CARE HOME ADULTS 18-65
Baytree House Torbay Council 22 Croft Road Torquay Devon TQ2 5UE Lead Inspector
Judy Cooper Unannounced Inspection 4 December 2006 11.15
th Baytree House DS0000037128.V318976.R01.S.doc Version 5.2 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 Baytree House DS0000037128.V318976.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 Adults 18-65. 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. Baytree House DS0000037128.V318976.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Baytree House Address Torbay Council 22 Croft Road Torquay Devon TQ2 5UE 01803 211300 01803 380164 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) Torbay Care Trust Mrs Nina Ann Down Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Baytree House DS0000037128.V318976.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service Users with Learning Disability who may have additional Physical Disability and/or Sensory Impairment. Service Users aged 16 or 17 years may also be admitted. Date of last inspection 03/01/06 Brief Description of the Service: The home was, until December 2005, owned and run by Torbay Council. However a merger of adult social services and adult health services within Torbay has led to the formation of Torbay Care Trust and it is the Trust that now manages Baytree House. The home offers short-term breaks, and a longer-term assessment service for adults and younger people aged between 16 and 18 years old with learning disabilities. Some residents may also have additional physical or sensory impairment. Three beds are allocated for the assessment service, two of which are in an annexe with additional kitchen facilities. All the other bedrooms are in the main part of the house. There is a large dining room, lounge, activity room, and an ample amount of bathrooms, showers and toilets. There are bathroom facilities adapted for disabled residents, and there is wheelchair access throughout the house, with a passenger lift giving access to the first floor and to all but three bedrooms. These three bedrooms do necessitate the resident occupying each room being able to negotiate steps. Baytree House is situated in Torquay town centre within walking distance of the shops, amenities, beaches and attractions. There is also access to train and bus routes nearby. The current weekly fee at the home is £901.90. The management keep the inspection report within the home’s office and inform interested parties that they may have access to it at any time. Baytree House DS0000037128.V318976.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on a Monday between 11.15 a.m. and 5.50 p.m. and on a Wednesday between 9.00 a.m. and 1.00 p.m. The home provides seven short term care beds and three assessment beds for residents with learning difficulties. The ages of residents currently at the home range from seventeen to fifty-four. During the visits the opportunity was taken to tour the home, examine appropriate records and policies and talk with the residents present, the assistant service manager, who was present throughout the first full day of the inspection and the unit manager who was present on the second, shorter day of inspection. Several other staff members were also spoken with. Other information about the home, including the receipt of questionnaires from interested parties, such as visiting professionals, has provided further feedback as to how the home performs and all of this collated information has been used in the writing of this report. All required core standards were inspected during the course of this inspection. What the service does well:
The staff interact very well with the residents and it was clear that residents enjoyed being with the different members of staff, in the communal areas of the home. Staff are fully involved in the residents’ day to day lives and there is no segregation between staff and residents, with all using the same facilities i.e. having meals together. Residents’ rights to individuality are fully upheld by all staff and residents are treated with the utmost respect. Baytree House DS0000037128.V318976.R01.S.doc Version 5.2 Page 6 Some residents have very differing/diverse needs and the staff do all within their power to meet these on an individual basis whilst also ensuring that the resident is still fully included in the day to day activities within the home. For example one resident has a severe food allergy. This is provided for but in such a way as to ensure that the resident is not isolated. The home’s cook prepares some meals that will be acceptable to all including the resident with the food allergy, so as all can enjoy the same dish on occasions. Other communal foods such as cakes are made in such a way that is acceptable to all and therefore again does not necessitate the resident involved in having to have different food than the main one served. One resident enjoys going to church when staying at the home. The staff facilitate this by ensuring transport is arranged. There are lots of enjoyable and well attended in-house activities as well as external activities provided/made available. An example of this is the monthly disco to which over 100 people, with a learning disability, regularly attend including those that have used the service at Baytree House throughout the year. Residents remain supported and encouraged to develop existing independence skills, learn new ones and make decisions about their lives. Due to the past success of a relationship group (where clients with a learning disability are encouraged to discuss and consider the implications of any social or personal relationship), a new one is due to commence in January 2007. Torbay Council have previously presented the Blue Shield award in recognition of this valued work. The environment at Baytree House is very clean, homely, well decorated and well furnished. The management has undertaken some excellent quality auditing of the services provided which has fully involved the residents and their families. The results obtained from this have been used to ensure that the service is one that meets residents’ and their parents/carers needs in a manner that is most appropriate and effective. The unit manager is a “person centred awareness” trainer who works along side the residents in the home to ensure that their needs are provided for by staff taking into account person centred planning. There is excellent support training provided for the staff at the home. An example of this is the fact that every single member of staff has received training in how to deal with any resident having a seizure. This level of training ensures resident welfare can be maintained to a high standard. The home operates an excellent key worker system. Four members of staff, including a manager, a senior care officer and two other carers work with each
