This should be prioritised where adjustable beds would alleviate medical conditions. People who use the service must have opportunities to exercise. This will help reduce the risk of falls but will also help maintain their mobility. Staff must consider their work practices to ensure that routines are in the best interest of the person and not for the staff, this should include the use of wheelchairs. A programme of activities must be introduced for all people who use the service and not available to those more able. People must be consulted and a programme of activities introduced to provide a stimulating life. People should also be reminded that the routines of the home are flexible if they choose. This will ensure people maintain some control over their lives. The manager must ensure all staff follow infection control procedures. An infection control audit is recommended to ensure best practice is occurring at the home. Staff should be reminded about the importance of wearing gloves and the way bedpans are washed should be reviewed to reduce the spread of infection. Accidents should be recorded accurately and call bells should be within reach to people who use the service and should not be tied up off the floor. The environment should be improved to ensure worn furniture and decoration is renewed where appropriate. Systems should be introduced to ensure there is an effective programme of routine and ad hoc repairs and maintenance at the home. Regular checks must be made by the Provider to ensure the home is being run in the best interest of the people living there. The manager should ensure the way she manages the home is open and inclusive and that staff have opportunities to share ideas or raise concerns. Supervision should be extended to show that aspects of care are discussed and training needs highlighted. The manager should also look at the quality of staff training to show that it reflects best practice and is appropriate for the workBay Court Nursing and Residential Home DS0000026700.V350418.R01.S.doc Version 5.2 Page 9place. The manager must ensure she and her staff are a

CARE HOMES FOR OLDER PEOPLE Bay Court Nursing and Residential Home 16-18 West Hill Budleigh Salterton Devon EX9 6BS Lead Inspector Clare Medlock Unannounced Inspection 13th November 2007 10:00 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 Court Nursing and Residential Home DS0000026700.V350418.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 Court Nursing and Residential Home DS0000026700.V350418.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bay Court Nursing and Residential Home Address 16-18 West Hill Budleigh Salterton Devon EX9 6BS 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) 01395 442637 Court Healthcare Limited Miss Susan Rosemary Stevens Care Home with Nursing 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Bay Court Nursing and Residential Home DS0000026700.V350418.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Notice of Proposal to Grant Registration of staffing/environmental conditions of registration issued 1/3/1999 18th October 2006 Date of last inspection Brief Description of the Service: Bay Court is situated in the centre of Budleigh Salterton in East Devon. The home has level access to the local shops some 200 metres from the home. Bay Court has three communal sitting areas in addition to a dining room. There are 24 bedrooms arranged over three floors. Qualified nursing staff are on duty 24 hours a day. The ethos of the home is to provide a relaxed homely environment in which the staff are able to care for people over the age of 65 years who require either personal or nursing care. At the time of this inspection the cost of care was £496.00 to £650.00 per week. Additional costs, not covered in the fees, include chiropody, hairdressing and personal items such as toiletries and newspapers. Current information about the service, including Commission for Social Care Inspection reports, Statement of Purpose and Service User Guide are available within the entrance hall. Bay Court Nursing and Residential Home DS0000026700.V350418.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on Tuesday 13th November 2007. The registered manager was present throughout the inspection. Prior to the inspection the manager completed a questionnaire, called an AQAA (Annual quality assurance assessment). This provides information about people who use the service, staffing levels, fees, and home maintenance records. It informs us whether these records and procedures are in place. Before the inspection we also sent out questionnaires to the people living in the home, their families and their health care professionals. We received six questionnaires from people who use the service. Eleven questionnaires from relatives or advocates and four from health care professionals. We also received eleven questionnaires from staff. All this information gives us a picture of what it may be like at the inspection and helps focus the inspection on what matters to the people who use the service. On the day of inspection we “case tracked” three people who use the service. This means the inspector spoke with staff about individual care, read the persons records and either spoke with the person or made observations if the person was unable to speak with us. We spoke with staff who were on duty. We also looked around the building and inspected other records. These included, accident records, staff files, medicine records, complaint records, care plans, maintenance records and other workbooks. What the service does well: The home is managed well with an atmosphere that is welcoming and caring. The environment is homely and furnished to a satisfactory standard. The people who were able said they liked living in the home and said staff are caring, helpful, hardworking and kind. This was observed throughout the inspection. The admission procedure at the home is good. Staff at the home gather enough information to decide whether the home can meet their needs. The person and their family also receive enough information and have time to decide whether the home is the right place for them to be. Bay Court Nursing and Residential Home DS0000026700.V350418.R01.S.doc Version 5.2 Page 6 Care Plans at the