Inspection on 05/03/08 for Baytree House

This inspection was carried out on 5th March 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Baytree House 18/02/09

Baytree House 04/12/06

Baytree House 03/01/06

Baytree House 11/07/05

Baytree House 25/01/05

Baytree House 05/08/04

Baytree House 24/02/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Baytree House Torbay Council 22 Croft Road Torquay Devon TQ2 5UE Lead Inspector Judy Cooper Unannounced Inspection 27 February 2008 10:00 th Baytree House DS0000037128.V358383.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.V358383.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.V358383.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.V358383.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 4th December 2006 Brief Description of the Service: In December 2005 a merger of adult social services and adult health services within Torbay led to the formation of Torbay Care Trust and it is the Trust that are classed as the Provider in relation to 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 people 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 people, 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 person occupying any of these three rooms being able to negotiate steps. A “Home Based Breaks” service is also based within Baytree House, which the manager oversees. This is a small additional outreach service, providing staff, who support clients for a short period of time within their own home setting. The service is managed by a coordinator employed specifically for the service and is from a separate area within the home with the home’s registered manager overseeing the service. Baytree House is situated near 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 £946.99. The management keeps the inspection report within the home’s communal hallway where it is easily available to all. Baytree House DS0000037128.V358383.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection took place on a Wednesday between 10.00 a.m. and 4.00 p.m. During the visit the opportunity was taken to tour the home, examine appropriate records and policies and talk with the people who were in the home during the time of the inspection. The unit manager, several other staff members, a visiting external trainer and two relatives were also spoken with. Other information about the home, including the receipt of 4 questionnaires from the people who have stayed/are staying at the home and 2 from the peoples’ relatives/carers has provided further feedback as to how the home performs. The manager also supplied information, prior to the inspection, about the services and facilities the home has to offer detailing such things as any improvements made or noting any areas where improvements can be made – it is a requirement to do this, the process is called an Annual Quality Assurance Assessment. All of the information collated from these various sources has been considered and/or 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 people living at the home and it was clear that they enjoyed the company of the different members of staff, whilst all were together within the communal areas of the home. Staff are fully involved in the people’s day to day lives and there is no segregation between staff and the people who stay at the home, with all using the same facilities for example, having meals together. People’s rights to individuality are fully upheld by all staff and people are treated with the respect. Some people 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 person is still fully included in the day to day activities within the home. This is particularly noticeable with those people who have very specialised needs, which require a one to one staff ratio. This is provided in a discreet and tactful Baytree House DS0000037128.V358383.R01.S.doc Version 5.2 Page 6 manner, which ensures the person does not become segregated or identified as being different in any way. There are lots of enjoyable and well attended in-house activities as well as external activities provided/made available, for example there is a weekly drama group which is very popular and several theatre trips have just been pre-booked for the year. Two zoo trips, which will be open to all the people who have used the service at any time, have also been booked. People remain supported and encouraged to further develop existing independence skills, learn new ones and make their own decisions about how they live their own lives. There has been on going success within the “relationship group” (where people with a learning disability are encouraged to discuss and consider the implications of any social or personal relationships they may have), and new group sessions are provided as required. The environment at Baytree House is very clean, warm, homely, well decorated and well furnished. The management has undertaken some excellent quality auditing of the services provided which has fully involved the people and their families. The results obtained from this have been used to ensure that the service is one that continues to meet people’s 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 people staying in the home to ensure that their needs are provided for by staff taking into account person centred planning. This means that the person is put at the centre of any care that is to be provided and is fully involved in any decisions in respect of this. There is good support training provided for the staff at the home, which helps ensure the people’s welfare can be maintained to a good 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 person to ensure that their specific needs are known in depth by all four members of staff and the person therefore has four members of staff that they can feel are special to them. The unit manager will spend whatever time is required to allow a person to discuss any issue that may be concerning them, or she will provide additional support for a person who may appear to have a specific need. This ensures people are able to talk freely and in confidence with someone who is skilled in understanding and/or recognising their needs. Contact is maintained with all people who have used the service who may just want to call in for a short period during the day, or in-house care provided for a known person whose parents/carers may just need a