Baytree House DS0000037128.V318976.R01.S.doc Version 5.2 Page 7 resident to ensure that the resident’s specific needs are known in depth by all four members of staff and that the resident therefore has four members of staff that they can feel are special to them. The manager of the unit will spend whatever time is required to allow a resident to discuss any issue that may be concerning them, or she will provide additional support for a resident who may appear to have a specific need. This ensures residents are able to talk freely and in confidence with someone who is skilled in understanding and/or recognising their needs. One of the particular strengths of the service is the way that contact is maintained with past service users as well as existing ones who may just want to call in for a short period during the day, or for a known service user whose parents just need a few hours of care during the day. The manager sees this very much as pro active work in allowing service users to be able to live outside a residential setting, knowing that support is always available if required. The management of the home will also offer an emergency placement to support both a service user and their carers in any time of unexpected need. There are good communications between the management and the staff groups with both sets of staff having four weekly meetings to discuss the general running of the home. This ensures that all involved in delivering the care to residents are fully informed of any developments or updates. There are also regular monthly meetings between a learning disability nurse and the staff to enable a discussion of any clinical issues that may arise such as medication and day to day care needs care. The management and the staff should be commended for the way that they have worked through a difficult period due to the possibility of change over the future use of the home and the change from being managed by Torbay Council to being managed by the Torbay care Trust. The changes involved have been handled sensitively and with good grace by all staff and have ensured that the service has remained consistent for the clients accessing it. The management have independently developed an emergency contingency plan to deal with any unforeseen event within the home. This ensures that the residents safety is always paramount regardless of circumstances. Baytree House DS0000037128.V318976.R01.S.doc Version 5.2 Page 8 What has improved since the last inspection? What they could do better:
The management of the home should always ensure that there is an in-depth pre-admission assessment undertaken and provided to the home by the placing care manager, prior to a resident’s admission.
Baytree House DS0000037128.V318976.R01.S.doc Version 5.2 Page 9 This is to ensure that the management and staff are fully aware of any new residents’ needs before the resident comes to stay at the home and so can then decide whether the home will be able to meet the resident’s needs and thus ensure that Baytree House is the most suitable placement. The homes own admission procedure should be upgraded to ensure that the staff are fully aware of all the resident’s needs and that these are recorded in the appropriate care planning documentation. This is so that all staff will be aware of the care needs of the resident and so ensure that appropriate care is always made available. The recording of what care is to be provided to the residents should more fully reflect the person centred care that the home does actually provide. Any use of a cot side should be risk assessed, following consultation with the resident themselves (if possible) and any other interested parties such as a District Nurse and the resident’s family/carer. This information should then be recorded in the individual resident’s risk assessment. This is to ensure that this form of protection remains the most appropriate and in the best interests of the resident. Updated medication training, from a suitable source, should be made available to all staff involved in this area of care. A photograph of each resident should be placed on each resident’s medication records whenever possible. Both these measures will ensure clients remain protected in respect of the medication administered to them. A risk assessment should be undertaken for each resident involved in helping in the kitchen area to ensure that any identified risks are known and minimised wherever possible. It was noted that rooms 15 and 16 felt cold and were recording a temperature of just 60 degrees Fahrenheit on the first day of inspection. (Both these rooms were unoccupied on the days of inspection). As the temperature controls of the home are not regulated from within the home (therefore not enabling the home’s staff to directly alter the heating within the home) but from an external central source, regular checks need to be made by the home’s staff and the central source informed of when the home feels cold so that residents are always able to be cared for in a comfortably warm environment. Staff records, including application forms, two written references and the Criminal Record Bureau checks should be forwarded to the manager, from the Trust’s personnel department, and then kept within the home so as to be available for inspection purposes. This is to ensure that the manager is able to be fully aware of all the newly appointed staff member’s details and so ensure that residents remain protected by the appointment of suitable staff.
