CARE HOMES FOR OLDER PEOPLE
Bay Court Nursing and Residential Home 16-18 West Hill Budleigh Salterton Devon EX9 6BS Lead Inspector
Michelle Oliver Announced 17 June 2005 09:30hrs 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 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 D54 D06_s26700_baycourt_v221823_170605 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Bay Court Nursing & Residential Home Address 16-18 West Hill Budleigh Salterton Devon EX9 6BS 01395 442637 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Court Healthcare Ltd Miss Susan Rosemary Stevens Care Home 29 Category(ies) of OP Old age (29) registration, with number of places Bay Court Nursing and Residential Home D54 D06_s26700_baycourt_v221823_170605 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1 Notice of Proposal to Grant Registration of staffing/environmental conditions of registration issued 1/3/1999 Date of last inspection 5 January 2005 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 D54 D06_s26700_baycourt_v221823_170605 stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection was the first statutory inspection of the current year; it took 8 hours to complete. There were 24 residents living at Baycourt on the day of inspection and the inspector saw the majority of them. 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 3 service users, 7 members of staff and the manager. The inspector toured the premises and inspected a number of records. All documents and records required during the inspection were available. Comment cards were received from two relatives and six residents. The nursing and care staff were friendly and professional throughout the inspection and helped where they could. What the service does well: What has improved since the last inspection? What they could do better:
The homes robust recruitment policy must be followed to ensure that residents at the home are protected. Criminal Records Bureaus checks and POVA checks must be carried out for all staff. No member of staff may begin work until a satisfactory POVA check has been confirmed. Bay Court Nursing and Residential Home D54 D06_s26700_baycourt_v221823_170605 stage 4.doc Version 1.30 Page 6 Prescribed medication must only be used for the resident for whom it was prescribed. It is recommended that expiry dates of creams in use are recorded when they are opened. Residents safety must be protected by ensuring that the temperature of hot water does not put them at risk of scalding. The hot water from a bath tap was excessively high potentially putting residents at risk from scalding. The cleanliness of some areas within the home need be improved. All bathrooms at the time of this visit were not cleaned to the general standard of cleanliness at the home. Lighting on the top floor corridor was dim, chemicals were noted in bathrooms and toilets and some areas of carpet on the lower ground floor were rucked all of which potentially puts residents health and safety at risk. Since the inspection the providers have said that consideration is being given to replacing the carpets. Residents, or their family or representatives, must be involved in reviews of their care plans whenever practicable. The resident must be told of any changes to their plan of care. Residents should either be given a menu offering a choice of meals or have it read or explained to them. Further staff training is required to ensure that all staff are aware of the procedures to follow in the event of an incident or allegation of abuse. Staff were unaware of the alerting procedure in the event of an incident or allegation of abuse. All staff should have regular formal supervision at least 6 time a year covering all aspects of practice, philosophy of care in the home and career development needs. 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 D54 D06_s26700_baycourt_v221823_170605 stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Bay Court Nursing and Residential Home D54 D06_s26700_baycourt_v221823_170605 stage 4.doc Version 1.30 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 standard(s) 3 & 6. Service users benefit from good admission and assessment practice that ensures that the home is able to meet their needs. EVIDENCE: The home has a comprehensive assessment tool. Three assessments were inspected, all were fully completed. Service users admitted through the care management process have a full assessment of their needs undertaken by the referring professional; the registered manager will visit people at home or in hospital prior to admission. The home does not admit residents for intermediate care. Bay Court Nursing and Residential Home D54 D06_s26700_baycourt_v221823_170605 stage 4.doc Version 1.30 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 standard(s) 7 & 9. Individual care plans have been developed but not all aspects of social care needs are identified or planned for. Medication is generally managed well; however some attention is needed in order to minimise risks for residents. EVIDENCE: Records are properly kept for each resident. Three care plans were looked at, all of which included good guidance on help needed with residents mobility and risk of falls. However, there is limited guidance recorded on resident’s social needs. There was inconsistent evidence of residents, family or representative’s involvement in the review of care plans. Staff said that they do not read the residents care plans regularly. They were unaware of information recorded on some residents care plans. Medication was well documented when received and administered. During a tour of the building a prescribed cream, not prescribed for the identified resident, was being used in their room. Also, no method of making sure that creams were not used when out of date was evident [i.e. date creams were opened, or their expiry was not recorded]. Creams and ointments are formulated with preservative to keep them stable in their unopened state.