home have enough information to identify each person’s basic needs and highlight any health care needs. Staff have an in depth knowledge and understanding of the needs of people who use the service. Personal care is provided in a caring way. Verbal and informal communication is very good at the home, which means that information about people in the home is passed on to all staff. People who use the service are encouraged to maintain links with their friends and family and have access to advocacy services. Promotion of the persons spirituality is respected and supported well by the home. Some meals are good at the home with balanced and varied meals being provided. Discreet help and specialist equipment are provided where required to promote independence. Access to a full range of health care is maintained at the home and the medication systems are managed well. Specialist advice is sought where necessary. The environment is generally a clean and safe place for people to live and work. The management of fire safety and specialist equipment is managed well at the home. A stable and dedicated staff group care for people who use the service. The induction process is thorough which means that staff are provided with enough information to perform their roles safely. Staff have opportunities to attend formal training (NVQ-National vocational qualification training) which ensures they have the skills and knowledge to perform their roles. The quality of the service is kept under review informally on a day-to-day basis with the presence of the manager and more formally through questionnaires and audits. This means that the service changes to reflect the changing needs of people in the home. What has improved since the last inspection? Feedback from relatives and people who use the service has prompted the purchase of new chairs for their rooms. Smaller tables for the lounge has made the room appear less cluttered Changes to the way medications are stored have been introduced with the introduction of a new drugs fridge. A formal system for the disposal of medications has also been commenced by the home. Allergies and photos are also recorded on the medication administration chart. Bay Court Nursing and Residential Home DS0000026700.V350418.R01.S.doc Version 5.2 Page 7 The promotion of spirituality continues at the home with the introduction of a specific religious service occurring at the home. Questionnaires on front table provide an opportunity for people who use the service, their families and other parties to provide anonymous feedback. What they could do better: Maintaining the safety of people who use the service must be a priority of the staff at the home. This can be done in a number of ways. Staff must receive formal training in the protection of vulnerable adults. This will ensure they are aware of the different types of abuse, how they can be prevented and how staff can report allegations correctly and promptly. Staff should also be provided with local contact details where abuse can be reported in the absence of the manager. Staff must also be made aware of what restraint is, and understand that inappropriate use of equipment can be classed as restraint. Staff must also be aware that the use of some equipment is discouraged unless an assessment has highlighted this as a need for safety and not just for the convenience of the home. The home must also consider issues about capacity to consent to this decision and show that discussions have been made with health care professionals and care managers. Staff must also develop robust risk assessment processes to show that checks have been performed and equipment is safe and appropriate to use. Records and care plans must also be improved to show how decisions have been made and must reflect the care that has been given. People must also be safeguarded from financial abuse. The manager must improve systems at the home to ensure the storage and management of personal money is secure and protects the person. Improvements to the recruitment process will also protect people by providing evidence that staff have received all the checks. This will show they are suitable to work with vulnerable adults. The manager must ensure the information required is provided and kept within the care home. Safety can also be improved by simple measures that prevent risks. Bath temperatures should be recorded formally to show checks are performed. This will reduce the risk of a person being scalded in the bath. Warning signs should also be placed where oxygen cylinders are stored. This will provide warnings in the event of a fire. Bay Court Nursing and Residential Home DS0000026700.V350418.R01.S.doc Version 5.2 Page 8 Improvements to staffing levels would mean that care is not rushed and will show the home are responding to the changing needs of people who use the service. Sufficient staff should be available so care can be given at an appropriate rate that does not out pace the person. This will also mean that people who use the service have time to understand what is happening to them. Nutrition can be improved at the home with a review of the supper menu. The manager should look at the food provided to ensure it is wholesome, nutritious and sufficient for the needs of the people who use the service. The manager should also improve the management of nutrition risks by considering how people can be weighed if they are unable to stand unaided. The manager should look at the programme of replacing divan beds for the people who receive nursing care. This should be prioritised where adjustable beds would alleviate medical conditions. People who use the service must have opportunities to exercise. This will help reduce the risk of falls but will also help maintain their mobility. Staff must consider their work practices to ensure that routines are in the best interest of the person and not for the staff, this should include the use of wheelchairs. A programme of activities must be introduced for all people who use the service and not available to those more able. People must be consulted and a programme of activities introduced to provide a stimulating life. People should also be reminded that the routines of the home are flexible if they choose. This will ensure people