Inspection on 17/07/06 for Bay Tree Court

This inspection was carried out on 17th July 2006.

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

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

Other inspections for this house

Bay Tree Court 06/02/06

Bay Tree Court 25/10/05

Bay Tree Court 02/11/04

Bay Tree Court 08/03/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Bay Tree Court Bay Tree Court High Street Prestbury Cheltenham Glos GL52 3AU Lead Inspector Mrs Janice Patrick Key Unannounced Inspection 11.55 17 , 18 , 19 July & 9th August 2006 th th th 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 Tree Court DS0000016383.V306476.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 Tree Court DS0000016383.V306476.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bay Tree Court Address Bay Tree Court High Street Prestbury Cheltenham Glos GL52 3AU 01242 236000 01242 244576 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) European Healthcare Group plc Mrs Natalie Kay Bonner Care Home 59 Category(ies) of Old age, not falling within any other category registration, with number (59) of places Bay Tree Court DS0000016383.V306476.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th February 2006 Brief Description of the Service: Baytree Court is a purpose built care home situated in the heart of Prestbury Village, which is on the outskirts of Cheltenham Town. It is convenient for local shops, the post office and a public house. It has its own designated parking within well-kept grounds. The Home offers both personal care and nursing care to those over 65 years of age. Accommodated over two floors, those requiring nursing care are predominantly cared for on the first floor. This area has a keypad entry. The ground floor is mainly designated to those requiring personal care only. Both areas offer well appointed, single accommodation all with en suite facilities. There are ample communal rooms and residents are welcome to use any throughout the home. There are assisted and non assisted bathing facilities. The Home and its grounds are extremely practical for wheelchair use. The care fees vary from £327.25 to £745.00 (information received 05/07/06). The home rarely has funded placements. Additional charges include: hairdressing, chiropody, toiletries and some activities. The most recent inspection report is located within the home’s Statement of Purpose in the reception area. Bay Tree Court DS0000016383.V306476.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by one inspector over four days. The first day was between the hours of 11.55am and 7.15pm. On the second day between 09.55am and 1.15pm, the third day between 12.25pm and 6.40pm and the fourth between 3pm and 4.30pm. The Registered Manager was available throughout the inspection as were other members of the senior management team. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. All 22 core National Minimum Standards (NMS) were inspected including 11 additional standards. Resident and relative comment cards were sent out by the Commission for Social Care Inspection (CSCI) prior to this inspection to gather views on the care and services provided. Additional information gathered since the previous inspection in February of this year has also been taken into consideration. Many key areas were inspected including how residents needs are assessed and planned for. How they and their relatives are involved in this and how much control they have over their care. Their access to external health care professionals was explored. The medication administration system was inspected. How staff maintain residents’ privacy and dignity was also explored. Access to activities and social opportunities were explored. The standard and choice of food was inspected and how different diets and preferences are met. Relatives were asked if they are made welcome and are informed of their loved ones condition. The home’s formal arrangements for dealing with complaints was inspected. The processes that help protect vulnerable residents were inspected. The home’s environment, its cleanliness and the systems in place to maintain and keep it safe were inspected. All areas of staffing were inspected from numbers on duty, training, recruitment and supervision. The management process was explored and various records inspected. How the home has improved its care and services to the residents was inspected. Bay Tree Court DS0000016383.V306476.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The staff need to ensure that care plans are reviewed on a regular basis and that they reflect the current needs of the residents, it would probably help the home to regularly audit the written content. Bay Tree Court DS0000016383.V306476.R01.S.doc Version 5.2 Page 7 The policy for Adult Protection could give clearer guidance in what action senior staff are to take in the event of an allegation of abuse towards a resident. 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 Tree Court DS0000016383.V306476.R01.S.doc Version 5.2 Page 8 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 Tree Court DS0000016383.V306476.R01.S.doc Version 5.2 Page 9 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): 1, 2, 3, 4, 5 & 6 Quality in this outcome area is judged to be excellent. This judgement has been made using available evidence including a visit to this service. There is a lot of information available to help residents and their relatives make an informed decision about their care at Baytree Court. An effort has also been made to provide additional information that maybe of help. Each resident has a contract and further information that ensures they are well informed of their financial commitment and of any payments due to them. All residents are assessed comprehensively before admission and a genuine effort is made by the home to make the process smooth. The home has the skill mix to meet the residents needs. Relatives are made welcome and can visit as they choose. Bay