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Inspection on 25/03/10 for Baytrees Nursing Home

Also see our care home review for Baytrees Nursing Home for more information

This inspection was carried out on 25th March 2010.

CQC found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Medication records include details of all medication entering the home and the quantity. Training systems are now in place and all staff have received fire, manual handling and infection control training.

What the care home could do better:

For the purpose of this visit the medication notice is met but further work must be undertaken. When new medication is prescribed or changes in direction authorised there can be a delay of up to a month in updating risk assessment protocols. This must be addressed to ensure medication systems are robust. Accurate records must be maintained confirming residents are given their medication as directed in order that systems are safe. For the purpose of this visit the training notice is met. However the responsible individual must ensure that new training is embedded into practise.

Random inspection report Care homes for adults (18-65 years) Name: Address: Baytrees Nursing Home 1 Highfield Road Worthing West Sussex BN13 1PX zero star poor service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Lesley Webb Date: 2 5 0 3 2 0 1 0 Information about the care home Name of care home: Address: Baytrees Nursing Home 1 Highfield Road Worthing West Sussex BN13 1PX 01903693833 01903693822 baytreeshomes@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Denise McWilton Type of registration: Number of places registered: Conditions of registration: Category(ies) : Bay Trees Homes Ltd care home 30 Number of places (if applicable): Under 65 Over 65 0 physical disability Conditions of registration: 0 The maximum number of service users to be accommodated is 30. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Physical disability (PD). Date of last inspection Brief description of the care home Baytrees Nurings Home is a care home proving nursing care and accommodation for 30 younger adults with physical disabilities. Baytrees Homes Limited owns the service and the Responsible Individual on behalf of the company is Mr T Francis. The Registered Manager responsible for the day to day running of the service is Mrs Denise Care Homes for Adults (18-65 years) Page 2 of 12 Brief description of the care home McWilton. The home is located in Worthing and is close to shops, pubs and other amenities. The main house consists of a three-storey building, which has been extended and adapted. In 2004 a new extension for 10 service users was added to the premises this increased the registration to 30 service users. All rooms in the new extension and a small number of rooms in the main house have en-suite facilities. All rooms are accessible by a passenger lift. Service users have level access to two lounges/dining rooms, a conservatory and a large decked area to the rear of the property. The fees charged range from £662.46 to £1500.00 per week. Additional charges are made for dry cleaning, newspapers, hairdressing, personal items, clothing and toiletries. Care Homes for Adults (18-65 years) Page 3 of 12 What we found: The reason for this inspection was to assess compliance with two Statutory Requirement Notices (SRN). The SRN for medication was issued on 3rd March 2010. The compliance date for this was 15th March 2010. The SRN consists of 3 elements, these being - 1. Ensure that a system is in place to ensure service users receive their medicines as prescribed by their general practitioner. 2. Ensure that staff are given clear instructions and guidance on when to administer medicines that are prescribed for service users on an as required basis. 3. Ensure a system is in place to ensure all service users who self administer their medicines are risk assessed and this is documented within their care plan. We sampled seven residents current medication administration records (MAR). All included a record detailing when medication entered the home and the quantity. For one resident the MAR chart details three medications that are to be given as and when required (PRN). For two of these risk assessment protocols were in place. We noted that for this resident one PRN medication Senna had been signed as administered on four consecutive days at 6 pm. The registered manager stated that the MAR chart had been signed in error and that the medication had not been given daily. She stated she would address this with the nurse responsible for the errors in recording. A second residents MAR chart states that they should receive one Simvastatin 40mg tablet at 6 pm every day. The MAR chart had not been signed confirming this had been given for two days. The registered manager checked the supply of medication which indicated that the medication had been given but the MAR chart not signed. The registered manager said that she would address this with the nurse responsible for this error. This residents MAR chart details two PRN medications. Risk assessment protocols were in place for both. A third residents MAR chart details three PRN medications. Risk assessment protocols were in place for two.The registered manager supplied documentary evidence that the PRN medication without a risk assessment protocol had been prescribed the evening before we visited the home. A risk assessment protocol was in place for a fourth resident who is prescribed PRN rectal Diazepam. The written consent of the resident was not included. The registered manager told us that verbal consent had been obtained but not written. She confirmed that written consent for any resident receiving medication by invasive routes has not been obtained. The risk assessment protocol for a fifth resident detailed a PRN medication Senna. The MAR chart had signatures in place showing that this medication is being given daily. The registered manager produced written confirmation that the directions for administering this medication have been changed by the General Practitioner. The risk assessment Care Homes for Adults (18-65 years) Page 4 of 12 protocol had not been changed to reflect this. All risk assessment protocols that we looked at had been reviewed monthly with the last review being recorded as 25.02.10. We asked the registered manager how staff are made aware of new PRN medication or in changes in direction to medication times and dosages if information is not up dated as and when a change occurs. She informed us that three handover sessions take place each day where this is discussed and recorded. The registered manager produced records that confirm this. She also produced professional visit sheets and residents daily review notes again where this information is recorded. The nurse on duty informed us that currently one of the twenty six residents self medicates some of their medication. A risk assessment protocol was in place for this practise. The SRN for training was issued on the 26th February 2010. The compliance date for this was 22nd March 2010. The SRN consists of 3 elements, these being 1. Have a rolling programme of appropriate training in place to ensure that all staff complete training appropriate to the needs of the service and the people who use it and that this programme is regularly updated. 