Bay Court Nursing and Residential Home D54 D06_s26700_baycourt_v221823_170605 stage 4.doc Version 1.30 Page 10 Preservatives are not of a sufficiently high concentration to maintain cream once they are in use. This puts residents at risk of infection and decreases the effectiveness of the cream. Bay Court Nursing and Residential Home D54 D06_s26700_baycourt_v221823_170605 stage 4.doc Version 1.30 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 standard(s) 12, 13 & 15. Social activities are well managed providing daily variation and interest for people, however further consideration needs to be given to developing activities for service users who lack capacity. Residents are encouraged to maintain contact with their families or friends as they wish. A varied balanced diet is provided served in a pleasant atmosphere. EVIDENCE: Residents said that they were able to choose their own clothes. None of the residents spoken to were involved in local social and community activities. A resident told the Inspector that they liked to read and would like some books or magazines. The manager said that the resident is supplied with books. The daily routine, including mealtimes, appeared to be flexible however residents’ interests and preferences had not been consistently recorded and several residents were unable to express a preference clearly. A record is kept of leisure activities undertaken by residents before admission to the home but not of any activities undertaken by them since 23.01.05. A resident said that she attends Sunday morning service at a local church.
Bay Court Nursing and Residential Home D54 D06_s26700_baycourt_v221823_170605 stage 4.doc Version 1.30 Page 12 On the afternoon of the visit several residents were taken to a local church to attend a flower festival. The menus are balanced and varied and provide a good standard of nutrition. These are displayed in the hall but are not easily accessible to residents. 3 residents said that they did not know what was on the menu. The manager said that residents are told what is on the menu daily. Residents did not confirm this. The Inspector spoke to 5 residents, all of whom said that they were not offered a choice at lunchtime but that they were given a choice of evening meal. The home caters for all dietary needs including vegetarian and diabetics. Fresh vegetables are used as often as possible. Residents said they usually enjoy the meals provided. The dining room is attractive and comfortable and provides pleasant surroundings at mealtimes. Dining tables have been laid with co-ordinating tablecloths and attractive cutlery and crockery. Good standards of maintenance and cleaning have been maintained in the kitchen. The kitchen was bright and clean and records showed cleaning and temperature monitoring routines were satisfactory. Two relatives contributed towards the inspection by completing comment cards. Relatives said they are always made welcome, and are kept well informed. Bay Court Nursing and Residential Home D54 D06_s26700_baycourt_v221823_170605 stage 4.doc Version 1.30 Page 13 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 standard(s) 16 & 18. Residents and relatives are confidant that they are listened to and their requests actioned. Staff have a good knowledge and understanding of the forms of abuse however staff were unclear of the procedures to follow to ensure adult protection, which potentially puts service users at risk. EVIDENCE: Six residents and two relatives contributed towards the inspection by completing comment cards. All residents confirmed that they would feel comfortable making a complaint to any member of staff. They were also confident that any issues would be taken seriously and acted upon. One relative was unaware of the home’s complaint procedure. A copy of the home’s complaint procedure is prominently displayed in the entrance hall for residents and visitors information. No complaints have been received by the Commission or by the home since the last inspection. A record of compliments and complaints was seen during the inspection – this contained lots of letters and cards thanking the home for the good care provided, and very few complaints. The protection of vulnerable adults was discussed in detail with the Manager of the home. Policies and procedures are in place and these demonstrated that the home has recognised the importance of this subject . Procedures for acting upon allegations or suspicion of abuse were discussed. Staff interviewed were unsure of the local guidelines and had not seen the relevant polices and procedures. Staff could identify forms of adult abuse and all said that they would challenge and report any poor practice. Bay Court Nursing and Residential Home D54 D06_s26700_baycourt_v221823_170605 stage 4.doc Version 1.30 Page 14 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 standard(s) 24, 25 & 26. Living accommodation is homely. Residents’ rooms are personalised and comfortable. Procedures for improving and maintaining a consistency in the cleanliness and hygiene in the home need to be improved. Procedures are not in place to ensure that a safe environment is maintained. EVIDENCE: A member of staff has direct responsibility for the cleanliness of the laundry and there is a cleaning routine. The laundry was clean and well organised at the time of the visit. No areas of the home had an unpleasant odour. Cleanliness in some areas of the home could be improved. A toilet, and floor, in one bathroom and another bathroom were not clean. Risks to residents safety were evident throughout the visit. The manager acted immediately these were highlighted and some were able to be removed. Some areas of carpets on the lower ground floor were rucked and could present a trip hazard to residents. Lighting along the top floor corridor was very dim. This was discussed with the manager who suggested this may be due to low energy bulbs being used.
Bay Court Nursing and Residential Home D54 D06_s26700_baycourt_v221823_170605 stage 4.doc Version 1.30 Page 15 Cleaning fluids, which could present a risk to residents if swallowed or spilled, were seen in bathrooms and toilets throughout the home. A member of staff was concerned about infection control measures in the home. Staff confirmed that infection control training had been “a while ago” and felt that an update would be beneficial. A lecture was planned to be given in May 2005 to update the staff in MRSA. No staff attended. Thermostatic valves have been fitted to ensure a safe water temperature however on the day of the inspection hot water temperatures from a tap in a top floor bathroom exceeded 55oC. The manager told the inspector that this bath was not currently used when bathing residents. Bay Court Nursing and Residential Home D54 D06_s26700_baycourt_v221823_170605 stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 29 The numbers of staff are sufficient to meet residents’ needs. The procedures for the recruitment of staff are inconsistent and do not always provide the safeguards for the protection of people living in the home. Failure to obtain satisfactory CRB and POVA checks before new staff begin work places vulnerable residents at risk EVIDENCE: Residents spoken to said that the staff were kind and caring and always there to help. Evidence seen during the inspection showed that staffing levels at the home are normally Mornings – Manager or RGN, 4 carers, 2 cleaners, a cook and a kitchen assistant. A maintenance person is available when required. Afternoons – Manager or RGN, 3 carers. Evenings – 3 care staff until 8pm At night there are 3 waking staff, two carers and a registered nurse. A sample of 3 staff recruitment files were seen. These contained application forms, proof of identity, copies of qualifications and training certificates, at least two satisfactory references.