Tree Court DS0000016383.V306476.R01.S.doc Version 5.2 Page 10 EVIDENCE: The Home has a Statement of Purpose and Resident Guide (the home’s version of the Service Users Guide) which are both within the reception area. Each resident is given a Resident Guide on admission. A copy of the homes terms and conditions need to be added to these. Additional information is also available from where to go for advice with care fees to where to stay locally. There is also an invitaion to visitors telling them where the homes policies are kept if they wish to read these. During this inspection the weather was extremely hot and there was useful advice on fliud intake and how to keep cool. All of this is presented well and easy to read. Five examples of resident contracts were inspected, all contained clear terms and conditions including notification of any changes in the Registered Nurse Care Contribution (RNCC) and of annual increses in fees. The administrator showed an example of a newly designed form which is used to gather additional financial information during the admission process. This includes the details of who holds Power of Attorney and any arrangements for funerals. Each resident is fully assessed prior to admission, usually by the Registered Manager. A comprehensive assessment format is used and great effort is made to ensure the admission process goes smoothly. An example of this involved a resident who needed to come into care but was reluctant to do so. This genuine reluctance was expressed in unhappyness with the colour of the room to be occupied, the day before the planned admision. It was agreed that this would be decorated in a colour of her choice before she moved in. This was carried out and the resident confirmed that the staff did everything possible to make her feel welcome at a very difficult time for her. Two completed pre assessments for residents wanting to come to the home were seen. The home is also able to demonstrate that it can use its varying resources as the residents needs alter. This has been demonstrated in the movement of a resident from the residential floor to the nursing floor when she required more health care supervision. She later returned to the residential floor recovered . The care staff in the home are well trained and the majority are experienced carers. They are complimented by qualified nurses who are on duty at all times. The residential floor, although managed on a day to day basis by a competent senior care co-ordinator, is also the base for the homes Deputy Manager who is a registered nurse. The home is awaiting a newly recruited registered nurse to start, who has been working within the Primary Care Trust (PCT) in acute care. It is anticipated that this person will bring with her updated knowledge in many areas that will benifit the homes nursing care. Bay Tree Court DS0000016383.V306476.R01.S.doc Version 5.2 Page 11 Visitors were seen in the home at various times over the three day inspection. One visitor took advantage of the open door policy which the Registered Manager encourages. Rapour between many visitors and staff was observed to be relaxed. One new residents relative was observed to be getting alot of support from staff on the day she moved her relative into the home. Another relative said she visits every other day and the staff are alays extremely friendly and helpful. This home does not provide dedicated rehabilitation. Bay Tree Court DS0000016383.V306476.R01.S.doc Version 5.2 Page 12 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 & 11 Quality in this outcome area is judged to be good. This judgement has been made using available evidence including a visit to this service. The care planning system reflects the needs of the residents and is offering updated guidence for staff. Residents health care needs are met. Residents medication is administered safely and residents are protected against poor practice. All residents are treated with respect and their dignity is maintained. Residents receive a high quality of care at the end of their lives and if their wishes and preferences are known they are respected and upheld. EVIDENCE: Five sets of care records were inspected in full including many others in less detail. The care documentation in most cases has been changed over to a new format. This process was completed during this inspection and the next stage Bay Tree Court DS0000016383.V306476.R01.S.doc Version 5.2 Page 13 for the home is to make sure all the staff using the documentation, understand it. The care documentation for one resident specifically did not, at the beginning of this inspection reflect the care being given. On completion of introducing the new paperwork and reviewing the resident’s needs the documentation was extremely comprehensive. This resident was actively incontrol of her care and there was a high level of family inclusion. This documentation aims to meet the ‘gold standard in end of life’ care. There were several examples of residents receiving care and assessments involving external health care professionals. These included the General Practitioner (GP), Seech Therapist and Chiropodist. The Continuing Health Care Nurse also preforms assessments for specialised equipment that maybe required and gives advice regarding pressure relief care/treatment. The staff considered that one resident was entitiled to and requires the help and support of the McMillan Nurse. A review was carried out by this specialised team and earlier in the year and at the time they felt that the resident would not benifit from their service. The staff of the home felt that circumstances had altered and requested further support. The medication system was inspected using the records of the five residents who were part of the casetracking exercise. All documentation was in place, a few gaps on the medication administration records (MAR) were seen on the residential floor. The controlled medication used for one resident was checked and corresponded with the