2. Have an induction programme that complies with the standard set by Skills for Care. You must ensure all new care staff and trained nurses complete this induction programme and are assessed by an appropriate trained and experience person, when completing it. 3. Ensure that staff responsible for the training and assessment of care staff have the necessary skills, training and competency to carry out this role. We looked at a training matrix that gives details of all staff employed at the home including nurses, care staff, domestic staff, maintenance staff and kitchen staff. The matrix showed that all staff are now up to date with fire, manual handling and infection control training. Safeguarding of vulnerable adults training was shown on the matrix as having been delivered to all staff except five who had undertaken the training in 2008 or 2009. For first aid training we noted that four staff had n/a recorded for their date of training. The managing director stated that these staff included the handyman, two domestic staff and one kitchen staff. She said these staff all work supervised by other staff who have completed a first aid course. She went on to say they would never administer first aid to a service user. All other staff were recorded as being up to date with first aid training. The training matrix showed all kitchen staff have had food hygiene training except one who is away on leave. The managing director stated they will not be returning to work until they have done it. The matrix shows that since January 2010 twenty staff in total have completed this training. The training matrix shows that seventeen staff have completed health and safety training since the last key inspection of 5th January 2010. The managing director stated this was a work in progress. A list of twelve staff due to undertake the training that evening was seen. Care Homes for Adults (18-65 years) Page 5 of 12 Mental capacity is listed on the training matrix but no one has undertaken it yet. The managing director stated she had investigated the comments made by the Expert by Experience at the last inspection regarding a resident and their communication needs. She produced a letter from the residents relative who visits regularly that says the family have not used sign language to communication with them. The letter also states that the relative was happy with Baytrees ability to communicate with the resident. We were also informed that the home have contacted the Deaf Association who know this resident and they say she has never used signing. A member of staff employed at the home who has British Sign Language certificate stage 1 has made a written statement saying the resident has never used sign language to communicate with her in three years and she could see no benefit to the resident learning now. The managing director informed us of a medical and physical condition that the resident has, stating that these would impact on the resident being able to sign back to people. She said the home have contacted the Speech and Language team and are looking into other communication tools for the resident. She also showed us a picture board they had received from the stroke team. The deputy informed us that since the key inspection of 5th January 2010 three staff have completed a National Vocational Qualification (NVQ) at level 2, five other members of staff have started this qualification and two others are signing up to start this. Another member of staff has recently stated the NVQ level 3. We asked about training of staff for residents who require assistance with feeding via specialised routes. The managing director stated only trained nurses are involved in this practise. Six staff files were looked at to sample certificates to verify what was stated on the training matrix was accurate. Certificates were in place confirming the information stated on the training matrix. We did note two discrepancies which we were informed were typing errors. The staff files also evidenced that new workers now receive an induction that complies with the standard set by Skills for Care. The deputy is responsible for staff training and has carried out all training apart from manual handling. This has been provided by an external company. The deputy holds a NVQ in Health and Social Care at level 3. We were shown written confirmation that the deputy is booked on a Train the Trainer course on the 3rd and 10th June 2010. The managing director informed us that the deputy provides training using a package that includes watching videos and answering questionnaires and that both she and the registered manager have observed the deputy carrying out training and deemed her competent. We were shown a written statement confirming that the managing director and registered manager deem the deputy competent to carry out training. Care Homes for Adults (18-65 years) Page 6 of 12 When looking at training records we noted that three courses had been undertaken on the same day, totalling the equivalent of eleven hours according to certificates. The managing director and deputy said they followed the training package purchased by the home. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Adults (18-65 years) Page 7 of 12 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 12 In line with regulation 05/02/2010 12(2)(3)(4) The registered person must enable residents to make decisions with respect to the care they receive. Particular attention must be given to choice of staff undertaking personal care, training of staff to meet the communication needs of individuals and regular meetings where residents can express their views. This must happen in order that residents rights are promoted. 2 19 13 In line with regulation 05/02/2010 13(1)(b) the registered person must be able to demonstrate through records maintained in the home that residents receive any necessary treatment from dentists, opticians and chiropody services. This must happen to ensure residents health needs are met in full. 3 22 22 In line with regulation 22 the 05/02/2010 registered person must ensure that all residents are made aware of the Page 8 of 12 Care Homes for Adults (18-65 years) Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action complaints procedure and be able to evidence that issues raised by residents are investigated and where possible acted upon. This must happen to ensure residents rights are protected. 4 24 23 In line with regulation 05/03/2010 23(2)(b)(p)(4)(5) the registered person must ensure the environment meets residents needs. Particular attention must be paid to - Ensuring adequate heating in all areas of the home, That the home is kept in a good state of repair, That fire doors meet required standards of the fire department, That infection control measures in the kitchen meet standards set by the environmental health department, And that staff receive training in infection control. This must happen in order that residents live in a safe and comfortable environment. 5 34 19 In line with regulation 19(11) 05/02/2010 the registered person must be able to demonstrate that if a member of staff commences working at the home without a enhanced CRB having been obtained this is only undertaken in exceptional circumstances to Page 9 of 12 Care Homes for Adults (18-65 years) Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action maintain staffing levels and that records evidence the member of staff is allocated a supervisor who where possible is on duty at the same time as the new worker. This must happen in order that the homes recruitment practises safeguard residents. 6 36 18 In line with regulation 18(2) the registered person must ensure that staff receive regular, formal supervision. This must happen in order that residents are supported by staff who understand their roles and responsibilities. 05/02/2010 Care Homes for Adults (18-65 years) Page 10 of 12 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 In line with regulation 13(2) 25/04/2010 the registered person must ensure accurate records are maintained when medication is given to residents. This must happen in order that medication records are robust. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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