CARE HOME ADULTS 18-65
Baytrees Nursing Home 1 Highfield Road Worthing West Sussex BN13 1PX Lead Inspector
Ann Peace Announced Thursday 6 October 2005, 8:00am
th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Baytrees Nursing Home H60-H11 S24113 Bay Trees Nursing Home V245649 061005 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Bay Trees Nursing Home Address 1 Highfield Road, Worthing, West Sussex, BN13 1PX Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01903 693833 Bay Trees Homes Limited Post Vacant Care Home 30 Category(ies) of Care Home with Nursing 30 registration, with number of places Baytrees Nursing Home H60-H11 S24113 Bay Trees Nursing Home V245649 061005 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Only service users in the category Physical Disability (PD) 18-65 years may be admitted. Rooms 21 and 27 can only be used for service users who are not independently mobile through the use of a wheelchair. Date of last inspection 12 May 2005 Brief Description of the Service: Baytrees 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 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, a smoking room and a large decked area to the rear of the property.
Baytrees Nursing Home H60-H11 S24113 Bay Trees Nursing Home V245649 061005 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection was carried out on 6th October 2005. A pharmacy monitoring visit was also carried out. Prior to the inspection the Inspector looked at previous reports and reviewed letters, complaints and reports held on file. Twelve satisfaction survey forms were received by CSCI from residents, 9 were very positive about the home 3 did make minor negative comments and this was discussed anonymously with Mrs Mc Wilton during the inspection. Staff and residents were spoken with during the visit to find out how it is to live and work in the home. A general tour of the home was undertaken and the majority of residents’ rooms visited. Case tracking from records to care given was carried out for a number of residents. Staff records and relevant records relating to the management of the home were examined Resident’s comments were positive about the home and they did say that they had noticed a general improvement in the home and the staff morale was much improved. Staff also said they were happier that general conditions had improved in the home. It was clear from their comments and by observation that residents are encouraged to make choices about their daily lifestyles and be involved in the running of the home where able. Mrs Mc Wilton is the manager for the home and with the help of a deputy manager has recently been able to implement changes to procedures in the home which have improved the conditions for residents and staff. Since the last inspection one adult protection issue has been reported and is undergoing investigation. Another is still outstanding. Following the last inspection a large number of concerns were identified which led to 15 legal requirements being made. Additional visits have been made by CSCI to the home to monitor progress. During this inspection it was noted that 13 of these requirements have been complied with and 2 are still outstanding. The Inspector discussed the findings of the inspection with the provider’s representatives Mrs Chappell and The Manager Mrs D Mc Wilton.
Baytrees Nursing Home H60-H11 S24113 Bay Trees Nursing Home V245649 061005 Stage 4.doc Version 1.30 Page 6 What the service does well: What has improved since the last inspection?
Staff morale has improved due to changes in conditions within the home and they have all been given new contracts with reviewed job descriptions. Staff numbers have been increased both during the day and at night. The safety of residents and staff has been given a higher priority and regular fire and health and safety checks are now being undertaken. Resident’s and staff meetings have been held and action taken where necessary. Further training sessions have been provided and teaching aids ordered. An audit has been undertaken in the home and due to this new bed linen and china has been ordered and new disability equipment has been provided. The medication administration procedures have been reviewed and improved. Improvements to the staff recruitment records have been made and in the majority of cases complies with legislation.
Baytrees Nursing Home H60-H11 S24113 Bay Trees Nursing Home V245649 061005 Stage 4.doc Version 1.30 Page 7 The cook is now responsible for the purchasing of the food so is able to plan menus in advance. Biscuits and cakes are now provided on a daily basis following requests from residents. An annual development plan for the home was available. What they could do better: 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. Baytrees Nursing Home H60-H11 S24113 Bay Trees Nursing Home V245649 061005 Stage 4.doc Version 1.30 Page 8 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 Standards Statutory Requirements Identified During the Inspection Baytrees Nursing Home H60-H11 S24113 Bay Trees Nursing Home V245649 061005 Stage 4.doc Version 1.30 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4. The last inspection report was available in the home to all interested parties. Residents have the opportunity of visiting the home to ensure that the lifestyle is compatible to meet their needs. EVIDENCE: A copy of the latest inspection report was available in the home. Assessments and related care records were examined in detail and tracked through to the care given to ensure resident’s aspirations and needs are met. More attention should be given to nutritional assessments, monitoring and recording. Records indicated that residents have an opportunity to visit the home to see if it will meet their needs. Baytrees Nursing Home H60-H11 S24113 Bay Trees Nursing Home V245649 061005 Stage 4.doc Version 1.30 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9,10. The majority of resident’s needs are reflected in the care plans. Residents are able with assistance to make choices about their lives and they are involved in the running of the home. EVIDENCE: Staff spoken with were well aware of the individual needs of the residents and how they were to meet them. The care plans document their care needs and have been updated on a regular basis. New weighing scales have been purchased by the home. Nutritional needs now