Inspection on 07/07/09 for Baytrees Nursing Home

This inspection was carried out on 7th July 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Baytrees Nursing Home 25/03/10

Baytrees Nursing Home 05/01/10

Baytrees Nursing Home 15/07/08

Baytrees Nursing Home 21/01/08

Baytrees Nursing Home 02/05/06

Baytrees Nursing Home 06/10/05

Baytrees Nursing Home 12/05/05

Baytrees Nursing Home 11/01/05

Baytrees Nursing Home 24/06/04

Similar services:

Thorndene

Sutton Lodge Nursing Home

Wingham Court

Bethany Lodge

17 John Street

Red Oaks

Clare House Nursing Home

Broad Oak Manor Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report CARE HOME ADULTS 18-65 Baytrees Nursing Home 1 Highfield Road Worthing West Sussex BN13 1PX Lead Inspector Lesley Webb Key Unannounced Inspection 7th July 2009 09:30 Baytrees Nursing Home DS0000024113.V376381.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought 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. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Baytrees Nursing Home DS0000024113.V376381.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Baytrees Nursing Home DS0000024113.V376381.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Baytrees Nursing Home Address 1 Highfield Road Worthing West Sussex BN13 1PX 01903 693833 01903 693822 baytreeshomes@aol.com 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) Bay Trees Homes Ltd Mrs Denise McWilton Care Home 30 Category(ies) of Physical disability (0) registration, with number of places Baytrees Nursing Home DS0000024113.V376381.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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: 2. Physical disability (PD). The maximum number of service users to be accommodated is 30. Date of last inspection 15th July 2008 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 Registered Manager responsible for the day to day running of the service is Mrs Denise 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, a smoking room and a large decked area to the rear of the property. The fees charged range from £662.46 to £950.00 per week. Additional charges are made for dry cleaning, newspapers, hairdressing, personal items, clothing and toiletries. Baytrees Nursing Home DS0000024113.V376381.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 that use this service experience adequate quality outcomes. We visited this home on Tuesday 7th July 2009, arriving at 9.30am and staying until 5pm. The purpose of this inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. The registered manager was not present during our visit. We were informed that the nurse on duty and deputy were responsible for managing the home in their absence. During our visit the managing director of the home was also present. All assisted us throughout our visit. During our visit to the home we had conversations with five residents and three staff. We examined the care records of three residents and recruitment records of three staff. We also looked at other documentation maintained in the home such as health and safety records, staff recruitment records, training and complaints. In addition to this we looked around the home and indirectly observed interactions between residents and staff. Prior to our visit the home supplied us with a copy of its Annual Quality Assurance Assessment (AQAA). Information from all of the above sources was assessed and used to help us form judgments on the quality of service provided to residents. What the service does well: Pre-admission assessments completed by the home ensure prospective residents’ needs are identified before they move into the home. Risk management forms part of the care planning system that is in place. This includes assessment of mobility, pressure care and nutrition and reduces risks to residents. Residents told us they were happy with the choice of community activities they can participate in. For example one person told us, “I go out now and again, Little Hampton, pub, every couple of weeks”. Specialist diets are catered for and a menu was seen to be on display that offers a choice of meals at every sitting. Staff were observed speaking and assisting residents with dignity and respect. Baytrees Nursing Home DS0000024113.V376381.R01.S.doc Version 5.2 Page 6 As at the previous inspection records show that residents have access to community based health professionals as required. For example visits by professionals such as district nurses where appropriate, general practitioners and chiropodists are noted and any advice or treatment recorded. All residents that we spoke with confirmed they are able to raise concerns and know who to speak to if unhappy. For example one resident informed us, “I would go to X in the office, she is very considerate, our matron is approachable”. Safe systems are in place to manage personal finances of residents who are not able to do this for themselves. All residents that we spoke with expressed satisfaction with staff working at the home. For example one person stated, “Staff are fantastic, we all love one another, like one big family” and another “staff are very friendly”. What has improved since the last inspection? What they could do better: Improvements must be made with regard to the monitoring of residents who are at risk of dehydration and/or pressure areas. This must happen to ensure residents’ needs are met safely and consistently. Baytrees Nursing Home DS0000024113.V376381.R01.S.doc Version 5.2 Page 7 A system must be introduced that ensure suitable numbers of staff receive training in all required areas. This must happen in order that residents are supported by suitably qualified staff at all time. Two written references, one of which must be from the most recent employer, must be obtained for anyone employed to work at the home. Also information confirming nurses are currently registered must always be maintained in the home. This must happen to ensure the homes recruitment practices offer sufficient safeguards to residents. Some medication practices must improve to offer further safeguards to residents. Quality monitoring must be undertaken on a regular basis, including obtaining the views of residents in order that they receive a consistent and safe service in all areas. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Baytrees Nursing Home DS0000024113.V376381.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Baytrees Nursing Home DS0000024113.V376381.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use this service and their representatives have the information needed to decide if the home will meet their needs. Assessment processes ensure prospective residents’ needs are identified before the move into the home. EVIDENCE: A requirement was made as a result of our last key inspection that the home must produce a Statement of Purpose and Service user guide. This requirement is now met. On arrival at the home we observed that a copy of the Statement of Purpose and Service User Guide were on display at entrance to the home. One resident that we spoke with informed us that they have received a copy of the above documents stating, “I had book given to me yesterday, it tells me all about Baytrees” During our visit the managing director for the service informed us that the Statement of Purpose is in the process of being produced in audio format. Baytrees Nursing Home DS0000024113.V376381.R01.S.doc Version 5.2 Page 10 Prior to our inspection the home sent us it’s Annual Quality Assurance Assessment (AQAA). With regard to assessment processes it states ‘A good detailed pre assessment, visits to the home are encouraged. Welcoming approach to relatives and friends, where possible a trial day, week, month is encouraged’. During our visit to the home we looked at the pre admission documentation for three residents, spoke with the nurse in charge and the newest resident to move into the home, all of which confirmed the contents of the AQAA. For example the resident confirmed they had visited the home before deciding if it was the right place for them and the nurse in charge said that the registered manager had completed a pre admission assessment for the resident before they moved to the home. The pre-admission assessments we looked at covered all aspects of needs and support required. Baytrees Nursing Home DS0000024113.V376381.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning and risk management processes give good information to staff in order that they can meet individuals’ needs. Some efforts are made to involve residents in decision making but this could be enhanced further. EVIDENCE: Prior to our visit the home sent us its Annual Quality Assurance Assessment (AQAA). With regard to care planning it states ‘Strong involvement in care plans, risk assessments, dialogue with residents’. The AQAA also informs us that ‘Vast improvements to care plans’ have been made. We sampled three residents care plans and were able to evidence some elements of the AQAA but not others. For example the new care planning system that has been introduced gives detailed instructions to staff, describing Baytrees Nursing Home DS0000024113.V376381.R01.S.doc Version 5.2 Page 12 how individual residents needs should be met. The new system also includes a ‘life story’ about the person. This information is centred on the individual and gives an insight into their past experiences. Care plans were in place for areas including mobility, personal care and behaviour. All plans that we sampled had been reviewed on a monthly basis. We found no evidence that residents were involved in this process. This was identified as an area that the home should explore at the previous inspection. We discussed this with the managing director of the home who agreed to look into this. The people who live at this home have a variety of communication needs. We did not see any information displayed around the home in large print or the use of symbols to aid communication. The nurse in charge informed us that the majority of residents are able to make their views known without these. We viewed records of a residents meeting that took place in May 2008. The managing director informed us another meeting took place “about three months ago” with the minutes waiting to be typed. She agreed residents may benefit further if the frequency of these increased. Risk management forms part of the care planning system that is in place. This includes assessment of mobility, pressure care and nutrition. Baytrees Nursing Home DS0000024113.V376381.R01.S.doc Version 5.2 Page 13 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): This is what people staying in this care home experience: 12,13,15,16 and 17. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the main residents are involved in decisions about their lifestyle choices. Residents receive a choice of well balanced, nutritious meals. EVIDENCE: With regard to lifestyle choices the homes AQAA states ‘Promote independence of service users, promote involvement in local community, offer worthwhile activities and outings. Give respect and privacy to service users, offer keys to service users if suitable. Give as much choice in all matters as is practicable’. During our visit we spoke with residents, examined records and undertook observations, all of which confirmed the above information to be accurate. For example with regard to activities in the community one resident informed us, “I go out now and again, Littlehampton, pub, every couple of weeks”. Baytrees Nursing Home DS0000024113.V376381.R01.S.doc Version 5.2 Page 14 The nurse in charge informed us that a day trip is arranged twice