Baytree House DS0000037128.V318976.R01.S.doc Version 5.2 Page 10 Any new staff members’ induction programme, should be formally recorded to evidence that they have received the necessary training to allow them to provide the required care to the residents. The dates of supervision provided by the home’ senior management team should be made available to the unit manager so that the manager can ensure that supervision is provided as required. This to ensure that staff regularly continue to receive the necessary support and training to allow them to undertake their roles in the best possible manner to meet residents’ needs. The last recorded visit by a representative of the Trust was in June 2006. It is understood that a visit was carried out in November 2006. It is a requirement that these visits are undertaken on a regular monthly basis ensure that there is a monthly audit of the home’s working practices and so consequently ensure residents remain cared for in a well managed setting. It should be noted that this inspection took place over two days and the shortfalls were noted on the first day. By the second day of the inspection the management had already either addressed or drawn up an action plan to address these shortfalls. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Baytree House DS0000037128.V318976.R01.S.doc Version 5.2 Page 11 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Baytree House DS0000037128.V318976.R01.S.doc Version 5.2 Page 12 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2. Quality in this outcome area is adequate. The home’s admission processes did not always provide enough detail to show that all prospective residents’ individual aspirations and needs had been adequately assessed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Although there remains a good introductory procedure for new residents, involving a number of visits for tea etc to familiarise residents and allow them to get to know staff and visa versa, the residents’ records, on admission, did not always contain the required information to allow all staff to be aware of their needs and how to meet them. Some of the details received from the placing care managers had not been sufficiently detailed enough to allow the manager and staff to have a clear understanding of the prospective resident’s needs and then decide if the home cold meet the needs of the prospective client. In the case of one resident, whose care was looked at in detail, from the date of their admission to when they left the home, it was noted that a risk assessment had not been carried out for the resident’s stay at the home and Baytree House DS0000037128.V318976.R01.S.doc Version 5.2 Page 13 there were incomplete medical records for the same resident as well as incomplete day to day records such as next of kin, date of birth etc. As this resident had very specific needs not having this information available, to staff providing the care to the resident, may have put the resident at risk as staff would not have a full awareness of the resident’s needs and how to fully meet them. However two other resident’s details were examined and in these cases there had been a clear assessment process undertaken. Baytree House DS0000037128.V318976.R01.S.doc Version 5.2 Page 14 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6,7,and 9. Quality in this outcome area is adequate. Although the manager and staff are skilled in planning for all aspects of residents’ overall needs and personal goals of the residents the residents are not always seen to be fully involved in the care planning processes. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Resident’s needs were well understood by staff, and some recently upgraded and amended care plans and risk assessments examined covered a comprehensive range of needs. However others were less detailed and informative. Although the staff and management were noted as upholding the principles of person centred planning, with the resident’s day to day routines being decided upon by the residents themselves and care being seen to be delivered in a manner that reflected the resident’s individuality, the recording processes of the home did not reflect this positive way of working.
Baytree House DS0000037128.V318976.R01.S.doc Version 5.2 Page 15 In most instances the care plans inspected had been completed by the staff and reviewed by the staff with little actual involvement from the resident. However residents spoken with stated that they were happy staying at the home and were seen to be fully involved in all aspects of choice such as mealtime choices, activity choices, bedtime routines etc. A new initiative is being commenced within the home in relation to the recording of resident information. This is called a “life book” and currently three residents are using this method of recording. It is a communication tool that is used and shared by all involved in the resident’s care, be it staff at the home, parents when the service user is at home of any other carer involved in the care of the service user. The service user also has a large input into the recording and may want to use the book themselves when attending reviews etc in the future. It is hoped that this way of recording may become the norm at the home, which would automatically lead to more person centred approach in regard to record keeping. A feedback comment from a visiting professional also stated the following: “I have every confidence in the service provided to young people through Baytree House. My experience is that they have worked closely and have been creative in fulfilling care plans that have been agreed and in resolving any problems in management that may at times arise”. Another stated; “ As a learning disability community nurse I have always found Baytree to function in a professional person centred manner asking for support when appropriate to improve staff’s knowledge and skills”. The staff within the home often use total communication skills to enhance the communication with those residents who use other ways of communicating rather than verbally. Risk assessments are maintained but again whilst some were excellent others were less detailed. In one instance a risk assessment had not been undertaken at all. The use of a cot side had not been fully discussed and agreed with the resident (if able), the resident’s family or any other professional that may be involved with the resident’s care. Undertaking this process ensures that all who need to be are fully aware of the use of the cot side and that it continues to be used in the best interests of the resident. The home operates an excellent key worker system with each resident being appointed a team of four staff that they are made aware will be able to help them with any specific issues. The team consists of an assistant manager, a senior care officer a care officer and a night time care officer. Baytree House DS0000037128.V318976.R01.S.doc Version 5.2 Page 16 Having this amount of staff allocated to each resident ensures that there is always someone on duty that the resident can turn to if they have specific concerns. Baytree House DS0000037128.V318976.R01.S.doc Version 5.2 Page 17 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14,15,16 and 17 were inspected. Quality in this outcome area is excellent. The residents have as active a lifestyle as possible within the constraints of their abilities. Residents’ lives continue to be enhanced by being supported to participate in many varied activities and by making good use of the local, nearby community facilities. All aspects of daily living within the home, continues to be determined, as far as possible, by resident choice whilst healthy and well planned meals are provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All residents at Baytree House are on short term breaks. The home also offers three assessment beds and these can be occupied for a period of up to three months however, on occasions, residents will be allowed to occupy these beds for longer periods until a suitable permanent placement can be found.