records being held. Fridges in both clinics were locked and the temperatures were within correct range. Both mediacation storage units require rag bolts fitting within the controlled medication cupboard in order to meet with the Royal Pharmacutical Guidelines. The home has recently changed to a new supplier who meets with the new requirements now in place for the disposal of medication from nursing homes. Two different examples of medication administration were observed and both demonstrated good practice. A full report had been compiled by the home on a recent mistake made by the supplying pharmacy. All staff that administer medication on the residential floor have completed an accredited training. This is due an update which will be carried out by the Registered Manager who has recently attended a medication update. Staff were observed at all times to be maintaining residents’ dignity in particular it was noted that this was carried out with a resident that is clearly extremly confused and unable to always comprehend what is happening. These times were dealt with sensitively by staff. Privacy is maintained by knocking on doors and carrying out care tasks in private. Bay Tree Court DS0000016383.V306476.R01.S.doc Version 5.2 Page 14 Bay Tree Court DS0000016383.V306476.R01.S.doc Version 5.2 Page 15 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): 12, 13, 14 & 15 Quality in this outcome area is judged to be excellent. This judgement has been made using available evidence including a visit to this service. Residents are able to make choices and their views are considered in some of the decision making within the home. The activities are not meeting all the residents needs, but the home has recognised this and is taking action to improve this. Arrangements are in place for residents and their next of kin to have access to their care documentation. The catering services within the home are popular and are meeting individual needs. EVIDENCE: There is a genuine desire for residents to be empowered and several were able to say that they feel this to be so. Many were able to give examples of how they make choices on a daily basis. Two residents said they prefered to remain in their rooms and receive their visitors there. One resident had chosen to remain in bed on the first day of this inspection as she felt tired. Bay Tree Court DS0000016383.V306476.R01.S.doc Version 5.2 Page 16 Another resident had made a specific choice to refuse some care intervention, despite being advised otherwise. Staff were respecting this wish but monitoring the situation carefully. One resident will not eat a meal in the dining room or in his bedroom and prefers to take meals alongside the nurses station. This is accomodated and it means staff are able to ensure that he eats adequately. Another example was seen of a resident unable to initiate her preferences any longer for herself. Staff put on one of her favorite pieces of music in her room. She was observed to be swaying to this clearly exhibiting a state of well being. A meeting was held recently and residents were asked what colour they would like the lounge and dining room to be decorated in. They have chosen a pale green for the lounge and do not wish the colour of the dining room to change as they like it. Minutes were seen of this meeting and one resident remembered it well. Another resident said she had been asked what colour she would like her bedroom painted in as it is due to be decorated. She said she has declined the offer of redecoration as she feels she cannot cope with a move. Activities are organised by a very committed activities co-ordinator who is very popular throughout the home. She was observed to be carrying out a quiz on one day and visiting individual residents in their rooms on another. In one case she and the resident were enjoying a crossword. She has taken one resident out to lunch several times to a place that would be very familiar to him. This has been particularly rewarding for the resident as his long term memory is better that his short term memory. It was noted that there was a special raport between the activities co-ordinator and this resident which has proved benificial during periods of aggitation. 10 out of the 15 resident comment cards received back indicated that there were always activities available. 1 clearly stated there were not enough activities and this resident said they were always bored. One did not like the choice of activity on offer. Another said they did not join in as they were hard of hearing. One survey completed by a relative on behalf of their loved one said activities did not apply as their relative had dementia. The Registered Manager’s survey showed that several residents felt there were not enough activities and that there was a lack of time to spend with those that require more one to one interaction. Interaction with two residents in particular has called for different ways of communication to be adopted. One resident speaks a mixture of her native language and english, therefore staff have created a point chart with key comments/questions written in both languages. Another resident who suffers from dementia will not always comprehend what is verbally being said to her, but will follow a written instruction sich as: ‘please eat your food’. The home has begun to have some of its main signs on doors written in braille also, in readiness for anyone needing this. Bay Tree Court DS0000016383.V306476.R01.S.doc Version 5.2 Page 17 The Registered Manager said this had come about mainly because when relatives cannot or choose not to escort their relative to an appointment, it is the activity co-ordinator that is allocated to do this. She has in several cases been able to make it an outing for the resident and they have gone for refreshments or shopping afterwards. A recent trip to Western-Super-Mare was very successful. The Registered Manager explained that several residents on the day of the outing changed their minds about