a week. A maximum of five residents who use wheelchairs are able to access these each time due to the size of the homes mini bus. During our visit to the home we did not observe any in house activities taking place. Residents were seen to be watching the television. A notice board in the main lounge area displays information regarding forthcoming activities. These include arts and crafts on a Monday and forthcoming daytrips to a garden centre, museum and the zoo. During our visit we spoke with five residents, all of whom expressed satisfaction with the meals provided by the home. For example one stated, “You have menu and you can pick what you want” and another “the meals are fantastic”. During our visit to the home we spoke with the cook who demonstrated knowledge and understanding of the dietary needs of residents. Specialist diets are catered for and a menu was seen to be on display that offers a choice of meals at every sitting. Baytrees Nursing Home DS0000024113.V376381.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The principles of respect, dignity and privacy are put into practice. The health needs of residents at risk of dehydration or pressure areas are not always monitored safely and consistently. Some areas of medication require improvement to offer greater safeguards to residents. EVIDENCE: With regard to personal and health care the homes AQAA states ‘We ensure sensitive and flexible peronal care, with the emphasis on privacy, choice, promoting independence. Same gender staff provided where possible’. Evidence gained at this visit in the main supports this statement. For example residents that we saw during our visit appeared appropriately dressed for their age, culture and the climate. Staff were observed speaking and assisting residents with dignity and respect. For example staff were observed to knock on bedroom doors before entering Baytrees Nursing Home DS0000024113.V376381.R01.S.doc Version 5.2 Page 16 and using individuals preferred choice of name when having conversations with them. We did note that on some occasions residents had to wait between five and ten minutes for assistance when they accessed the call bell system in their bedrooms. As at the previous inspection records show that residents have access to community based health professionals as required. For example visits by professionals such as district nurses where appropriate, G.P, chiropodist are noted and any advice or treatment recorded. We sampled three residents care plans pertaining to health care needs. The care plans sampled were being used in conjunction with other monitoring documents that are used as part of the care planning process for individuals. For two individuals the monitoring documents have not been completed in full and do not demonstrate that the contents of the care plans are being complied with. For example one residents care records include a letter from a health professional dated March 2009 that instructs staff to give a total of 1900ml of fluid and feed via a peg feed site every twenty four hours. The home uses daily fluid charts to record when fluids have been given. We looked at the fluid charts for this person from the 8th June 2009 to the 5th July 2009. No records were in place for the 17th, 18th and 23rd of June. For the dates when records were in place on ten occasions records do not demonstrate the resident was given 1900ml of fluid and food supplement as instructed by the specialist. The same person has a moving and handling assessment that states they must be turned ‘every few hours’. The home uses turning charts to record when staff have carried out this action. We found none to have been completed for this person. A second residents records also include a letter from a health consultant with regard to fluid intake via a peg feed site. This instructs that 50ml water flushes should be undertaken twice a day. We viewed fluid charts for this person for 7th June 2009 to the 6th July 2009. No records were available for the 18th and 19th June or the 1st and 2nd July. Records that were in place do not evidence that water flushes were undertaken on four days. The third resident’s records that we looked at include a care assessment that states they need their position changing regularly when in bed. We asked the nurse in charge for records that demonstrate this is undertaken by staff. We were informed none were completed. When giving feedback to the managing director we raised concerns regarding the inconsistencies with monitoring records as the home is not able to Baytrees Nursing Home DS0000024113.V376381.R01.S.doc Version 5.2 Page 17 demonstrate residents who have been identified at being at risk from dehydration or pressure areas are having their needs met safely and consistently. She agreed and informed us she would arrange an emergency staff meeting. We sampled a number of residents’ medication administration records, all of which were in good order and up to date. We did note that a prescribed cream for one resident was not being stored in the fridge as recommended by the manufacturer. The nurse in charge moved this immediately when we drew it to their attention. On arrival at the home we observed a nurse carrying a plastic container with medication in it. This also contained a piece of paper with the name of a resident on it. The nurse informed us she was going to administer medication to the resident. During the afternoon of our visit we discussed the administration of medication with a second nurse on duty. They confirmed they also administer medication into containers with paper identifying who it belongs to, then taking around the home to administer. This is a outdated and unsafe practice and is not in line with best practice as described in The Administration and Control of Medicines in Care homes and Childrens