Baytree House DS0000037128.V318976.R01.S.doc Version 5.2 Page 18 During the three months an assessment is undertaken using the HALO assessment tool (Hampshire Assessment for Living with Others). This looks at where the best place would be for the service user following their three month assessment and whether or not the service user is ready to move into a more independent living environment. On the day of the inspection two of these beds were being used. Staff support residents to continue with leisure activities they enjoy. Residents continue to go to various clubs and are well supported by staff to undertake other activities such as shopping, going for a walk, going to the local pub etc. There were several in-house activities to do at Baytree House like pool, a computer, board games, art and craft, T.V etc. One resident spoken with stated: “I like Baytree. I like all the staff especially X and X. I like my friends. I enjoy my meals it is nice. I sometimes go to the town”. The same resident was noted as wanting a pasty for lunch, rather than the planned lunchtime choice, and wanted to go to the town to get one. This was organised and the resident enjoyed being able to make this choice. Recently some residents went on a shopping trip to a newly opened shopping centre in Plymouth, which was enjoyed by all who went. The week following the inspection there was to be a disco in the evening. Several staff are now able to drive the home’s mini bus and as such residents are often given the opportunity to go out for a trip if they wish. These are often arranged informally depending on what residents want to do do. The home produces a quarterly newsletter for all service users and carers of Baytree House. It is very informative and written in a clear and easy to understand manner. The winter edition was seen and had such items of interest such as what social events were to take place, staff news as well as details of local events that the readers may be interested in. There were notices of several events displayed throughout the home as well as pictures of participants in past events. There were also pictures on the walls that had been drawn/painted by the residents. A visitors signing book was available. Discussion took place as to the need to ensure that all visitors do sign in when visiting the home, as some visitors coming very regularly do not currently sign the visitors book. Therefore the management would not always be aware of who was in the building in the event of an emergency. Family contact remains an integral part of the service at Baytree House. During the second day of the inspection it was noted that a new resident was visiting the home with his parents. All were seen as being made welcome and comfortable and it was noted that care was taken to answer all questions sensitively and honestly. The parents were very much a part of the decision process regarding whether the home would be a suitable place for their son. Baytree House DS0000037128.V318976.R01.S.doc Version 5.2 Page 19 Baytree House has a welcoming atmosphere, and visiting is very much encouraged. On the second day of the inspection there was a coffee morning for any one associated with Baytree House. There were hot mince pies and coffee and those attending were warmly welcomed and clearly enjoyed being there. The registered manager previously ran a very successful a relationships course, which helped residents develop and maintain positive personal relationships and which was recognised by the Torbay Council with the home being achieving a “Blue Shield” award in recognition of this service. The manager is due to re-commence another such course in January 2007. Many of residents at Baytree who have short breaks normally live at home, so their day activities continue during the stay. On the first day of inspection several residents returned from various day centres around 4.00p.m. The time for admission to the home is normally 2.00.pm. although flexibility about this timing is available as required to accommodate parents’ needs. Residents leaving the home, following their stay, usually do so by 11.00 a.m. The full time cook, who was spoken to, has worked for several years at the home and is fully aware of healthy eating and of how to provide for specific dietary needs and healthy nutritious meals are provided. She was enthusiastic about her role and clearly took pride in providing a range of meals that residents would enjoy. The home also employs a second cook to work on the full time cook’s days off. Both of these cooks have regular meetings to ensure that they both continue to provide the best meals for the residents at the home. Menus were inspected and were noted to be varied and interesting. The main meal of the day is in the evening after all the residents return home and staff sit with residents during the meal to ensure that it is a social and shared occasion. This was seen to be happening on the first evening of the inspection. All residents stated that they wee enjoying their tea, which looked and smelt very appetising. Snacks are provided throughout the day as required and there is an area where residents can make their own hot drinks if able/desired. Residents are also welcomed into the home’s kitchen to help with food preparation. However it was agreed that a risk assessment should be undertaken for each resident involved in this practice to ensure that any identified risks are known and minimised wherever possible. Baytree House DS0000037128.V318976.R01.S.doc Version 5.2 Page 20 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18,19 and 20. Quality in this outcome area is good. Staff provide sensitive and flexible personal support and care to maximise the residents’ rights to privacy, dignity, independence and choice over their own life. Staff also have a good awareness regarding the residents’ health and emotional needs which allows the residents to maintain as good health as possible and build feelings of self worth and esteem. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents’ health needs are well understood by staff, with specialist training provided as necessary, for example care staff working at the home attend epilepsy, person centred awareness and total communication training to ensure that they can meet the needs of the residents. It is to the manager’s credit that she ensures that all staff, whatever their position, attend epilepsy training. This is to ensure that any staff member would be able to deal with a resident who suddenly had a seizure and consequently ensure all staff can provide the correct treatment.