maintain some control over their lives. The manager must ensure all staff follow infection control procedures. An infection control audit is recommended to ensure best practice is occurring at the home. Staff should be reminded about the importance of wearing gloves and the way bedpans are washed should be reviewed to reduce the spread of infection. Accidents should be recorded accurately and call bells should be within reach to people who use the service and should not be tied up off the floor. The environment should be improved to ensure worn furniture and decoration is renewed where appropriate. Systems should be introduced to ensure there is an effective programme of routine and ad hoc repairs and maintenance at the home. Regular checks must be made by the Provider to ensure the home is being run in the best interest of the people living there. The manager should ensure the way she manages the home is open and inclusive and that staff have opportunities to share ideas or raise concerns. Supervision should be extended to show that aspects of care are discussed and training needs highlighted. The manager should also look at the quality of staff training to show that it reflects best practice and is appropriate for the work Bay Court Nursing and Residential Home DS0000026700.V350418.R01.S.doc Version 5.2 Page 9 place. The manager must ensure she and her staff are also up to date with the required mandatory training and specialist training to ensure they have the skills, knowledge and competence to care for people in a safe and appropriate way. 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 Court Nursing and Residential Home DS0000026700.V350418.R01.S.doc Version 5.2 Page 10 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 Court Nursing and Residential Home DS0000026700.V350418.R01.S.doc Version 5.2 Page 11 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, and 5 (The home do not provide intermediate care) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The effective admission and assessment procedures in place ensure that peoples are able to make an informed choice about where they want to live. EVIDENCE: The people we spoke with told us it was their decision or their family’s decision to move to the home. One person said she knew the home before and wanted to come to Bay Court. Another person said they were too poorly but their family came to look at the home before moving here. Questionnaires from people who use the service confirmed that enough information is provided before moving to the home. All questionnaires ticked that they had received enough information and one comment included ‘It was Bay Court Nursing and Residential Home DS0000026700.V350418.R01.S.doc Version 5.2 Page 12 a nice friendly home and I knew someone in the place and I wanted to stay in Budleigh Salterton’ The manager said trial visits are available but the majority of people are too poorly to visit before they come to the home. The manager also told us that all people have a trial period in which they can spend time to decide whether the home is right for them. Questionnaires received from people who use the service contained a comment that read ‘I entered on an open ended basis but it became necessary for me to stay’ We case tracked three people who use the service. All three people had been thoroughly assessed before coming to the home. This included getting information from the person, their family and other health care professionals who were caring for them. The manager told us that she visits people before they come to the home to perform this assessment. Each person receives a contract from the home, which sets out details about the room, fees and terms and conditions of what the person can expect. The manager stated that she is currently reviewing how written information is provided at the home and would like to introduce an initial pack for enquiries before further documents are provided. Bay Court Nursing and Residential Home DS0000026700.V350418.R01.S.doc Version 5.2 Page 13 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 and 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Health and personal care needs are met but sometimes rushed which means people who use the service do not always have control over what is happening. Care Plans are generally good but changes would improve communication and reflect the care that is given. More equipment would mean that health care needs could be met more effectively. The effective medication practices protect the person’s health and welfare. EVIDENCE: People seen on the day of inspection appeared generally well cared for. Those people who were being nursed in bed appeared warm, clean and pain free. Specialist mattresses and other pressure relieving equipment was available Bay Court Nursing and Residential Home DS0000026700.V350418.R01.S.doc Version 5.2 Page 14 throughout the home. Finer details of care had been given. These include clean nails, appropriate footwear and attention to personal and oral health. Questionnaires received from people were generally positive about the staff and healthcare they receive but comments also showed that care was sometimes rushed. Many comments were received about staff being too busy and rushing care. One comment received read ‘Sometimes the reason for doing things are not explained which confuses her’. Feedback from staff also confirmed that sometimes they ‘had to rush to get the work done’ and that ‘it would be really nice to spend more time with the people who use the service’. Staffing issues are referred to later in this report. Other comments about the care received at the home. These included ‘Her health has improved since leaving hospital’ and ‘Staff are helpful with knowledge about mobility and risk and prevention of falls’ and ‘they are supporting her disability needs appropriately’. People told us that staff help them to be independent and to take responsibility for their own personal hygiene where appropriate. People told us there were routines at the home, which included set days for bath. One person said this day could be changed but another person was not sure if this was possible. People living at Bay Court have access to health care services both within the home and in the local