need to be re-assessed, monitored and recorded. Baytrees Nursing Home H60-H11 S24113 Bay Trees Nursing Home V245649 061005 Stage 4.doc Version 1.30 Page 11 Residents said that they are encouraged by staff to make decisions about their lives and the inspector noticed this during the visit. A new routine for helping residents get up in the morning has been implemented which ensures all residents are treated equally, the feedback from residents was positive. All residents have a daily activities and environment check list in their rooms, staff sign the form to indicate when they have carried out care for a resident and that the room has been checked. This has made staff more accountable for their actions and staff said they were happy with the procedure. Residents do have the opportunity to express their feelings and minutes of the residents meetings were available. A quality assurance system is in operation in the home, however the last formal consultation with published results was in 2004. Baytrees Nursing Home H60-H11 S24113 Bay Trees Nursing Home V245649 061005 Stage 4.doc Version 1.30 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13, 14,15,16,17. Residents enjoy a flexible routine within the home, appropriate activities are provided. Residents do go out into the local community either independently or with staff. It could be concluded that resident’s rights are respected and that they are encouraged to take responsibility where possible in their daily lives. Home cooked meals are available with choices for those who wish. EVIDENCE: Baytrees Nursing Home H60-H11 S24113 Bay Trees Nursing Home V245649 061005 Stage 4.doc Version 1.30 Page 13 The home owns minibuses, which are available for residents to go out on organised trips, or for private appointments. Trips that are being arranged are displayed on the notice board in the hallway of the home. Notices indicated that shopping trips to Worthing and Shoreham were arranged on regular basis. There is a library trip weekly and various other trips for pub lunches, bowling and to Shoreham airport. It could be confirmed that residents are encouraged to go out on their own and risk assessments are carried out. In house activities included exercise classes, aromatherapy and massage, bingo and art classes. A musician visits the home monthly and was due to come on the day of the inspection. He had cancelled the visit at the last minute so staff took residents who wished out for a walk to the local shopping areas and park. Residents were able to tell the Inspector that they can make choices about personal, family and sexual relationships and that they are supported by staff. The kitchens were visited and the cook spoken with. There was a record of the meals prepared and cooked and the cook was aware of any diets, allergies, likes and dislikes of the residents. Mrs Mc Wilton and the cook have attended a basic course on nutrition since the last inspection. However more specialised training should be made available in this area. There is a snack machine in the dining area which residents can purchase snacks if they wish. At a recent resident’s meeting the minutes recorded that there were a few comments about the meals, Mrs Mc Wilton said that they were looking into this. There was also a suggestion that biscuits and cakes should be made available for residents at coffee and teatime. These are now being provided as requested. Baytrees Nursing Home H60-H11 S24113 Bay Trees Nursing Home V245649 061005 Stage 4.doc Version 1.30 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20. Care staff do strive to give personal support how residents would like and do strive to meet their physical and emotional needs. The medication procedures and practices in the home are safe. The storage of some medicines is not satisfactory. EVIDENCE: All residents had care records which included the majority of assessments needed and risk assessments. More attention should be given to assessing and meeting the nutritional needs of residents. Due to more management time being allocated, the care documentation and practices and procedures throughout the home have improved since the last inspection. A monitoring visit by the pharmacy inspector on the day of this inspection concluded that the majority of the standards relating to administration of medicines and related issues were met. This was mainly due to more qualified staff now being on duty on a daily basis. Baytrees Nursing Home H60-H11 S24113 Bay Trees Nursing Home V245649 061005 Stage 4.doc Version 1.30 Page 15 However the storage arrangements for some medication was still causing concern and the registered person is now required to take appropriate action. Mrs Mc Wilton was reminded to ensure that resident’s consent to medication was recorded in their care plans. Baytrees Nursing Home H60-H11 S24113 Bay Trees Nursing Home V245649 061005 Stage 4.doc Version 1.30 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23. Complaints are handled in accordance with the home’s procedure. Residents have stated that their views are listened to and acted on. The recruitment procedures have improved but are still not fully robust. EVIDENCE: The complaint procedure was displayed in the home and complaints are recorded with any action taken. Adult protection training is being offered in the home at regular intervals and staff when spoken with were aware of the procedure to take. The providers are reminded to ensure that all staff including kitchen staff are aware of the procedure to follow. Two adult protection investigations are underway at the home. Baytrees Nursing Home H60-H11 S24113 Bay Trees Nursing Home V245649 061005 Stage 4.doc Version 1.30 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,28,29,30. There is homely friendly atmosphere in the home and the resident’s accommodation and communal areas are clean. The home provides safe and comfortable surroundings. EVIDENCE: The home is warm, clean, homely and comfortable. During a tour of the home, bedrooms and communal areas were visited Residents are encouraged to furnish their rooms with personal possessions to make them more homely. Residents have access to two large lounge/dining rooms, both have televisions and one has a large screen television. A conservatory with a decking area is available and also a smoking room. There is an area with a computer terminal for residents to use.