Baytree House DS0000037128.V318976.R01.S.doc Version 5.2 Page 21 Adequate monitoring of residents with epilepsy is in place with the provision of sensor pads for use with those residents that suffer with epilepsy. These monitor movement and alert staff if a resident may be about to have a seizure. These residents also have an epilepsy profile, which clearly documents what course of action to take in respect of the resident having a seizure. This helps ensure that these residents receive the correct and agreed care necessary. Usually other routine health care appointments are usually undertaken with the parents of the residents, but the staff at the home will also support residents with t these as required. Health care needs for those residents occupying the assessment beds and who are therefore resident in the home for a longer period, are also well understood and appropriate health care appointments and check ups arranged as necessary. There was also evidence of the appropriate use of healthcare professionals to advise of medication, and health related issues. A learning disability nurse visits the home monthly and attends a staff meeting to discuss any medical or clinical matters. This ensures that there is excellent communications between outside professionals, which ultimately benefits residents by allowing staff to have an up to date awareness of any clinical/physical needs and the best way they can meet them. An example of this was the recent care provided for a resident with an existing illeostomy and for a resident with diabetes. The manager and the nurse ensured staff received training in how to provide care for these conditions so that the service users could be sure that their needs would be met. Staff receive other relevant training and were observed to provide sensitive personal support to residents. Residents are encouraged to do as much for themselves as possible, although support is always available as needed. The home’s medication cupboard was inspected and noted as being locked with the storage of medicines in order. There was also a fridge available to store any medication that required a cold temperature. Medication was being administered and recorded appropriately by named staff, who are all senior members of staff. Residents, able to, administer their own medication and are supported in this by the staff. A risk assessment is also maintained in respect of this. The home operates a sound medication system, which helps ensure that residents are protected. There is a medication profile for each resident and records seen were up to date. There is also an annual (or sooner if required) review of residents’ medication, when parents/carers are asked to send in an updated list of medications that a resident may be taking. This ensures that staff at the home are fully aware of any changes that may have occurred over the twelve months (or sooner if necessary). Due to the nature of the frequent short stays of the residents at Baytree, this safeguard does help to further protect residents.