community. The majority of people who live at the home access the local GP (general practitioner) and attend local dentists, opticians and other community services including chiropodist. Health needs are monitored and appropriate action and intervention taken. An example of this included the registered nurses obtaining specialist advice from wound care specialist nurses. Each person has a care plan that records personal details, medical history, skin assessment, care plans and details of health care professional visits. There are some gaps in information including the reason why major decisions about care had been made. Staff were able to give a detailed verbal update but improvements to records would improve communication, safety and consistency. Nutritional assessments were seen in all three care plans however observation confirmed the home do not have access to scales to weigh those people who are unable to stand independently This is useful for monitoring the needs of those people who are at risk of being over or under weight. The manager explained that staff at the home are considering new nutritional assessments. People who use the service and staff told us there are no formal opportunities for exercise. Those people who were more independent were able to walk Bay Court Nursing and Residential Home DS0000026700.V350418.R01.S.doc Version 5.2 Page 15 around the home and walk into town. However feedback from relatives raised concerns about the lack of exercise and mobility opportunities. Comments from relatives included ‘I am concerned that they are left in the wheelchair rather than transferring to another chair’ and ‘We would like to see her use her legs more rather than being taken everywhere in the wheelchair’ All feedback was that staff were very kind and worked extremely hard. People told us that although staff seemed very busy, they meet their needs and said staff generally treat them in a way that is respectful. One person said staff make sure the doctor is called when needed and that staff give out medicines on time. Medication records are up to date for each person. Medicines received, administered and disposed of are recorded appropriately. Each person has a locked cabinet in their room for their medication to be stored in. Staff then come to each room and administer the medicines or take them to the place where the person has chosen to be. No one was self administering their own medication at the home which was appropriate for the needs of the people being cared for. Further storage for medication is available in other areas of the home. Changes to the way medications are stored have been introduced with the introduction of a new drugs fridge. A formal system for the disposal of medications has also been commenced by the home. Allergies and photos are also recorded on the medication administration chart. People told us that staff maintain their dignity when personal care is being given. Staff were seen to knock before entering rooms and prevented entry when personal care was being given. Two of the three care plans we inspected detailed the wishes of individuals about terminal care and arrangements after death is recorded. All care plans had contact details of family, next of kin or other representatives. Bay Court Nursing and Residential Home DS0000026700.V350418.R01.S.doc Version 5.2 Page 16 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): 12,13,14,15 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The routines of daily living and limited range of activities means that people are not always offered a flexible stimulating place to live. People generally receive a wholesome balanced diet but improvements to the supper menu would mean people get a more satisfying meal. EVIDENCE: The overwhelming feedback from people who use the service, their relatives and staff was that there were not enough activities arranged by the home. One comment from a relative included ‘It seems OK if they are independent or happy with their own company but for the rest of them there is nothing for them to do apart from stare at the TV.’ Some questionnaires contained information that people were able to walk into town whenever they chose and were able to attend local churches and church groups. Other questionnaires said there was not enough going on. All questionnaires and observation confirmed that links with family and friends are supported and encouraged. Bay Court Nursing and Residential Home DS0000026700.V350418.R01.S.doc Version 5.2 Page 17 Staff told us if they know someone is going out for the day they ensure they help the person get ready in time. Comments about activities confirmed that for those people who are not independent there is not enough being done to provide a stimulating environment. Comments from questionnaires included ‘There is no stimulation in the lounge. Six or seven spend their day in the lounge with no stimulation apart from watching TV’ and ‘More stimulus is needed-simple exercises, craft reading and games’ and ‘there is no provision of 1:1 which would enable her to go out when she wanted’ Staff questionnaires also stated that a way the home could be improved would be to have more activities and for staff to spend more time with the people who use the service. People we were case tracking confirmed these comments. Those that were more independent told us they entertained themselves most of the time and went out to visit friends, attend church and had opportunities to entertain themselves when they chose. Two of the three people we case tracked said they would attend activities if they were appropriate. Another person we were case tracking was unable to hold a conversation but observation confirmed they spent the day in their room with no stimulation. The home do not have an activities coordinator or a regular programme of events. People told us they ‘sometimes have someone who reads poetry’ On the day of inspection the manager was arranging a game of scrabble for those that were more able. People told us they have some choice about their lives at the home but that there are strict routines so staff could ‘fit every one in’. One person told us they would like more baths but they have been allocated one bath a week. This person thought the time of day or