Baytrees Nursing Home H60-H11 S24113 Bay Trees Nursing Home V245649 061005 Stage 4.doc Version 1.30 Page 18 Two passenger lifts are available, one in each house, both were in working order. Since the last inspection an environmental audit has been undertaken and new domestic linen, crockery, pillows and duvets have been purchased or ordered. There is also an annual development plan for the home. New scales, commodes and hoists have been purchased. A new laundry is at present being built and is due to be completed in the next few weeks. A general risk assessment for the home should be available. Baytrees Nursing Home H60-H11 S24113 Bay Trees Nursing Home V245649 061005 Stage 4.doc Version 1.30 Page 19 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,36. The procedures for the recruitment and training of staff have been improved but there are still organisational issues to be addressed. Staff numbers and skill mix meet the needs of the residents and a staff appraisal and supervision programme is now in operation. EVIDENCE: Since the last inspection staff numbers have increased to the benefit of the residents and other staff. More qualified staff have been employed which is allowing Mrs Mc Wilton and her deputy to have protected management time. A training plan had been implemented for carers and qualified staff, this seems to be working well and according to residents is raising standards. Baytrees Nursing Home H60-H11 S24113 Bay Trees Nursing Home V245649 061005 Stage 4.doc Version 1.30 Page 20 Appraisal and supervision of staff is a high priority and the staff are working well as a team to the benefit of the residents. Staff said they were happier and felt well supported to carry out their work. The home’s recruitment procedures have improved but still need more attention especially for obtaining POVA, CRB and references before staff commence work at the home. The induction arrangements for kitchen staff should be recorded. Baytrees Nursing Home H60-H11 S24113 Bay Trees Nursing Home V245649 061005 Stage 4.doc Version 1.30 Page 21 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38, 39,40,41,42,43. In the majority of cases resident’s best interests are safeguarded by the home’s policies and procedures. In the majority of cases resident’s health, safety and welfare are promoted and protected. EVIDENCE: The home has sent regular reports on the conduct of the care home to The Commission. There is no registered manager at present although Mrs Mc Wilton told the Inspector that she would be applying. Baytrees Nursing Home H60-H11 S24113 Bay Trees Nursing Home V245649 061005 Stage 4.doc Version 1.30 Page 22 Mrs Mc Wilton has recently achieved NVQ 4 in management and the successful completion of the Registered Managers Award. Since the last inspection Mrs Mc Wilton has managed more administrative time to oversee the management of the home, due to this improvements were noted. Mrs Mc Wilton and the deputy manager have introduced various clinical quality assurance systems to record and monitor practices and aspects of the care for the residents. Residents also told the inspector that overall, conditions had improved throughout the home and they were well looked after. They all said they enjoyed a good relationship with the staff. Resident and staff meetings have been held and from the minutes it was concluded that residents and staff are listened to and changes have been made as a result. A number of the policies and procedures for the home are outdated and irrelevant to current good practice, this was discussed during the inspection and Mrs Mc Wilton. There is still a problem with the telephone system in the home and this must be addressed. The staff only have access to one phone in the nursing office. If the phone rings, care staff have to leave whatever they are doing and may have to come down three floors to answer it. As with the last inspection staff said that often they do not get to the phone in time and so the call goes unanswered. The hands free phone does not work well so residents are unable to use it. Baytrees Nursing Home H60-H11 S24113 Bay Trees Nursing Home V245649 061005 Stage 4.doc Version 1.30 Page 23 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 2 3 3 x Standard No 22 23
ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 3 3 3
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 2 Standard No 31 32 33 34 35 36 Score 3 3 3 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Baytrees Nursing Home Score 3 2 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 3 2 2 2 2 H60-H11 S24113 Bay Trees Nursing Home V245649 061005 Stage 4.doc Version 1.30 Page 24 yes 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. 2. Standard YA20 YA34 Regulation 13(2) 19 Requirement Medicines must be stored within the temperature range stated by the manufacture The registered person shall not employ a person to work at the care home unless he has obtained in respect of that person the information and documents specified in paragraphs 1-7 of Schedule 2 of The Care Home Regulations 2001. The registered providers shall appoint a registered manager to manage the care home. The registered person shall provide appropriate telephone facilities and which are suitable for the needs of the service users. Timescale for action 6/11/05 6/11/05 3. 4. YA37 YA26 8 16 6/11/05 6/11/05 5. 6. 7. 8. 9. 10. 11. 12. 13.
Baytrees Nursing Home H60-H11 S24113 Bay Trees Nursing Home V245649 061005 Stage 4.doc Version 1.30 Page 25 14. 15. 16. 17. 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. 2. 3. 4. Refer to Standard YA20 YA17 YA9 Good Practice Recommendations The residents consent to medication should be obtained and recorded in the care plan. Further nutritional training should be available. General environmental risk assesssments should be carried out. Baytrees Nursing Home H60-H11 S24113 Bay Trees Nursing Home V245649 061005 Stage 4.doc Version 1.30 Page 26 Commission for Social Care Inspection 2nd Floor, Ridgeworth House Liverpool Gardens Worthing, West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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