few hours of care Baytree House DS0000037128.V358383.R01.S.doc Version 5.2 Page 7 support during the day. The manager sees this very much as pro-active work to enable and encourage the people 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 person and their carers in any time of unexpected need. There are good communications between the management and the staff groups with regular meetings held to discuss the general running of the home. This ensures that all involved in delivering the care to people are fully informed of any developments or updates. What has improved since the last inspection? What they could do better: The management of the home must always ensure that all elements of a preadmission assessment, including providing an updated risk assessment are undertaken and the information recorded prior to an admission to the home taking place. This is to ensure that the management and all staff can be fully aware of any person’s needs before the person comes to stay at the home. This applies equally to a person who is known to the home because they have frequent stays as their needs may change in between stays. In one particular instance a person had been re-admitted but had newly presenting risks, which had not been formally recorded prior to admission. This could have put the person and staff at risk by all staff not being aware of the verbally agreed care procedures that had been put in place by the management but which had not Baytree House DS0000037128.V358383.R01.S.doc Version 5.2 Page 8 been recorded. The recording of what care is to be provided to the people should evidence that each person was fully involved in deciding what care would best be of benefit to them. The home’s medication trolley should always be secured to the wall to ensure medications remain secure when not in use. All staff must receive updated training in the protection of vulnerable adults. This is to ensure that all staff have the skills/knowledge needed to deal with any allegations of abuse and therefore can ensure that correct action is always taken to protect the people who are staying at the home. Any monies held for the people who are staying at the home should be held in separate containers to ensure that peoples’ monies remain safe and can be individually accounted for. It was noted that the hot water supply to the hand basin in room 14 was hotter than the safe recommended temperature of 43 degrees Centigrade. This was confirmed on the day of inspection by a staff member measuring the water temperature, which registered as being over a safe temperature. This heightens the risk of someone sustaining a scald and this risk must now be minimised. It was noted that two window restrictors were not in place in vulnerable areas within the home, which included the downstairs flat window and a window directly above in a bedroom. This increases the risk of someone using the downstairs window to access/exit the home (as had recently occurred) or of someone trying to exit from the upstairs window and then sustaining a fall from this first floor window - these risks must also be minimised. The registered provider and manager should undertake a review of the care staffing hours currently allocated to ensure the numbers always meet the needs of the people who live at the home to ensure the people remain safe when staying at the home. All staff recruitment records should be easily available within the home. This is to ensure that the manager is always fully aware of all the newly appointed staff member’s details and so can ensure that people remain, at all times, protected by the appointment of suitable staff. At this inspection it was difficult to “track back” two new staff members’ appointments as not all documentation could be inspected, as not all was available in the home, with some details being held in the Trust’ head office. The management of the home must always ensure that the Commission is immediately alerted to any issue, which could compromise the health, safety or well being of any person who is staying at the home. This is so that the Commission can monitor any such event and be assured that correct action has been taken to ensure the person’s best interests remain upheld. Baytree House DS0000037128.V358383.R01.S.doc Version 5.2 Page 9 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.V358383.R01.S.doc Version 5.2 Page 10 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.V358383.R01.S.doc Version 5.2 Page 11 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. There is a satisfactory process in place for assessments prior to admission, but not ensuring that information obtained from the assessments is recorded leaves people at risk of staff not being aware of their needs on admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a good introductory procedure for new people considering a stay at the home. Tea visits are arranged to allow them to get to know the home and staff and visa versa and on the day of inspection two new people were coming in for such a visit. At these visits details are obtained from the person and/or their families/carers, which then informs the overall care planning process. The parents/carers are very much a part of the decision process regarding whether the home would be a suitable place for their son. There are also good and close liaisons with the peoples’ families to allow them to understand what the service can offer. The management are further intending to update the home’s current documentation in respect of the service user guide and statement of purpose to ensure that it fully covers all aspects and facilities the home is offering. However it was noted that in the case of one person, who has regular stays at the home, a necessary risk assessment had not been formally documented prior to the person’s stay at the home. This was because the necessary Baytree House DS0000037128.V358383.R01.S.doc Version 5.2 Page 12 information and arrangements had been agreed verbally and had not then been written down. Not having this information easily available, to all staff providing the care to the person, may have put both the person and the staff at risk, when the person was admitted, as staff would not have had a full awareness of the person’s needs and how to fully meet them safely. Baytree House DS0000037128.V358383.R01.S.doc Version 5.2 Page 13 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. The management and staff are skilled in planning for all aspects of the overall needs and personal goals of the people staying at the home. They show both sensitivity and awareness of each person’s current and changing needs. However, not having access to recorded, up to date information in relation to known risks associated with each person, may mean that staff are not fully aware of how to deliver the required and agreed care. This therefore would compromise the safety and well being of the person. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People’s needs were well understood by staff, and a care plans examined covered a comprehensive range of needs. The management and staff ensure that they consider a person’s right to having their own particular needs upheld. This includes such things as beginning to incorporate into care plans individual spiritual beliefs and ensuring that female clients, staying at the home, are happy to have male staff provide care and vice versa. Baytree House DS0000037128.V358383.R01.S.doc Version 5.2 Page 14 The manager intends to update the home’s bereavement policy to ensure that the customs of different religions and ethnic groups are covered so that people can be assured that should they have any specific needs these will also be known and understood. Although the staff and management were noted as upholding the principles of person centred planning, with the person’s day to day routines being decided upon by the person 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. In most instances the care plans inspected had been completed by the staff and reviewed by the staff with little evidence that there had been some actual involvement from the person. However people 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, etc. A new initiative continues to be introduced within the home in relation to the recording of a person’s personal information. This is called a “life book” which is a communication document that is used and shared by all involved in the person’s care, be it staff at the home, parents when the person is at home or any other carer involved. The person also has a large input into the recording and can choose to use the book themselves when attending reviews etc in the future. The use of the “life book” is still only available to a few people but is hoped that in time it will be extended to all the people using the service, which would automatically lead to more person centred approach in regard to record keeping. The staff within the home often use total communication skills to enhance the communication with those people who use other ways of communicating rather than speaking. The manager had stated in the information received prior to the inspection (AQAA), that risk assessments are now fully maintained following an incident within the home, but these were not found to be fully in order at the inspection. For example, in respect of a person whose care was looked at in detail, a risk assessment had not been completed regarding a newly presenting issue that had led on to a vulnerable adult investigation. Neither had this person’s increasing mental health needs been risk assessed. The vulnerable adult investigation had resulted in certain new safeguards being put in place in respect of future stays. The person had been re-admitted with a verbal agreement that these additional safeguards would be in place and staff would adhere to them. Because these were not documented, (the risk assessment relating to this person was last dated 2005), it could not be assumed that all staff would have been aware of the newly presenting risks and of the subsequent care they should provide to safeguard the person, and themselves. It was noted that two agency staff both worked with this person, during the day of inspection on a one to one basis, without having access to this Baytree House DS0000037128.V358383.R01.S.doc Version 5.2 Page 15 information. The second agency worker, who came on duty in the afternoon, was reading the care plans which, at that time, did not have any reference to the newly agreed care to be provided to ensure that the identified risks could be minimised. The agency staff stated that they did not usually work with this particular person and did not know the person that well. Therefore they would not immediately have known of the care required by any other means than having it written down to refer to. Not having access to this information could potentially have put both the person and the staff members, providing the care, at risk. (It should be noted that once this was brought to the attention of the manager, during the inspection, an updated risk assessment was provided). The home operates an excellent key worker system with each person 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. Having this amount of staff allocated to each person ensures that there is always someone on duty that the person can turn to if they have any specific concerns/personal needs. There are pictorial signs throughout the home to aid communication for the people who find this method easier than the written word and there are interesting and relevant pieces of information displayed, throughout the home, such as what activities are available in the local area, etc. Comments received from relatives included such comments as: “The home is very supportive physically and mentally and emotionally”. And in response to the question: do you feel that the care home meets the need of your relative? The relative’s response was: Yes, even to receiving phone calls if there are concerns regarding X and their care/falls/medical/ emotional. X is allowed to phone me at home or whenever X has a concern needing my advice and as a parent I can phone her too. This is valued by us both”. “Only once was I not notified of X’s fall otherwise I am always kept informed and satisfied of their appropriate action”. A visiting parent stated: “X loves coming to Baytree. I am full of confidence she is well looked after, treated with respect and staff listen to what I have to say. I never have any complaints but know I could speak to the management if I had. I can speak to anybody at any time and they try and accommodate X’s respite breaks. They try and give X the same room each time”. Baytree House DS0000037128.V358383.R01.S.doc Version 5.2 Page 16 Another visiting parent stated: “I have a good communication with the management and I can’t speak highly enough of them. They are understanding to the people who stay at the home, they support them, they listen to them and they give them the time needed. For example X likes to stay in bed and the home allows this, even providing a member of staff to stay in the home if others want to go out. It is an invaluable service and we would be lost without it”. Baytree House DS0000037128.V358383.