day of the week could be changed but that they had not tried to do this. Another person said they were ‘not sure if this was allowed’. People told us that staff support them when they have a specific activity they want to attend. An example of this is that staff enable the person to be ready in time to attend their local church and church activities. Staff told us this was easy to do and that if people had any other religious beliefs they would try their best to support the person in any way they could. People told us that they are able to see their friends and families whenever they chose and could use the communal areas, their room or other smaller and quieter rooms for privacy. Visitors told us all staff are welcoming and friendly when they visit the home. A tour of the building confirmed people who use the service are able to bring personal possessions and small items of furniture to the home. People told us they are able to control their own finances where possible. The manager gave Bay Court Nursing and Residential Home DS0000026700.V350418.R01.S.doc Version 5.2 Page 18 an example where an outside advocate was obtained to support one person who had a specific need. Feedback about food was mixed. People we spoke to said the food was ‘OK’ or ‘Not bad’ or ‘lovely’. Feedback from questionnaires was also mixed. Positive comments included ‘The home provides a good varied menu especially at lunchtime’ and ‘staff cut up food to help her eat unaided’ Negative comments included ‘The food is poor, breakfast cold, food inedible, nobody asks what do they like. It’s all meat and mince’ and ‘Food is inappropriate for this age groupTrifles, instant whips and packet soups are not right for elderly people’ People told us that the food was served hot and staff told us the routine in the morning meant that drink and food was able to be served hot. The lunchtime meal was sampled and found to be full of texture colour and flavour using freshly prepared ingredients. The meals that had been pureed were also full of flavour. The menu showed a difference between the quality of meals served at lunch and the quality at tea/supper time. Main lunchtime meals were balanced and offered a range of home cooking. Tea time/supper meals were less varied using packet soups, whips and pre packed ingredients. Soup was served most days and there were regular ‘whips and mousses’ served. Staff told us that the soups were packet-powdered soup. People told us there was often times when meals at supper times were inadequate and they needed a snack in the middle of the night. Staff said this was available upon request. Bay Court Nursing and Residential Home DS0000026700.V350418.R01.S.doc Version 5.2 Page 19 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): 16,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service can be confident that formal complaints will be dealt with appropriately. However, improvements to communication would ensure people know that their concerns are also listened to. The lack of vulnerable adult awareness training, lack of staff knowledge and poor safeguarding procedures mean that people are at risk. EVIDENCE: Bay Court has a complaints procedure that is clearly written and easy to understand. It is supplied to everyone living at the home and is displayed in the entrance hall. People who use the service told us they know who to speak to if they have a complaint but ‘try not to do this if possible’. Comments on resident, staff and relative questionnaires were mixed regarding how the home deal with complaints. One comment read ‘I got a poor response from the manager to my complaint’ another stated ‘It is not worth complaining because we are not listened to’ Another comment included ‘I have never needed to make a complaint’ Bay Court Nursing and Residential Home DS0000026700.V350418.R01.S.doc Version 5.2 Page 20 The manager maintains a complaint and concerns book. This contained only minor issues and showed what action has been performed. The manager told us there have been no formal or serious complaints received by the home since the last inspection. The Commission for Social Care Inspection have not received any complaints regarding this service since the last inspection. During the inspection, one person we were case tracking was found sitting in a bedroom in a chair that was being used inappropriately. This person was secured by means of a lap belt, which restricted their mobility and was unable to reach or use a bell to call for help. Care Plans and records did not explain why the person was being cared for this way. There were no records to show that this decision had been made in the best interest of the person or had been agreed with care managers and other health care professionals. Although staff were able to explain that this was being done to protect the person from falling from the chair, there was a lack of knowledge that this inappropriate use of this equipment could be seen as a form of restraint. An immediate requirement was issued to ensure this person was checked on a regular basis to ensure they were safe. A follow up letter was sent to ensure the manager provided evidence that this restraint was being performed in the best interest of the person and had been discussed with the care manager and multidisciplinary team. Some people who use the service were also seen to have bed rails in use. There were no records to show that an assessment had been made regarding this decision, or that the use of bed rails was based on the need to ensure the persons safety. There were no risk assessments in place to show that the equipment was appropriate or had been checked to ensure safety. Staff told us they had not received formal training on the protection of vulnerable adults but had watched a video in the past. Staff also confirmed they would have no doubts of reporting allegations of abuse but were not clear who they should report this to if the manager or senior nurse was absent. Staff told us they had received a CRB (criminal records bureau-police check) and POVA (protection of vulnerable adults register-employment check). Staff also sign a criminal declaration on their application prior to working. People who use the service have a small amount of money kept with the manager for ease of access when they need to pay for any extras. The management of this will be reported in a later section of this report. Whilst checking peoples ‘personal monies’ it was noted that systems were not in place to ensure the process is secure, which means that people may be at risk of financial abuse. Balances for four accounts were checked and found to be incorrect. Two accounts had too much money in and two accounts did not have enough. Bay Court Nursing and Residential Home DS0000026700.V350418.