going. One relative had been very upset at their relative not going and said that her relative should be made to go. Another situation is proving very difficult where relatives again feel staff should make their relative comply. The Registered Manager explained that these residents are fully able to exercise choice for themselves. She is considering how this sensitive subject should be dealt with as it is in direct conflict with the homes philosophy. Care plans are now accessible in residents bedrooms unless otherwise stated by the resident. In one case, additional assessments have been shared with a relative who disagreed with their relative’s Registered Nurse Care Contribution assessment. Many residents have their own phone line in their bedrooms, but a pay phone is available on each floor. Advice on advocacy is available on the homes notice board. Since the previous inspection a new kitchen Manager has been employed. She holds the Advanced Food Hygiene certificate and is a food hygiene trainer. She has a clear understanding of catering and what the residents require. She has attended resident meetings and spoken with residents individually, encouraging their involvement in the devising of new menus. All records required to be kept were seen as being well recorded. The kitchen staff were extremely organised during the serving of lunch and were seen to be interacting well with the residents. Special diets for those frailer residents were a concern in the past but have been transformed since the last inspection. One example was a chocolate mint mousse, beautifully presented in a spiral shape with a cherry and sprig of mint on the top. This however contained a supplement designed to get extra calories into a resident who has a poor appetite. Fresh fruit is now taken around to each resident on a daily basis, which residents say they like and fruit smoothies have become a popular drink. Choices for meals are made the day before and a special ‘menu notice board’ has been started outside the dining room. One resident said she could not Bay Tree Court DS0000016383.V306476.R01.S.doc Version 5.2 Page 18 remember what she had ordered but said the notice board is there to remind you it is a very good idea. Food is served directly from the kitchen on the lower floor and vegetables are taken to the table in covered dishes. On the nursing floor, food is served from a large hot trolley. Bay Tree Court DS0000016383.V306476.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is judged as good. This judgement has been made using available evidence including a visit to this service. The home has robust arrangements in place to deal with complaints and to protect vulnerable residents. EVIDENCE: The home has a satisfactory complaints policy, which is on display in the reception area. The Registered Manager has explained that the company wish to make this more robust and are due to meet to discuss this shortly. Residents and relatives have confirmed in the pre inspection surveys that they are aware of how to make a complaint. Arrangements are in place in the reception area if visitors wish to raise a concern/complaint without seeing a member of staff. A record of formal and informal complaints is maintained. A new format has been created to formalise this record. Complaints and concerns are monitored by the company as part of their quality assurance process. The home has an Adult Protection policy of which procedures may need a review in order to make the guidance for senior staff a little clearer. All staff have received basic awareness training in the Protection of Vulnerable Adults (POVA) and the Registered Manager has attended the ‘Alerters’ training delivered by the Adult Protection Team for Gloucestershire. She is due to complete the ‘train the trainers’ coure, which will then enable her to deliver Bay Tree Court DS0000016383.V306476.R01.S.doc Version 5.2 Page 20 this training to her own staff. Elderly abuse is also discussed within staff supervision sessions. Every resident spoken to confirmed that staff are kind and caring and that they feel well looked after. Bay Tree Court DS0000016383.V306476.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 24, 25 & 26 Quality in this outcome area is judged as excellent. This judgement has been made using available evidence including a visit to this service. The home is well maintained and clean and therefore offers comfortable accommodation for residents. Residents’ lives are made easier and more comfortable through the use of specialised equipment. Residents are protected by staff being actively aware of good infection control practices. EVIDENCE: The home benefits from being purpose built and offers comfortable accomodation on two floors. All bedrooms are single and ensuite. Each floor has well appointed communal rooms, which can be used by any resident within the home. There is a shaft lift to the first floor. Bay Tree Court DS0000016383.V306476.R01.S.doc Version 5.2 Page 22 The environment is well maintained with an ongoing programme of decoration. Each bedroom and communal area has an individual audit carried out each month. Maintenance jobs or residents wishes are recorded and passed onto the maintenance team who in turn, report back to the Registered Manager when the work has been completed. There are no offensive odours within the building. The home meets with the Fire Officer’s requirements. All bathrooms were inspected and a wide selection of assisted and non assisted bathing facilities are available. A wide range of specialised equipment is in use, particularly on the nursing floor. These include bedrails, specialised beds, pressure relief mattresses and cushions and specialised feeding equipment. The home has adequate hoists and a new stand aid is due to arrive for a trial period soon. A maintenance record of wheelchairs is kept with a strict rotation of chairs either in service or being maintained. Call bells are located in all areas of the home and are easily