Baytree House DS0000037128.V318976.R01.S.doc Version 5.2 Page 22 However some staff have not received training in medication administration from a suitably trained person such as the supplying pharmacist, although these staff members had been given in-house training from an experienced senior staff member who does administer medication. However, although these senior staff had originally received suitable training, they had not had updated training within the past two years. It was also noted that the administration of medication was an area that was reviewed by the Trust’s management during their monthly required visit in June, and a shortfall that was noted then was immediately rectified to further minimise any risk to residents. Therefore it can be concluded that these senior management visits also help protect residents in the safe administration of medication. Residents are encouraged to make decisions throughout their stay at Baytree House about all aspects of their day to day lives, which was evident from residents’ records, interaction with staff and from the excellent quality assurance system that the registered manager had implemented. One of the particular strengths of the service is the way that contact is maintained with past service users, as well as existing ones, who may just want to call in for a short period during the day, or to provide a few hours care for a known service user whose parents may just require this small amount of respite time. There are also monthly meetings held for past service users where day to day matters are discussed and support made available with as required. The manager sees this work as being very much pro-active in allowing service users to be able to manage outside a permanent residential setting, whilst knowing that support is always available if required. Baytree House DS0000037128.V318976.R01.S.doc Version 5.2 Page 23 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23. Quality in this outcome area is good. There is a satisfactory complaints procedure and arrangements for protecting residents from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an appropriate complaints procedure, which is displayed in the home’s hallway with an easy to understand edition also available for residents in the home. The Torbay Care Trust are in the process of changing the complaints policy but the one displayed still does contain necessary information including the contact details of the Commission and the local Social Services. The Commission for Social Care Inspection has received no complaints about the service since the last inspection in January 2006. The home has policies and procedures in place to provide staff with details of how to deal with any areas of suspected abuse. The majority of staff have now received training in adult protection, with some having recently updated their knowledge and with further training planned. Risk assessments need to be in place in respect of any form of agreed use of restraint such as the use of cot sides to ensure that the continued use of these remain in the best interests of the resident. The residents’ monies are managed by their relatives/advocates. The management will hold small amounts of money for residents during their stay, if asked to, and there are safe facilities available and full records of any such monies held, with the balance being checked twice daily by the senior
Baytree House DS0000037128.V318976.R01.S.doc Version 5.2 Page 24 staff on duty. These measures ensures residents’ monies are protected whilst at the home. Residents also have a locked facility within their rooms to keep any money or valuables safe. Baytree House DS0000037128.V318976.R01.S.doc Version 5.2 Page 25 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 and 30. Quality in this outcome area is good. Baytree House is clean warm, comfortable and homely. Residents’ bedrooms are personalised and well furnished. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager and staff work hard to maintain the environment at Baytree, and on the days of inspection it was very clean and welcoming with the home being nicely decorated for Christmas. The communal areas had comfortable and modern furnishings and were being well used. Bedrooms were also well presented and there was evidence of some small personal items, in the rooms, belonging to the residents currently staying at the home. Each room has been provided with a stereo and a bedside lamp since the last inspection. All rooms also have a call bell available.
Baytree House DS0000037128.V318976.R01.S.doc Version 5.2 Page 26 There were adequate well equipped bath and toilet facilities which were again pleasantly presented and were provided with a suitable locking facility. Since the last inspection the outside of the building has been repainted and six bedrooms redecorated. The ground floor of the annexe consisting of a lounge/dining /kitchen area has also been completely refurbished. Although this area is not currently in full time use consideration is being given to its future use, with such thoughts as utilising the area to possibly provide an independent training skills centre. There are also two bedrooms in the annexe, which can be accessed from the main home or from the annexe. The two rooms do necessitate the resident being ambulant, as they do need to be able to mount stairs to access the rooms. The Environmental Health Department visited the home in March 2006 and the report indicates that the home is complying with the requirements of the department. The management of the home are also maintaining the home’s fire precautions adequately, with the home’s fire records being made available. This ensures residents would be protected in the event of a fire occurring in the home. The garden had been landscaped by a local day service project and now has easy access making the use of it available to all. The laundry room has been upgraded and now provides a suitably hygienic and functional place to undertake residents’ washing. Hygiene control systems are in place throughout the home including anti-bac dispensers for staff to use and the provision of paper hand towels dispensers in various areas of the home. The heating of the home is remotely managed i.e. the staff cannot turn the heating on as this is set on a timer and a temperature control situated outside of the home. The staff can, however, alter the temperature within the home when the heating is on. It was noted that two rooms, 15 and 16, felt cold during the first day of the inspection, although the rooms were not being occupied at the time of the inspection. The temperature of the rooms was registering at just 60 degrees Fahrenheit. On the second day of the inspection the home’s management had contacted the Care trust’s property department and the temperature control of these rooms was being adjusted to ensure they were kept at a warmer temperature. The security of the home is appropriate with the home having an alarm on all exit doors and locks on all full length windows. During the tour of the home it was noted that windows checked on the first floor had restrictors in place, however one window inspected did not have a restrictor in place. This was immediately rectified and replaced. Baytree House DS0000037128.V318976.R01.S.doc Version 5.2 Page 27 Baytree House DS0000037128.V318976.R01.S.doc Version 5.2 Page 28 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32,34 and 35. Quality in this outcome area is good. Residents are well supported by an appropriately experienced and trained staff group. The staff recruitment programme is adequate and protects residents. There are sufficient designated staff on duty to meet the residents’ agreed needs at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staffing rota was discussed and it was concluded that there was sufficient staff employed to work with residents, including a one to one staff member for those residents who needed this ratio of staff. At night there is a waking night staff member and a sleep in member of staff. The home has adequate ancillary staff including an office administrator who was present on both days of inspection and is responsible for the administration work involved in the organisation of the many short term placements (currently approximately about fifty a month). Cooking staff, domestic staff and a maintenance man also from part of the ancillary staff group.