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Some improvement is required within the environment to ensure the home is a safe, hygienic pleasant place to live and work. EVIDENCE: Bay Court is a large period house that has been adapted to meet the needs of people who require nursing and personal care. There are 25 rooms some of which would be suitable for tow people who chose to share. All rooms have a wash hand basin but only a small number have ensuite toilet facilities. All rooms had a toilet within close proximity to their room. Bay Court Nursing and Residential Home DS0000026700.V350418.R01.S.doc Version 5.2 Page 22 The home has three floors and an extension which can be accessed by passenger lift. There are grab rails and ramps to assist those with mobility restrictions or wheelchair users. We were told by 2 staff members that there is no programme of routine maintenance, but that the process is more informal but continues where needed. The provider has notified us that there is a routine programme of maintenance. Since the inspection, the provider told us that fifteen rooms have been decorated and the outside of the home has been painted in the summer. New carpets have been fitted in some rooms. Whilst the home appeared to be in a good state of repair, some areas of the home were not. The garden was overgrown. The manager said that the home had not had a regular gardener for a while. In one bathroom a sink was coming loose from the wall, many rooms had areas of peeling wallpaper and had signs of general wear and tear. The majority of furniture was of a satisfactory standard but some items of furniture were looking worn. A number of sink surrounds were chipped and bedside tables were rusty. Feedback from relatives and people who use the service confirmed that the home is not always well maintained. Comments included: ‘The garden is poorly maintained’ and ‘It is a struggle to get things fixed e.g. TV electric sockets taps etc.’ and ‘It would be good to see a maintenance plan in place’ and ‘the Standard of furnishing in her room is dreadful’. The manager explained that there is a plan in place to extend the home to increase the size of the lounge and kitchen and provide more bedrooms. Records were seen of recent EHO (Environmental Health Office) and fire inspections, which showed the home were addressing any recommendations made. Call bells were available throughout the home. People told us that generally these are responded to promptly but sometimes they have to wait if staff are busy. Not all call bells were accessible. In more than one room the bell could not be reached and in two bathrooms then bell was tied up which means that it could not be used if someone was lying on the floor. Not all beds were adjustable beds despite being used for nursing care. One person had a medical condition where it is necessary to sit up in bed to alleviate their condition. Observation confirmed that this person was being cared for in a divan bed that was not adjustable. All areas of the home were warm, well lit and well ventilated. All radiators were covered and had low surface temperatures. The home was free from offensive odours and was generally clean and tidy. All bedrooms were clean and tidy. People who use the service told us their room was always clean and smelt fresh. Bay Court Nursing and Residential Home DS0000026700.V350418.R01.S.doc Version 5.2 Page 23 Laundry facilities are located separately and have machines that wash at suitable temperatures. Staff were not always wearing gloves and aprons when handling foul laundry and do not have access to disposable gloves. This was addressed at the inspection. Feedback from staff confirmed that although the home have sluices, there are no facilities to wash bedpans resulting in measures that may result in increased cross infection. There has not been a recent infection control audit in the home. The manager explained that infection control training is shared between all trained staff. Bay Court Nursing and Residential Home DS0000026700.V350418.R01.S.doc Version 5.2 Page 24 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 adequate. This judgement has been made using available evidence including a visit to this service. There is not always sufficient staff on duty to meet the needs of people in a timely, caring way. Recruitment procedures are inadequate and do not show that the necessary employment checks have been performed. EVIDENCE: People we spoke with all said staff were very kind and worked extremely hard but that they rushed at times and forget to come back when they say they will. Other comments included ‘The staff are always in a hurry’ One relative said ‘Sometimes staff don’t spend enough time seeing to her needs’ and another said ‘Sometimes staff are too quick and don’t explain what they are doing’ Feedback from staff confirmed this. Staff comments included: ‘We need more staff so we can spend more time with them and not rush them’ and ‘We need more time to spend with the residents’. Bay Court Nursing and Residential Home DS0000026700.V350418.R01.S.doc Version 5.2 Page 25 Staff told us that over the years the needs of people who use the service has become more complex and more time is needed to care for them properly. Questionnaires from relatives supported this viewpoint. Comments included ‘Staff need more time to spend with the residents-They are nearly always rushed or short staffed’ and ‘It would be lovely if staff could spend more time with their patients’ People told us that generally staff answer the bells as quick as they can. One questionnaire from a person living at the service don’t respond promptly to call bell because there are not enough staff another said they had to wait for the commode when staff are busy. Some