CARE HOMES FOR OLDER PEOPLE
Bay Court Nursing and Residential Home 16-18 West Hill Budleigh Salterton Devon EX9 6BS Lead Inspector
Michelle Oliver Unannounced Inspection 15th November 2005 09:00 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.V259242.R01.S.doc Version 5.0 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.V259242.R01.S.doc Version 5.0 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 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.V259242.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Notice of Proposal to Grant Registration of staffing/environmental conditions of registration issued 1/3/1999 17th June 2005 Date of last inspection Brief Description of the Service: Bay Court is situated in the centre of Budleigh Salterton within 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 23 bedrooms, all centrally heated with colour television and nurse call. Qualified staff are on duty 24 hours a day. Activities are provided on a regular basis. Daily menus are based on fresh seasonal produce and individual dietary requirements are catered for. The ethos of the home is to provide a relaxed homely environment in which the staff are able to care for service users over the age of 65 years who are suffering from medical problems both acute and chronic. Bay Court Nursing and Residential Home DS0000026700.V259242.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 4 hours on 15th November 2005. The Registered Manager was present during the inspection. Residents and all members of staff on duty also took part in the inspection. The home has a large number of residents who have a dementia related illness and some do not have the capacity to communicate fully or understand the inspection process. The inspector spoke at length with 6 service users, 6 members of staff and the manager. The inspector looked around the home. A number of records were inspected, which included care plans, staff files, accident book, fire log and menu. What the service does well: What has improved since the last inspection?
Seven of the nine requirements made at the last inspection have been met. Residents and relatives or representatives have been involved in regular review of individual care plans. This ensures that changing needs are assessed and that residents are given appropriate care with their input. When topical creams are opened the date of expiry is recorded on the container. This ensures that creams remain stable when they are in use reducing residents risk of infection and ensure the effectiveness of the cream. The risk to residents of scalding from excessively hot water has been minimised by making adjustments to a boiler at the home since the last inspection. The cleanliness of the home has improved. All areas of the home were clean and there were no offensive odours. All residents spoken to said that the home and their rooms are always kept clean and tidy. Chemicals and cleaning materials are safely stored in locked cupboards thereby further protecting residents safety. Residents protection is promoted by the robust recruitment procedure at the home. This has improved since the last inspection. Three files were looked at and all included the required information and documentation.
Bay Court Nursing and Residential Home DS0000026700.V259242.R01.S.doc Version 5.0 Page 6 The manager has started to undertake formal supervision for all staff. This will cover all aspects of practice and philosophy of care, and staff individual career needs. A record of the content of these sessions are not recorded, only the date it took place. Areas of the home have been recarpeted and some rooms redecorated. This is because carpet presented a trip hazard at the last inspection. The manager said that the rooms were redecorated as part of the home’s ongoing maintenance programme as they were looking tired. Residents are satisfied with the quality of the accommodation at Baycourt. A printed menu, which is changed regularly, is now available to all residents to enable them to make an informed choice about meals. 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. Bay Court Nursing and Residential Home DS0000026700.V259242.R01.S.doc Version 5.0 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 Court Nursing and Residential Home DS0000026700.V259242.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed at this visit. EVIDENCE: Bay Court Nursing and Residential Home DS0000026700.V259242.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 The staff have a good understanding of the health and personal care needs of residents, which are generally documented clearly in care plans. Medication is well managed. EVIDENCE: All residents have a plan of care based on an assessment of needs undertaken before they decide to live at Baycourt. Four plans of care were looked at during this visit. The plans are comprehensive, include assessments of risks and provide staff with the information to meet residents needs. Residents and family are included in regular reviews of the plans. One plan did not include information relating to complex nutritional needs, wants, choice of a resident. A record is kept in the kitchen of residents likes and dislike but there was no record for this resident. However, staff were able to give detailed information about these needs and how they are met. The cook was aware of the needs and explained the arrangements in place for ensuring that the residents requests are met as far as possible. The manager had brought individual items of food which the resident had requested at the time of this visit. The manager agreed that this information would be detailed in the care plan. The systems for the administration of medication are well managed ensuring that residents needs are met. Medication records were correct.