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 people have active and individual lifestyles, which are respected and maintained by staff. Healthy and well planned meals are provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All the people 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, people will be allowed to occupy these beds for longer periods until a suitable permanent placement can be found. 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 person following their three month assessment and whether or not the person is ready to move into a more independent living environment. Baytree House DS0000037128.V358383.R01.S.doc Version 5.2 Page 18 Staff support people to continue with leisure activities they enjoy. People 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 at Baytree House like pool, a computer, board games, art and craft, T.V, DVD’s etc. One person spoken with stated: “I like Baytree. I like all the staff especially X and X. I like my friends. I enjoy my meals they are nice. I sometimes go to the town”. The home produces a quarterly newsletter for all people and carers of Baytree House called the “Baytree Bugle”. It is very informative and written in a clear and easy to understand manner. There were notices of several up to date events displayed throughout the home as well as pictures of participants of past events/activities. There were also pictures on the walls that had been drawn/painted by the people. Many of people at Baytree who have short breaks normally live at home, so their daily activities continue during their stay, such as attending college, training centre etc. A visitors’ signing in book was available and it was clear that there are many visits made at different times of the day/evening. Family contact remains an integral part of the service at Baytree House. Visitors were noted as being made welcome and comfortable and there were good relationships between the home’s staff and visitors. Baytree House has a very welcoming atmosphere, and visiting is very much encouraged. The registered manager has previously run successful relationships courses, which have helped people develop and maintain positive personal relationships. 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. People leaving the home, following their stay, usually do so by 11.00 a.m. The full time cook has worked for several years at the home and is fully aware of healthy eating and of how to provide for specific dietary needs. Healthy nutritious meals are provided. She clearly takes pride in providing a range of meals that people would enjoy. The home also employs a second cook to work on the full time cook’s days off. Tea on the day of inspection was homemade pizza and the people stated that this was a favourite of theirs. The main meal of the day is in the evening after all the people return home from various activities or have been admitted for their stay and the people and staff sit down together to ensure that it is a social and shared occasion. Both of these cooks have regular meetings to ensure that they both continue to provide the best meals for the people at the home. Baytree House DS0000037128.V358383.R01.S.doc Version 5.2 Page 19 Snacks are provided throughout the day, as required, and there is an area where people can make their own hot drinks if able/desired. People are also welcomed into the home’s kitchen to help with food preparation and it was noted that one person, with a high level of need, went into the kitchen to help make a cup of tea with the support of their one to one carer. This level of care ensures that people of all abilities can undertake practices such as these and consequently no person is excluded or made to feel different. Comments received from parents/carers stated such things as: “Wrong behaviour and language is explained to clients as unacceptable. All clients are encouraged to become part of the family at BayTree whilst their individuality is encouraged”. “They share with the client other options that may be available to them so that people have a broader picture and can make the decisions better on how to live their lives. They continue learning skills to help in the future, from the basic simple everyday tasks and each person is individually treated according to their abilities”. “Theme nights are very popular as are the “Skills For You” course where clients have one to one experience and learning whilst enjoying tasks for living independently. Clients are encouraged to be as responsible as they can for themselves and help out laying tables, making coffee etc”. “The food served is delicious with many healthy variations to choose from”. “X is now on a self chosen weight awareness programme and is encouraged to choose wisely and is weighed every two weeks. Baytree House DS0000037128.V358383.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 18,19,20 and 21. Quality in this outcome area is adequate. Staff provide sensitive, flexible personal support and care to maximise the peoples’ rights to privacy, dignity, independence and choice. Staff also have a good awareness regarding the peoples’ health and emotional needs and ensure that good health is maintained as far as possible. Medication procedures are robust, but a recent error did put a person’s health at risk. Staff encourage the people to feel valued and as a consequence people were confident and felt able to “be themselves”. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Peoples’ 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 people. Adequate monitoring of people with specialist needs is in place. For example in respect of those people suffering with epilepsy there is the provision of sensor pads on beds and intercoms are also used to ensure that staff would be alerted if any person suffered a fit. Baytree House DS0000037128.V358383.R01.S.doc Version 5.2 Page 21 It was noted that the staff member, responsible for providing one to one care for such a person, was sat near the listening monitor whilst the person had a rest. This ensured the person could have privacy in their room but was also safely monitored at the same time. Routine health care appointments are usually undertaken with the people’s parents but the staff at the home will also support people with these needs as required. There was also evidence of the appropriate use of healthcare professionals to advise on general health and psychological related issues. Staff were observed as providing sensitive personal support to people who 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. People who are able to can administer their own medication and are supported in this by the staff. The home operates a sound medication system, which helps ensure that people are protected. There is a medication profile for each person and records seen were up to date. Staff have received up dated training in medication administration since the last inspection from an outside provider. However, it was noted that the medication trolley was not secured to the wall at this inspection, which is a security breach. ]The assistant service manager stated that this would be rectified immediately. A previous medication administration error that had been made by the home’s staff had been fully documented, and had been reviewed by senior management. The actions taken and subsequent actions to be taken to avoid the mistake happening again, were clearly documented, which confirmed that the management of the home fully investigates any such errors and puts new procedures into place to ensure it doesn’t happen again. For example two staff members always now sign to say that medication has been administered. During the inspection it was also noted that there strict controls on medication being received from a person coming in for a stay. One person had been prescribed a new medication since their last stay. For example their parent had come to the home a day before the daughter’s stay to inform the home of a new medication their daughter had now been prescribed. Therefore it can be concluded that both strict controls and continuous self monitoring within the home’s medication systems does ultimately help protect people in the safe administration of medication. However the Commission were not alerted to the incident regarding the medication misadministration, which resulted in a person having a reaction in respect of their medication not being given at the prescribed time. This meant that the Commission were not in a position to monitor the situation. Baytree House DS0000037128.V358383.R01.S.doc Version 5.2 Page 22 People are encouraged to make individual decisions, throughout their stay at Baytree House, about all aspects of their day to day lives, which was evident from peoples’ records, their interaction with staff and from the excellent quality assurance system that the registered manager has implemented. Contact is maintained with all past and present people, who may just want to call in for a short period during the day, or the home will provide a few hours of supported care for a known person whose parents/carer may just require this small amount of respite time. Baytree House DS0000037128.V358383.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 adequate. There is a satisfactory complaints procedure with the complaints policy being easy to understand by all people as it has been provided in an easy read format. Not all staff have yet received updated training in the protection of vulnerable adults. Therefore the people may not be fully protected as staff are not as informed as they need to be in respect of ensuring people are both protected from abuse and/or responding appropriately to any allegations of the same. 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 people staying in the home. Although the Commission for Social Care Inspection has received no formal complaints about the service since the last inspection in December 2006, there have been three adult protection investigations since November 2007, two of which are ongoing. Two have involved a police investigation. Both these have been in relation to alleged inappropriate sexual behaviour between some people staying at the home. The third allegation has not involved the police and is in relation to person alleging that a staff member caught them with a playing card during a game of cards. This is currently being investigated using the Care Trust’s “Safeguarding” policies. Baytree House DS0000037128.V358383.R01.S.doc Version 5.2 Page 24 The Commission were alerted on the day of inspection in respect of this allegation. The first allegation of inappropriate sexual behaviour was fully investigated by the police and no further action was taken. However the Commission were not notified of the allegation until three weeks after it had been made. The second allegation, involving the police, is still ongoing and in this instance the Commission were alerted as soon as the allegation was made. The home does have policies and procedures in place to provide staff with details of how to deal with any allegations of suspected abuse. The management have introduced a new flow chart to be followed by all staff in the event of any allegation of abuse being declared to ensure all staff are aware of the appropriate action to take. Staff spoken to stated they were familiar with the correct procedures and actions to take if a disclosure of abuse was to be made. This helps protect people further. However the recommended formal updated training in adult protection, following the recent allegations, has not yet been provided to all staff. All of the management staff have attended recent risk assessment training provided by the Care Trust. However it is important to ensure that existing risk assessments are updated to reflect any known increased/changing risk to ensure the protection of people who stay at the home is upheld. The peoples’ monies are mostly managed by their relatives/advocates. The management will hold small amounts of money for people during their stay, if asked to. There are safe facilities available and full records of any such monies held, with the balance being checked twice daily by the senior staff on duty. However the monies are held collectively in one large