people are not assisted until later in the morning even if this is not their choice. The manager told us that the staff group is stable and that some staff have been at the home for many years. The manager explained that the twenty-four people at the home are cared for by two trained nurses in the morning and three care staff. In the afternoon, one trained nurse and three care staff care for the people who use the service. The manager told us that seven of the fourteen staff have a NVQ 2 or equivalent and that all staff perform a formal induction programme before starting work Records at the home did not show that the recruitment practices at the home are always robust. However the manager notified us that some of the missing documents were with the providers. Three files were checked. None contained all the information that is required to show all pre employment checks have been carried out. None of the files contained a photograph. One file for a registered nurse did not contain evidence that a Nursing and Midwifery Council PIN check had been performed and did not contain evidence of the statement of entry which shows that nurses are on the professional nursing register. One file did not contain evidence that a CRB and POVA check had been performed. These are the documents that we were told were with the providers. None of the files contained evidence of any training sessions attended. Bay Court Nursing and Residential Home DS0000026700.V350418.R01.S.doc Version 5.2 Page 26 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 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is efficiently managed but the ethos could benefit from being more open and inclusive. The health, safety and welfare of people and staff is protected at the home, but improvements to training and changes to practice would improve this. EVIDENCE: The Manager is a registered nurse with a certificate in management in the health services. She has been managing the home for a number of years. The manager told us she attends mandatory training update sessions so she can Bay Court Nursing and Residential Home DS0000026700.V350418.R01.S.doc Version 5.2 Page 27 share information with staff. The manager could not provide evidence to show she had updated her skills, knowledge and competence. Feedback from relatives was positive about the manager. One comment read ‘If Matron is on duty life is much easier. She is approachable and helpful and very hard working’ Feedback from staff was mixed. Some staff said there was a clear sense of leadership and direction whilst others said leadership was often not clear and there were not opportunities to raise concerns and issues. All staff were clear about what was expected of them and were aware of the General Social Care Council Code of Practice. Staff told us there are not enough meetings held. Staff said when staff meetings occur it is just the staff on duty that attend and it is an opportunity for information to be given rather than an chance for staff to share new ideas. One comment in the questionnaire read ‘It is no good suggesting ideas because they would just be ignored’. Feedback from staff confirmed that they do not have formal supervision sessions. Supervision records listed training sessions and group training sessions but these records did not show that the sessions were formal and an opportunity to highlight training needs and an opportunity to discuss aspects of practice. The AQAA (Annual quality assurance assessment) showed changes had been introduced because of feedback from relatives and people who use the service. These changes included purchasing new chairs for rooms, smaller tables for lounge and the chance for people who use the service to attend the funerals of people who have died at the home. The manager obtains feedback from people and their families on an informal basis and more formally by particular subject headings. There are questionnaires on the front table but the response to these so far has been poor. The manager told us people manage their own money where possible and advocates have been arranged where there is no family. People who use the service have a small amount of money kept with the manager for ease of access when they need to pay for any extras. Whilst checking peoples ‘personal monies’ it was noted that systems were not in place to ensure the process is secure, which means that people may be at risk of financial abuse. One person is responsible for managing this system. Balances for four accounts were checked and found to be incorrect. Two accounts had too much money in and two accounts did not have enough. This was raised as an issue at a previous inspection. Bay Court Nursing and Residential Home DS0000026700.V350418.R01.S.doc Version 5.2 Page 28 The health and welfare of people who use the service and staff is promoted at the home, although some areas need improvement to ensure people are safe and have any risks reduced. An example of this was that bath thermometers were present in bathrooms but no records were kept which showed that bath water was checked before baths to reduce the risk of scalding. Mandatory training is provided in house. The manager attends training and then provides training for staff. Staff questionnaires showed that some staff had received training whilst others had not. One comment read ‘We need more training’. Comments were made about the quality of this training. One comment read ‘The only training we get is manual handling and fire safety. Both are carried out by the matron who I don’t feel covers all the relevant information. I don’t feel I gain any more knowledge from these sessions. It would be better to have someone from outside the home to carry out these training sessions’ Staff feedback informed us that some staff had not received training in food hygiene or first aid. Maintenance records are well maintained at the home. These showed records for gas, electric, fire safety. Records were seen to show that other equipment in the home was well maintained. These included hoists and the lift. Accident records are kept in the home. The majority of these were adequately completed, however one entry contained the incorrect date and another was not reported on in the daily notes. All areas of the home appeared to be free from risks. Discussion was held regarding correct fire labelling of a room where oxygen cylinders were to be stored. Bay Court Nursing and Residential Home DS0000026700.V350418.R01.S.doc Version 5.2 Page 29 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 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 1 2 2 3 2 X 2 3 2 Standard no Score 27 28 29 30 2 3 2 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 x 2 2 X 2 Bay Court Nursing and Residential Home DS0000026700.V350418.