Bay Court Nursing and Residential Home DS0000026700.V259242.R01.S.doc Version 5.0 Page 10 Staff showed clear respect for residents’ privacy. For example, they knocked on bedroom doors and waited to be asked in before entering. Residents said that all staff were very kind and helpful. Bay Court Nursing and Residential Home DS0000026700.V259242.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 & 15. A variable, nutritious diet is provided at the home. Residents are encouraged to maintain their independence and to make choices about the way they live their lives at the home. EVIDENCE: Most residents’ had brought many of their own possessions to the home and the rooms were personalised and comfortable. All residents expressed their satisfaction at the accommodation provided at Baycourt. Most of the residents said that the food at the home was good, nutritional and that the meals were varied. A menu is available to residents although most of them said they didn’t want to see it. Residents may have their meals in the dining room, lounge or their rooms if they choose. Residents are not rushed at meal times and assistance is given to those needing it discreetly. A resident said that they have “very exacting” dietary requirements. They spoke about their likes and dislikes and had written a list of foods that they would like to have. The manager had bought some of these foods for the resident at the time of this visit. The cook and staff were able to explain the procedure undertaken by the resident of going to the kitchen and discussing and deciding with the cook what they would like for their meals each day. Bay Court Nursing and Residential Home DS0000026700.V259242.R01.S.doc Version 5.0 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18. There was nothing to suggest that residents at Baycourt are anything but protected and well cared for. However staff would benefit from Adult Protection Training to ensure that they are aware of all forms of abuse and the procedure for reporting alleged incidents of abuse to the appropriate people therefore protecting resident’s welfare. EVIDENCE: Staff were not fully aware of the procedure for responding to allegations of abuse. Staff said that they had never seen any signs of abuse in the home and showed a reasonable understanding of what constituted abuse. All residents spoken to said that they felt safe with the staff. This was discussed with the manager who agreed that staff training would be undertaken to ensure that staff would be aware of all aspects of adult abuse and of the procedure for alerting any allegations of abuse. Bay Court Nursing and Residential Home DS0000026700.V259242.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 25 & 26. A comfortable standard of accommodation is provided for the residents. EVIDENCE: The home provides a lounge and dining room on the ground floor, a lounge/ diner on the lower ground floor and a quiet lounge on the first floor. New carpet has been fitted throughout the ground floor, as the previous one was rucked and presented a trip hazard to residents, and consideration is being given to replacing the carpeting throughout the home. Two bedrooms have been fitted with new carpet and have been redecorated as the manager said they were looking tired. Residents rooms were warm, comfortable and personalised with residents’ own possessions. Adjustments have to made to a boiler since the last inspection which ensures that hot water from is not excessively hot. The home was clean with no offensive odour at the time of the visit. Cleaning fluids are stored in locked cabinets in bathrooms to reduce the risk to residents.
Bay Court Nursing and Residential Home DS0000026700.V259242.R01.S.doc Version 5.0 Page 14 Staff confirmed that since the last inspection they had received an update in basic hygiene and MRSA which they found useful but said that an update in Infection Control would be of benefit to them all. They confirmed that protective clothing is readily available at the home. At the time of this visit the risk of cross infection was increased by poor infection control procedures in relation to wearing protective gloves and the procedure for the management of soiled laundry in a residents room. Bay Court Nursing and Residential Home DS0000026700.V259242.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 & 30. The procedures for the recruitment of staff are consistent and provide the safeguards for the protection of people living in the home. Residents benefit from having skilled, experienced and friendly staff who have a good understanding of their needs. EVIDENCE: Staff are able to clearly explain their role and responsibilities are attentive to individual residents’ needs. The staff team is fairly stable and staff turnover is relatively low. robust recruitment procedure is in place to ensure that all essential information is included in each staff member’s file. This was confirmed when three staff recruitment files were looked at. All relevant information including references, police checks and proof of identity were included. Three members of staff attended a tissue viability course recently. Staff said that they would benefit from infection control and Protection of Vulnerable Adults training. [refer to Standards 18 & 26] Bay Court Nursing and Residential Home DS0000026700.V259242.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35, 36 & 38. Residents benefit from the continuity of the staff team led by the manager. Residents financial interests are safeguarded. The health and safety of residents is protected by the systems in place. EVIDENCE: Some personal allowances are managed for residents by the home. A record is kept of all transactions and receipts of purchases are kept. The file was inspected and was detailed and accurate. The manager said that staff are formally supervised. However, no record of the content of the sessions were available. The importance of records being kept of these sessions in order for development to be assessed at subsequent supervision was discussed with the manager. Bay Court Nursing and Residential Home DS0000026700.V259242.R01.S.doc Version 5.0 Page 17 Liquid soap and paper towels were available in communal bathrooms, toilets and some residents rooms. Staff confirmed that gloves and aprons were always available. Substances which could be hazardous are safely stored in locked cabinets. Records inspected indicated regular safety and fire checks are carried out. Staff confirmed that they undertake regular training in the prevention of fire. Fire alarms and emergency lighting are regularly checked. Bay Court Nursing and Residential Home DS0000026700.V259242.R01.S.doc Version 5.0 Page 18 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 x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 1 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 1 x x x x x x 3 1 STAFFING Standard No Score 27 x 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x 3 2 x 3 Bay Court Nursing and Residential Home DS0000026700.V259242.R01.S.doc Version 5.0 Page 19 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 OP18 Regulation 13[6] Requirement Timescale for action 2 OP26 13[3] The registered person shall make arrangements , by training staff or by other measures, to prevent 15/02/06 service users being harmed or suffering abuse or being placed at risk of harm or abuse. [ This is the 2nd time this requirement has been made. The first timescale was not met] The registered person shall make suitable arrangements to prevent infection, toxic conditions and 15/02/05 the spread of infection at the home. 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 OP8 op26 Good Practice Recommendations A record is maintained of nutrition of nutritional needs.[ this relates to a resident with complex needs, likes and dislikes] It is recommended that staff receive updating in infection control.[ staff identified this need]
DS0000026700.V259242.R01.S.doc Version 5.0 Page 20 Bay Court Nursing and Residential Home 3. OP36 A record of the content, outcomes, plans and discussions planned at individual staff supervision sessions to be kept on file. Bay Court Nursing and Residential Home DS0000026700.V259242.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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