tin and as it was noted that there was a shortfall of £2.00 this could not be attributed to any one person’s monies. Management stated they will subsequently ensure that all people get the balance that is individually stated. Having arrangements in place to keep people’s monies individually would prevent this happening. People also have a locked facility within their rooms to keep any money or valuables safe if they wish to use this. Comments from relatives/carers in relation to the complaints were such as: “Myself and X know how to make a complaint as information is explained in easy to understand posters within the home’s hall for all clients”. “As parents we were called in once and informed of the verbal complaint made by X about someone”. This evidences that people and/or their carers know how to complain and that the home is proactive in dealing with any day to day complaints. Baytree House DS0000037128.V358383.R01.S.doc Version 5.2 Page 25 The home also keeps written records of any complaints received and of action taken to resolve them which was made available and which evidenced that the home try their best to resolve issues to everyone’s satisfaction. Baytree House DS0000037128.V358383.R01.S.doc Version 5.2 Page 26 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 adequate. Baytree House is clean warm, comfortable and homely. People’s bedrooms are individually personalised and well furnished. Some health and safety issues, such as the lack of hot water regulation to a wash hand basin and lack of some window restrictors are compromising people’s safety. 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 day of inspection it was very clean and welcoming. 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 people currently staying at the home (as no one lives at the home permanently items are limited). Each room is provided with a stereo, a bedside lamp and most have a television. Rooms waiting for new occupants were welcoming with clean towels etc provided. All rooms have a call bell available. Baytree House DS0000037128.V358383.R01.S.doc Version 5.2 Page 27 There were adequate well-equipped bathing and toilet facilities, which were again pleasantly presented and were provided with a suitable locking facility. Since the last inspection there has been the provision of some new furniture and fittings, bought by both monies raised by the home and from monies from the Care Trust. (Other upgrading has also been identified, including the upgrading of the first floor bathroom – a new shower base and is currently being planned for). There are also two further bedrooms in the annexe area of the home, along with a small communal lounge and kitchen area, which can be accessed from the main home or independently from the annexe itself. The two rooms necessitate a person being ambulant, as they do need to be able to mount stairs to access the rooms. The management of the home are maintaining the home’s fire precautions as required, with the home’s fire records being made available. The garden is easily accessible with a rabbit run being sited on the grass. The rabbit gave people pleasure to watch. The laundry room 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. It was noted that all rooms, being occupied were warm. The security of the home is appropriate with the home having an alarm on all exit doors and locks on all full length windows. However, during the tour of the home it was noted that one bedroom window on the first floor of the annexe did not have a restrictor in place and the communal lounge on the ground floor of the annexe also did not yet have a restrictor in place, even though there had been a recent incident involving two people using this as an inappropriate entrance into the home. Some hot water outlets were tested and it was noted that in one room the water temperature was much hotter than the recommended 43 degrees centigrade. A member of staff measured the water temperature using a water thermometer, which further confirmed the temperature to be very high. A relative’s comment made about the home stated: “The Bedrooms are always well furnished and clean”. Baytree House DS0000037128.V358383.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. An appropriately experienced, enthusiastic and trained staff group support the people who live at the home in a very positive manner. Staff numbers are currently sufficient to meet the needs of people and the recruitment policies are in order. 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 although there were sufficient staff employed to work with the people on the day of inspection, including a one to one staff member for the two people who needed this ratio of staff, the current ratio is one staff member for every five people staying at the home (excluding those receiving one to one care). The manager maintains these levels but stated, that on occasions, she felt that it would be safer to have a carer for every three people who live at the home rather than the current level of one carer for five (excluding the people receiving one to one care). 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 is responsible for the administration work involved in the organisation of the Baytree House DS0000037128.V358383.R01.S.doc Version 5.2 Page 29 many short-term placements, as well as general day-to-day administration work. Cooking staff, domestic staff and a maintenance man also form part of the ancillary staff group. Agency staff are used if necessary, but the management try and utilise known agency workers to ensure consistency; this was evidenced during the inspection when the two agency staff on duty both confirmed that they had worked at the home on several past occasions. Regular staff also knew these two agency staff. All staff were seen to be approachable and genuinely enjoyed working with the people. 