Baytree House DS0000037128.V318976.R01.S.doc Version 5.2 Page 29 The home has a staffing board indicating, in an easy to use format, who was or would be on duty and observing the board residents were able to have this information. Agency staff are used if necessary, but the management try and utilise existing staff if at all possible, to ensure consistency as much as possible. Staff were seen to be approachable and genuinely enjoyed working with residents. One of the home’s permanent staff, who has worked at the home for several years has mild learning difficulties and is well supported in her role. Speaking with her she said how much she enjoyed working at the home and clearly was a great asset to the home, being very involved in helping to keep the environment spotlessly clean. A feedback comment received from a visiting professional stated: “ I have visited Baytree many times over the past four years. I have always found the staff to be friendly and welcoming. They are professional in their manner of working. The clients I work with who received services from Baytree all enjoy the time they spend there”. Staff said they were provided with a range of specialist learning disability training, which helped them do their jobs, and were involved as key workers in reviewing resident’s needs. Training provided for staff has included induction training, fire awareness, infection control, moving and handling, health and safety, disability awareness, first aid, epilepsy, handling violence and aggression, adult protection, child protection, deaf awareness, food hygiene, anti-discrimination, and total communication. Person centred awareness training is also to be made available early next year. On going adult protection training will also be provided early next year. Over half the care staff at Baytree had attained, or are working towards a nationally recognised qualification in care with six staff in the process of undertaking this training this year. This level of training ensures staff are competent within their role and able to provide the necessary level of support to the residents. A staff member’s comment about working at the home was: “It’s a good staff team, we give good care, and I like working here. We enjoy being with the clients they become like family”. The Care Trust is not using the previous records for induction training and, as yet, have not formulated a record of the induction training provided to new staff. However the home’s management team ensures that a newly appointed member of staff undertakes an in-house induction programme and spends time shadowing an experienced member of staff. Feedback from three service users’ relatives stated the following: “We are very satisfied with the standard of care X receives at Baytree House. We have an excellent relationship with the staff who are always friendly and answers any queries”. Baytree House DS0000037128.V318976.R01.S.doc Version 5.2 Page 30 “We have nothing but praise for the staff at Baytree House. They are always willing to help and assist you”. “The staff at Baytree are great. Baytree House provides an essential service and does so effectively and with appropriate care. We could not do without the respite care from Baytree and X enjoys her stays at the home as much as she can enjoy anything”. Regular staff meetings take place and a recent team training day was held followed by an “away day” which was used to discuss the changes arising at the home and to help build staff morale. Staff were encouraged to speak freely and the management of the home has addressed the issues raised. It was noted that there had been some staff changes since the last inspection with three new staff being appointed. However the full staff records including the two written references and the Criminal Record Bureau checks were not available in all the staff records as these are now being held centrally rather than in the home. Therefore it was not possible to fully verify the suitability of the three new staff members’ appointments within the home, as not all records were available for inspection. Staff receive regular supervision with one of the assistant managers having recently undertaken supervision skills training. Both assistant managers are responsible for staff supervision and the unit manager is responsible for supervising the assistant managers. The unit manager’s supervision records were available as was the one of the assistant managers however, one assistant manager’s records were not available to inspect as the records were locked away and the assistant manager was the only on with access to this locked area and she was off duty. Although this maintains the staffs’ confidentiality, the unit manger was not able to verify whether the staff had received the adequate number of supervision sessions and what the content had been. It was therefore advised that the assistant manager also let the unit manager know of when supervision sessions had taken place and what the content had been. Baytree House DS0000037128.V318976.R01.S.doc Version 5.2 Page 31 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37,39 and 42. Quality in this outcome area is good. The home is managed efficiently and well. Staff endeavour to ensure that the home is run in the best interests of the residents. The home provides a safe, secure environment where residents’ safety and well being is maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has many years of working in and managing services for people with a learning disability, and keeps her practice up to date by attending training and running groups. She has completed her NVQ 4 in care and management and is currently awaiting verification of the award having submitted her work. Baytree House DS0000037128.V318976.R01.S.doc Version 5.2 Page 32 All the required health and safety training is provided for staff including moving and handling, first aid and food hygiene. Health and safety records that were inspected were noted as being up to date. These included the home’s accident reporting which was clear as was the electrical testing and maintenance records of such things as the home’s lift. The home’s risk assessment is in the process of being updated accordingly. An annual workplace inspection audit was carried out in January 2006. The new Care Trust