accessible. The majority of bedrooms were seen and most have been personalised. Residents are free to bring in small pieces of furniture and other personal items. All were clean and free from odours. During this inspection the weather was very hot. The home was having problems particularly on the first floor obtaining an adequate flow of fresh air. The home was adhering to health and safety requirements set by the Environmental Health Officer who had recently visited, regarding window restrictors. It was decided by the Registered Manager that the need to ventilate the home and cool down some of the residents took priority but, that it could be accomplished by some of the windows being opened further than the recommended 2.5 cm’s but following a strict risk assessment. Lights were also turned off in response to advice from the Primary Health Care Trust (PCT) in order to lower the heat output. All major utilities are serviced regularly and records and certificates were seen to this effect. Regular recording of the hot water temperature at source ensures the risks associated with Legionella are reduced. Records pertaining to this were very well kept and the maintenance person had a good understanding of why this was being carried out. The home is kept clean and infection control practices are good. To improve upon this further and to ensure all practice is up to date, the Deputy Manager is booked onto a course in September of this year and will become the home’s Heath Protection Agency’s ‘link nurse’. She will then audit practice and train staff in infection control. Bay Tree Court DS0000016383.V306476.R01.S.doc Version 5.2 Page 23 Plastic aprons and gloves are available and colour coding is used to further good practice. The laundry was not inspected on this ocassion. Bay Tree Court DS0000016383.V306476.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is judged as adequate. This judgement has been made using available evidence including a visit to this service. Staffing numbers and skill mix are constantly reviewed to meet the residents needs. Staff are provided with appropriate training to care for the residents well. The home generally carries out a robust recruitment process, but must ensure that all of this is complete before employing a new member of staff. EVIDENCE: The Registered Manager confirmed over the last year the home has increased its staffing levels in order to meet the needs of the residents and the home. The skill mix has improved and there has now been consistent management in place for a substantial period of time. The home’s receptionist hours have increased to include cover each weekend; this has enabled the care teams to concentrate on the care of the residents. Out of the 15 resident comment cards received back, all agreed that staff were available when they needed them. A couple of comments were made about having to wait when they ring their bell. 3 of the 8 relative comment cards felt there was insufficient staff on duty. Bay Tree Court DS0000016383.V306476.R01.S.doc Version 5.2 Page 25 The home has identified from its own survey that an additional activities coordinator, on a part-time basis is needed. Since the last inspection there is a full time housekeeper and a new member of staff in the laundry. The Care Co-ordinator on the residential floor has been given additional supernumerary time enabling her to concentrate on her management tasks. The home has required another full-time nurse, who commenced in post during this inspection. The home is also in the process of recruiting new night care staff. Care staff are actively encouraged to undertake the National Vocational Qualification (NVQ) in Care. The care staff have been let down in the past by colleges who have been short of assessors and students have had to abandon their courses. This situation has improved and currently there are 6 staff who hold the qualification. 5 others are working towards Level 2 and a further 6 are working towards Level 3. This demonstrates that the home is endeavouring to meet the minimum requirement of 50 of staff holding an NVQ Level 2 or equivalent qualification. The home has been using various induction formats in the past. One was discussed at this inspection and appeared to give the member of staff a good initial training. It is designed to link in with further study such as the NVQ Award, which the Registered Manager is keen for all care staff to hold. Food hygiene will be part of the induction training for all staff. The home has recently learnt that it has passed all requirements to be a teaching centre for this and intends to update all their own staff first. The files of 4 new staff were inspected. All requirements were in place except one person had been employed on the basis of one reference only. The Registered Manager is to follow up the second reference as soon as possible and ensure in the future that staff are only recruited on the basis of two satisfactory references. In another case a member of staffs Criminal Bureau Record (CRB) clearance showed areas that required risk assessment before employment. The Registered Manager had not been made aware of this from elsewhere in the company. The process of how CRB’s are processed within the company has been altered to avoid a repetition of this. Bay Tree Court DS0000016383.V306476.