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 and is considered a very valued member of staff. Speaking with her she stated 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. Staff said they were provided with a range of training and felt the training was good, which helped them do their jobs, and they were involved as key workers in considering people’s needs. Training provided for staff has included such areas as induction training, fire awareness, infection control, moving and handling, health and safety, disability awareness, first aid, epilepsy, total communication as well as person centred awareness training. Nine out of the current twelve permanent staff care at Baytree have attained a nationally recognised qualification in care with others in the process of commencing this training or undertaking additional enhanced training. This level of training ensures staff are competent within their role and are able to provide the necessary level of support to the people. An NVQ assessor was visiting the home on the day of the inspection to assess some work of an NVQ level 3 candidate. Staff comments contained within the home’s own quality audit findings stated: “I feel that training is more organised since becoming part of the Torbay Care Trust and I have been most impressed with the professionalism of the NVQ assessors”. “I am honestly very grateful for the training I have received at Baytree House”. An agency staff member’s commented: “This is one of the best places I’ve ever worked. The standards are met properly and people who live at the home are treated with dignity and respect. I have never seen anything other than that. The residents are very comfortable with the staff. Every client has a folder we are encouraged to read it, which enables me to know all necessary details which is really helpful. I feel I am always told everything I need to know”. Other staff comments included: Baytree House DS0000037128.V358383.R01.S.doc Version 5.2 Page 30 “I have worked at a lot of places. This is the best. Independence and choice are upheld and the people are asked what they want”. “People are treated as individuals, not just a group and their needs are paramount to everyone who works here”. “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 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. Regular staff meetings take place and a recent team building day is to be held in May following issues surrounding the recent vulnerable adult investigations to allow staff to discuss any feelings they may have and offer a day of support and encouragement following what has been and continues to be a stressful time. It was to the manager’s credit that she has understood these concerns and is taking action by allowing staff the time to reflect and voice their concerns in a safe setting away from the home to help build on their strengths of being good and effective team members. During the inspection a staff meting took place, which was well attended. During the meeting staff were encouraged to speak freely and it was clear that there was a good flow of communication between the manager and the staff team. There have been minimal staff changes since the last inspection with only three new staff being appointed. However the full audit trail involved in the staff recruitment process could not be fully verified as these records are now being held centrally rather than in the home. However there was standard form informing the manager that all checks had been carried out by the Trust’s personnel department and these were deemed to be satisfactory, which then allowed the manager to be able to employ the member of staff within the home. One of the newly appointed staff members was spoken with and she was able to confirm that she had undergone a full recruitment process including filling in an application form, providing two referees, and submitting details to allow an enhanced CRB disclosure to be undertaken. (It was noted that this had not yet been received back but the person was working under supervision). The staff member was suitably qualified and had a good understanding of the peoples’ needs and also confirmed she is currently undertaking a detailed induction programme, a record of which was later seen which verified this. Baytree House DS0000037128.V358383.R01.S.doc Version 5.2 Page 31 Staff receive regular supervision with records seen which helps ensure there are good communications between the management and the staff with both sides being aware of any personal or pertinent issues that may affect a staff member’s ability to perform their duties to the standard required. Both assistant managers are responsible for staff supervision and the unit manager is responsible for supervising the assistant managers. A comment received in respect of staff from a relative stated: “The staff are so caring, going out of their way to ‘encourage’ so that the clients fulfil their best potential in every way. Nothing is too much trouble for them to do, arrange, or sort out for the clients and their carers”. Baytree House DS0000037128.V358383.R01.S.doc Version 5.2 Page 32 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): 37,39,42. Quality in this outcome area is adequate. The management of the home is responsive to the peoples’ needs, however some necessary areas of management administration had not been completed as required which had resulted in staff not being fully aware of how best to protect the people who live at the home, this has compromised their safety and welfare at times. Peoples’ views are taken into account with the delivery of the service and the home is aimed to run in the best interests of the people. 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 sessions and running groups. She has completed her NVQ 4 in care and management. Baytree House DS0000037128.V358383.R01.S.doc Version 5.2 Page 33 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 such as the home’s fire log book. A staff comment noted in the home’s own audit stated: ”I think the in-house fire training is effective and helps staff to see the less obvious risks”. The Torbay 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. He is currently involved in the current internal investigation that is underway within the home following the recent vulnerable adult allegations. This helps protect people by ensuring the home remains a safe place to live in. The home’s hot water temperature is regulated to 43 degrees Centigrade and extra safeguards are also in place with bath water temperature being tested by a thermometer prior to a person taking a bath. However one hot water tap in room 14 was noted as being significantly over this temperature and as such could pose a risk to the people. All radiators have low surface temperatures. The home has a crisis intervention protocol, developed by the manager, which takes into account