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? no 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 OP8 Regulation 16 (1, 2n) Requirement The manager must: • Provide people with opportunities to exercise and maintain fitness to ensure the risk of falls is kept to a minimum. • Ensure opportunities to exercise and mobilise are not reduced because of staffing issues Timescale for action 01/02/08 2. OP12 16(2m,n) 3 OP18 13 (6) 4 OP18 13 (6) The manager must consult all 01/02/08 people about their social interests and provide opportunities for activities that meet their needs Immediate requirement issued 13/11/07 on the day of inspection The manager must ensure the named person is safe when unable to call for help or assistance The manager must make sure 01/04/08 all staff have received training in prevention of vulnerable adult abuse so they are: • Aware of the different types of abuse and what constitutes restraint. DS0000026700.V350418.R01.S.doc Version 5.2 Page 31 Bay Court Nursing and Residential Home 5 OP18 13(7) 6 7 OP18 OP18 13(8) 13(6,7,8) Know how to report allegations correctly • Aware of how to prevent abuse occurring The manager must provide 08/12/07 evidence that the decision to restrain a person is made in exceptional circumstances. The manager must record 08/12/07 details of the above restraint The manager must provide 01/02/08 evidence to show that the decision to use bed rails or restraint has been made only after ensuring: • a suitably qualified, competent and trained individual has assessed and identified the need for bed rails. • the decision is based on the need to ensure the persons safety and not for the convenience of the home. • that issues of capacity to consent are considered and that wider consultation occurs where necessary if the person is not able to make an informed decision. • Effective risk management strategies are in place to ensure the equipment is safe. • that relevant records are maintained and kept under review. The manager must ensure there are systems in place protect people from financial abuse. The manager must ensure there are sufficient numbers of staff on duty to meet the needs of people who use the service in an appropriate way DS0000026700.V350418.R01.S.doc • 8 9 OP18 OP27 13(6) 18(1a) 01/02/08 01/02/08 Bay Court Nursing and Residential Home Version 5.2 Page 32 10 OP29 19 (1a-c) schedule 2 (1,4,5,7) The manager must make sure 01/02/08 staff do not work at the care home unless information is obtained about them. This must include: • Photograph • Documentary evidence of qualification (Statement of entry and Nursing and Midwifery Council PIN number • Evidence of CRB and POVA check 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. 3 4 5 6 7 8 Refer to Standard OP7 OP8 OP8 OP8 OP12 OP15 OP16 OP18 Good Practice Recommendations The manager should ensure care plans reflect the care that is given and clearly explain why decisions are made The manager should ensure staff are able to care for people in a way that is not rushed and give clear explanation about what is happening. The manager should ensure people who use the service can be weighed even if they can not stand unaided The manager should look at work practices to ensure the use of wheelchairs is in the best interest of people. The manager should make sure people are aware that they have a choice regarding their care and are able to make changes to their care if they choose. The manager should review the supper menu to ensure it is wholesome, balanced and uses appropriate ingredients for the age group of people who use the service. The manager should ensure evidence shows all concerns are responded to in a positive way The manager should consider providing details of organisations and telephone numbers to contact in the event of allegations of abuse when the manager is not present. The manager should ensure there is a routine programme of maintenance to ensure the home is well maintained and DS0000026700.V350418.R01.S.doc Version 5.2 Page 33 9 OP19 Bay Court Nursing and Residential Home 10 11 12 13 OP20 OP22 OP24 OP26 14 15 16 OP31 OP32 OP35 17 18 OP36 OP38 kept reasonably decorated The manager should consider replacing furniture when it is in a poor state of repair The manager should ensure call bells are within reach The manager should ensure people are nursed in adjustable beds if there is a nursing or medical need The manager should prevent the spread of infection by: • Ensuring suitable processes are in place to wash bed pans • Ensuring laundry staff are aware of the need to wear protective clothing including appropriate gloves • Performing an infection control audit The manager should ensure she is up to date with periodic training to show she has the rights skills knowledge and competence to perform the role The manager should show that the management and ethos of the home is open and shows an inclusive atmosphere The manager should ensure systems are in place which minimise risks to the people who chose to keep money at the home. It is suggested that the manager obtains two signatures are in place for each financial transaction The manager should ensure supervision sessions are formal and include opportunities for staff to discuss practise and aspects of care. The manager should ensure risks to people who use the service are kept to a minimum and should: • Record bath temperatures before each bath • Ensure warning signs are placed where oxygen cylinders are stored • Ensure accident records are completed correctly and referred to in the persons record Bay Court Nursing and Residential Home DS0000026700.V350418.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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. 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