has appointed a health and safety officer with whom the staff can discuss any risk and get advise as to how to minimise the risk. This again protects residents by ensuring the home remains a safe environment. The home’s hot water is regulated to 43 degrees Centigrade and extra safe guards are also in place with bath water temperature being tested by a thermometer prior to a resident taking a bath. All radiators have low surface temperatures. The home has a crisis intervention protocol, which the manager has developed throughout the year, and should be commended for, which takes into account how to respond to any serious incidents occurring in the home and how to deal with them with the minimum of disruption to the residents. The registered manager should also be commended for the quality assurance system that are in place, which are resident-centred and fully involves their families and other stakeholders. A quality assurance day was implemented for the third year running earlier this year. Specific areas that were audited this year included the building, activities, choice, and money. Outside facilitators were used to enable all residents and staff to participate. It was conducted in a professional yet informal manner to allow all participants to feel comfortable with the process. Following the quality audit exercise a social evening with refreshments and a disco was provided to allow residents to know that giving their views was considered a positive experience and necessary to allow the service to be run in their best interests. A full feedback session was held at a later date at an external venue, where all who participated were invited to attend. The results were seen and it was very pleasing to note that although many significant strengths were noted such as: “The staff make me feel safe”, and that “most felt the staff knew enough about the residents to provide the support they needed”, it was also noted that some residents felt that agency staff did not have the same awareness and some found it more difficult with new staff. This specific feedback was noted as being welcomed and had allowed the management of the home to strive to improve and build on the high standards already in place. In this instance known staff are now being utilised whenever possible to help residents feel more comfortable and confident regarding the carers at the home. Baytree House DS0000037128.V318976.R01.S.doc Version 5.2 Page 33 A full and detailed draft business plan for 2006/2007 based on the outcome of the quality auditing exercise has been published. The home also has a suggestion box prominently displayed to allow residents or others to make any suggestions in an anonymous manner if they should so wish to. The home’s polices and procedures were available for inspection and contained relevant polices and procedures to inform staff as to what is expected of them and to support them in their role. Regular staff and management meetings are held and the minutes wee seen. It was pleasing to note that minutes are recorded honestly to ensure the management know which areas staff feel there can be improvements in. It was also pleasing to note how the management addressed any area of concern raised by staff. Staff did confirm that they mostly felt very supported by the management of the home. They did state, however, that they had found this past year unsettling with the future of the home being undecided at the beginning of the year and the change over to being managed by the Care Trust. It was to the manager’s credit that she had both understood and dealt with these concerns sensitively and effectively by allowing staff the time to reflect and voice their concerns and had addressed these concerns as best she could by communicating all the knowledge she had. The last recorded visit by a representative of the Trust was in June 2006. It is understood that a visit was carried out in November 2006. It is a requirement that these visits are undertaken on a regular monthly basis to ensure that there is a monthly audit of the home’s working practices and so consequently ensure residents remain cared for in a well managed setting. Baytree House DS0000037128.V318976.R01.S.doc Version 5.2 Page 34 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 2 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 2 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 3 3 LIFESTYLES Standard No Score 11 x 12 4 13 4 14 4 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 x 4 x x 3 x Baytree House DS0000037128.V318976.R01.S.doc Version 5.2 Page 35 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 YA2 Good Practice Recommendations The management of the home should ensure that there is a pre-admission assessment undertaken, and provided to the home by the placing care manager, prior to a resident’s admission. The home’s admission procedure should ensure that all the resident’s needs are fully recorded in the appropriate care planning documentation. The recording of what care is to be provided should more fully reflect the person centred care that the home does actually provide. A risk assessment should be undertaken for each resident involved in helping in the kitchen area to ensure that any identified risks are known and minimised wherever possible. The management should ensure that there is a detailed
DS0000037128.V318976.R01.S.doc Version 5.2 Page 36 2 YA6 3 YA9 4 YA19 Baytree House risk assessment undertaken in respect of any resident who uses ct sides. 5 YA20 Updated medication training, from a suitable source, should be made available to all staff involved in this area of care. A photograph of each resident should be placed on each resident’s medication records Staff records, including references and Criminal Record Bureau checks should be forwarded to the manager from head office to keep on the home’s file and then kept available within the home for inspection purposes. The registered manager should maintain records of the induction training made available to new members of staff. A representative from the Care Trust should ensure that monthly regulation 26 visits to the home are maintained. 6 YA34 7 8 YA35 YA37 Baytree House DS0000037128.V318976.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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