how to respond to any serious incident occurring in the home and how to deal with it whilst ensuring the minimum of disruption to the people. There is also a list of the qualified first aiders that work within the home. The registered manager should also be commended for the quality assurance system that are in place, which are person-centred and fully involves peoples’ families. A quality assurance day was implemented for the fourth year running last year. Areas that were audited included the building, activities, choice, and money. Staff were also asked for contributions on communication, health and safety, activities and their current feelings 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 was provided to allow people to know that giving their views was considered by management to be positive and necessary to allow the service to be run in their best interests. The results were seen and it was very pleasing to note that many positive comments were received such as: “X enjoys his time at Baytree and likes the events that are laid on”. “In the years X has been having respite at Baytree I have been impressed with the level of care and attention shown to X (and me). The staff are professional, always cheerful and genuinely care about what they do. Baytree House DS0000037128.V358383.R01.S.doc Version 5.2 Page 34 I feel we are part of a large happy family. Without the short breaks and holiday provision I would not have been able to continue as carer for X for so long. Every single member of staff deserves the highest praise”. “X always seems happy to stay at Baytree and would be upset if the excellent service was not available for the user and carer”. Staff also fed back that: “Now things are settling back down I look forward to a better future with the Care Trust”. It was pleasing to note this comment as, at the last inspection carried out in December 2006, there had been feelings of uncertainty due to the recent merger of the local Social Services department with the Health Authority to form the new Torbay Care Trust. The management should be commended for seeing through these changes in a positive manner, which has helped allow staff to now feel more secure as is noted from the above staff statement. The home also has a suggestion box prominently displayed to allow people 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 information to inform staff as to what is expected of them and to support them in their role. Regular staff and management meetings are held with the minutes seen and on the day of inspection a full staff meeting took place. Staff confirmed that they felt very supported by the management of the home. A representative of the Trust visits monthly and minutes were also seen of these visits. A comment received from a relative prior to the inspection stated: “The management of the home is responsive. We cant praise the whole ethos of Baytree enough”. Baytree House DS0000037128.V358383.R01.S.doc Version 5.2 Page 35 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 2 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 3 x 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 2 x 4 x x 2 x Baytree House DS0000037128.V358383.R01.S.doc Version 5.2 Page 36 No (none made) Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA9 Regulation 13(4) (c) Requirement Risk assessments must be reviewed and amended to ensure that they reflect any changing needs. This will ensure that both the people at the home and the staff are aware of what actions can be taken to minimise any presenting risk factors. 2 YA35 13 (6) Approved adult protection training must be made available to all staff members. This is to ensure that staff are aware of abuse issues and how to deal with them. This will then ensure the people at the home are protected. The management must ensure that the full details regarding the circumstances of any serious illness, appertaining to any person staying at the home, are forwarded to the Commission. This is so the Commission can monitor any such events and ensure correct action has been taken which will help to protect DS0000037128.V358383.R01.S.doc Timescale for action 27/03/08 27/04/08 3 YA41 37 1(e) 27/03/08 Baytree House Version 5.2 Page 37 the people at the home. 4 YA42 13(4)(c) The registered provider must 27/03/08 ensure that unnecessary risks to the health or safety of the people are identified and so far as possible eliminated. This refers specifically to completing risk assessment in relation to the bedroom in the annexe, which does not have window restrictor in place as well as the lounge window in the annexe which also does not have a restrictor in place. Restrictors must then be installed where a risk is identified. This so that the people who live at the home can live in a safe, risk free environment The registered provider must 27/03/08 ensure that unnecessary risks to the health or safety of the people are identified and so far as possible eliminated. This refers specifically to completing risk assessments for: the hot water supply to hand basins in peoples’ bedrooms and regulating the supply to a safe temperature where required. This so that the people who live at the home can live in a safe, risk free environment 5 YA42 13(4)(c) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Baytree House DS0000037128.V358383.R01.S.doc Version 5.2 Page 38 No. 1 Refer to Standard YA6 Good Practice Recommendations The recording of what care is to be provided should more fully reflect person centred care, that is care that is determined by the people themselves The home’s medicine trolley should always be secured to a fixed surface when not in use. The money belonging to different people should be held individually within the home’s safe. The numbers of staff provided should be reviewed to ensure all peoples’ needs are being met and people remain protected. Staff records, should be forwarded to the manager from the Trust’s head office so that the records can be accessed in the home. 2 3 4 5 YA20 YA23 YA33 YA34 Baytree House DS0000037128.V358383.R01.S.doc Version 5.2 Page 39 Commission for Social Care Inspection South West Regional Contract Team Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Baytree House DS0000037128.V358383.R01.S.doc Version 5.2 Page 40 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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