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 & 38 Quality in this outcome area is judged as excellent. This judgement has been made using available evidence including a visit to this service. The home is benefiting from being managed competently on a day to day basis. Residents and visitors are encouraged to put their views forward and arrangements are in place to ensure these are listened to and that they form part of a system that can improve the home’s services for the residents. Residents monies and financial affairs are protected. Arrangements are in place to ensure staff are providing a good standard of care and that the home is run in such a way that safeguards the residents health and safety. Bay Tree Court DS0000016383.V306476.R01.S.doc Version 5.2 Page 27 EVIDENCE: The present manager is registered with the CSCI and has undertaken the Registered Managers Award in management. She is a registered nurse with several years of care home management experience. She has also undertaken recent update training in skin care, nutrition in the elderly, handling of medication and the protection of vulnerable adults. In September of this year she is due to commence a 6 month course in ‘end of life’ studies. The home’s Deputy Manager and the Care Co-ordinator for the ground floor also confirmed several areas of updated training and will also be attending the ‘end of life’ study course. An open door policy has been adopted and several people were observed making use of this. There are clear lines of responsibility throughout the home and a heads of department meeting is held to cascade information and discuss the outcomes of any audits carried out as part of the home’s quality assurance system. This is to be monthly but was last held in April of this year due to illness in June. Communication is actively encouraged amongst residents and relatives. This is achieved by the open door policy, regular resident and relative meetings or by one of the management team visiting those who do not find this forum easy, on a one to one basis. Several residents confirmed that their views and opinions were often sought. Plans to start a relatives association are underway, so far 11 relatives have shown interest. Thought has also been given to commencing a residents association with future plans that residents should have some involvement in choosing who works at the home. Monies for a sound system has been recently sought that will enhance some residents ability to hear at the meetings. The home’s quality assurance system is expanding with maturity and now includes several audit areas. Once the new care planning system is fully complete consideration should be given to a simple way of auditing these on a monthly basis, which was discussed during this inspection. The last resident and relative satisfaction survey was carried out in April/May of this year. Information had started to be collated and was due to be made available to residents and visitors soon. A pre-admission/admission survey was also carried out, aimed at nine new admissions to the home to evaluate their views on the admission process. It is intended in the future that staff and residents will be asked to voice their opinion on the management of the home. Bay Tree Court DS0000016383.V306476.R01.S.doc Version 5.2 Page 28 As part of the quality assurance survey the company’s Care Services Manager also carries out an unannounced monthly visit to the home and submits a copy of her findings to the CSCI. Monies are kept for 17 residents at present and the amounts and corresponding records were inspected for 7 of these. All were well documented and correct. The administrator is extremely organised in how residents, relatives and those acting as Power of Attorney are kept informed of various financial processes. Examples of invoices were seen and of how appropriate persons are made aware of the Registered Nurse Care Contribution (RNCC). The key holding to these monies is limited and an audit is carried out each time one of the key holders goes on holiday. Staff receive supervision which is being formally recorded along with annual appraisals. There were two examples in particular where staff had received supervision and support in their roles and who have benefited from this since the last inspection. The Registered Manager has recently carried out supervision on several night staff. The Inspector also met with the company’s Estate Manager who was able to explain how he is beginning to ensure the home meets with the new Fire Regulations, due to come into effect from October of this year. The Fire Officer carried out a full audit in April of this year and fire fighting equipment was inspected and serviced in May of this year. Fire drills and fire alarm tests are carried out regularly. All records were seen demonstrating the above. The home meets with the requirements set by the Health and Safety Executive and the Environmental Health Officer. At present 13 staff members hold a first aid certificate with others being trained in rotation. Manual handling training and updates are ongoing and it was reported by the Registered Manager that most staff are updated. The training record confirmed this including two cares spoken to. They were also able to confirm that they had received recent fire training. Bay Tree Court DS0000016383.V306476.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 4 3 4 3 4 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X 3 3 X 4 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 4 X 3 3 X 3 Bay Tree Court DS0000016383.V306476.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 OP2 Regulation 5(1)(b) Requirement The Registered Manager must ensure that each copy of the Resident Guide contains a copy of the home’s terms and conditions. The Registered Manager must ensure that gaps on the medication administration record are avoided or accounted for and that the Controlled Medications cupboards are fitted with Rag Bolts on the back plate. The Registered Manager must ensure that new staff are only recruited on receipt of 2 satisfactory references. Timescale for action 31/08/06 2 OP9 13(2) 31/08/06 3 OP29 19 Schedule 2(3) 31/08/06 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 OP7 Good Practice Recommendations That a simple audit tool be used to ensure care plans and DS0000016383.V306476.R01.S.doc Version 5.2 Page 31 Bay Tree Court assessments are reviewed regularly and remain relevant to the residents’ needs. Bay Tree Court DS0000016383.V306476.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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. 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