Bay Court Nursing and Residential Home D54 D06_s26700_baycourt_v221823_170605 stage 4.doc Version 1.30 Page 17 All of the files looked at showed that staff have started work before a satisfactory POVA check has been received. The home must ensure that in future no staff are confirmed in post unless a satisfactory POVA check has been received. The managers agreed to comply with this requirement from now on. Bay Court Nursing and Residential Home D54 D06_s26700_baycourt_v221823_170605 stage 4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34, 36, 37 & 38 The management of the home ensures clear leadership and direction, giving staff guidance and support to meet the needs of residents. Compliance with systems to ensure the good health safety and welfare of residents and staff needs to be improved. EVIDENCE: The manager gives a clear lead and direction to staff. Residents feel she is approachable and seeks to ensure all their needs are met. Regular staff meetings are held. The systems for resident consultation are good with evidence that indicates resident’s views are both sought and acted on. Results were available of a questionnaire completed by some residents and relatives in May 2005 where they are asked to comment on the environment of Baycourt.
Bay Court Nursing and Residential Home D54 D06_s26700_baycourt_v221823_170605 stage 4.doc Version 1.30 Page 19 Staff are supervised on an informal basis but there is no formal supervision system in place. Hazardous substances were not all correctly stored. Water temperatures from a bath hot water tap were recorded in excess of 60C in an upstairs bathroom. Staff identified the need for their knowledge of infection control to be updated. Monthly visits by the Registered provider are being carried out. The reports would benefit from being more comprehensive. This was discussed with the manager. Records inspected indicated regular safety and fire checks are carried out. Staff spoken to confirmed that regular fire instruction and drills had taken place. Bay Court Nursing and Residential Home D54 D06_s26700_baycourt_v221823_170605 stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 2
COMPLAINTS AND PROTECTION x x x x x 3 1 1 STAFFING Standard No Score 27 3 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 x 3 3 3 x 1 3 1 Bay Court Nursing and Residential Home D54 D06_s26700_baycourt_v221823_170605 stage 4.doc Version 1.30 Page 21 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 op7 Regulation 15[2][c ] [d] Requirement Timescale for action 17.09.05 2. op9 3. op18 4. op25 The registered person shall, where appropriate and, unless impracticable to carry out such consultations, after consultation with the service user or a representative of his, revise the service users plan and notify the service user of any such revision. [ this has improved since the last inspection but is inconsistent]. 13[2] The registered person shall make 18.07.05 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. [This relates to cream being used for a resident when prescibed for another resident. ] . 13[6] The registered person shall make 17.10.05 arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. 13[4][a][c The registered person shall 18.07.05 ] ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. Unnecessary risks to
D54 D06_s26700_baycourt_v221823_170605 stage 4.doc Version 1.30 Bay Court Nursing and Residential Home Page 22 5. op26 23[2][d] 6. op29 19. Schedule 2 19 schedule 2 18[1][2] 7. 8. op29 op36 the health or safety of service users are identified and so far as possible eliminated. [This relates to hot water being recorded as 60 C] The registered person shall ensure that all parts of the home are kept clean. [This relates to a three bathrooms which were not clean]. New staff must not be confirmed in post until satisfactory Protection of Vulnerable Adults checks have been received. New staff must have an up to date CRB disclosure. The registered person shall ensure that persons working at the home are appropriately supervised.[ This relates to all staff receiving formal supervision at least 6 times a year.] The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users.[ This relates to chemicals being easily accessible to residents,lighting in top floor corridor being dim, tiles missing around bath. 18.07.05 18.07.05 18.07.05 18.07.05 9. op38 12[1][a] 17.07.05 10. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard op 9 Good Practice Recommendations Date of expiry or opening should be recorded on medication when opened.[ this relates to creams not being dated when opened.]
D54 D06_s26700_baycourt_v221823_170605 stage 4.doc Version 1.30 Page 23 Bay Court Nursing and Residential Home 2. op15. 3. op26 The registered person ensures that there is a menu, offering a choice of meals in written or other formats to suit the capabilities of service users, which is given, read or explained to service users. It is recommended that staff receive updateing in infection control.[ staff identified this need] Bay Court Nursing and Residential Home D54 D06_s26700_baycourt_v221823_170605 stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 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
© 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 Court Nursing and Residential Home D54 D06_s26700_baycourt_v221823_170605 stage 4.doc Version 1.30 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