Services, produced by The Royal Pharmaceutical Society of Great Britain. This practice was also described as frequently associated with medication errors in a report by the Department of Health, Building a safer NHS for patients. When giving feedback on our inspection to the managing director she agreed and informed us an emergency staff meeting would be arranged. The home maintains a record of the temperature of the fridge used to store medication as is good practice. Records for the 29th June 2009 to the 7th July 2009 range from 18.3 Celsius to 3.9 Celsius. When asked, the nurse in charge did not know what the safe temperature range should be maintained within. We informed the managing director of this who agreed to discuss this in the emergency staff meeting. The managing director also said arrangements would be made to either repair or replace the fridge. We did note that the home maintains a stock of some medication such as pain relief. The nurse in charge said that a stock record is not maintained and agreed this should be implemented to aid monitoring and safety. We examined the records and storage facilities for controlled drugs. All were in good order and up to date. Baytrees Nursing Home DS0000024113.V376381.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to express their concerns and have access to a robust, effective complaints procedure. Residents would be offered greater protection if more staff received safeguarding training. The systems for managing residents’ finances offer safeguards to individuals. EVIDENCE: With regard to complaints and protection the homes AQAA states ‘Take complaints seriously and respond as per our complaints procedure. Ensure all service users are informed of procedures. We react to complaints immediately. We try to deal with issues before they become complaints. As soon as we are aware there is an area of dissactifaction we strive to deal with the matter before it becomes a complaint’. During our visit to the home we examined records and spoke with residents and staff, finding this information to be accurate. For example there is a complaints procedure on display throughout the home that informs people of their rights. There is a complaints folder that includes a log of complaints, actions taken and outcomes. The complaints procedure is also included in the homes Statement of Purpose. All residents have recently received a copy of this. Baytrees Nursing Home DS0000024113.V376381.R01.S.doc Version 5.2 Page 19 All residents that we spoke with confirmed they are able to raise concerns and know who to speak to if unhappy. For example one resident informed us, “I would go to X in the office, she is very considerate, our matron is approachable”. The homes AQAA informs us that the home has received twelve complaints in past twelve months, all of which were resolved within 28 days and three of which were upheld. Since our last inspection the home has altered the system for recording complaints to ensure confidentiality is promoted. We saw that the home has a copy of the West Sussex Multi-disciplinary safeguarding adult policy and procedures in place. Information viewed during our visit to the home and shared with us before, by West Sussex Adult Services confirms that there have been seven safeguarding alerts raised in the past twelve months. Two of these were found to be substantiated and pertain to care plans and health monitoring records. Evidence from this inspection indicates that care plans have improved but that further work is required with regard to health monitoring records. There are currently thirty three staff employed at the home. Information supplied to us during our visit states that twenty one have not undertaken safeguarding training. There are systems in place to manage personal finances of residents who are not able to do this. These include individual records that detail income, expenditure and balances. All those that we sampled were in good order and up to date. From these we saw that the balance and records are checked weekly. Baytrees Nursing Home DS0000024113.V376381.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the main the physical design and layout of the home enables residents to live in a safe and comfortable environment. EVIDENCE: With regard to the environment the homes AQAA states ‘We provide a well maintained, clean, odourless environment. Our building is fit for purpose, well furnished. Safety is given utmost priority’. During our inspection we looked around the home. In the main we found the contents of the AQAA to be accurate. For example there is a large decking area accessible to people who use wheelchairs through the lounge/conservatory. As at our previous inspection it Baytrees Nursing Home DS0000024113.V376381.R01.S.doc Version 5.2 Page 21 was observed that most people living in the home stayed in the smaller lounge throughout the morning and also during lunchtime. People living in the home ate their lunch in their chairs with a small table in front of them or with assistance from members of staff. The larger lounge/conservatory area was generally unused. The managing director informed us that “major electrical re-wiring of the premises has taken place”. This has resulted in areas of the home needing redecorating. We were informed arrangements are being made for this to take place. On the day of the visit to the home the communal areas, bedrooms and bathrooms looked generally well maintained and clean and hygienic. We did note that one resident’s bedroom had a strong malodour. The managing director immediately made arrangements for the carpet to be cleaned when we drew this to her attention. Residents’ bedrooms have been personalised to suit their individual interests and hobbies. A requirement was made at our last inspection that the Registered Person must consult with the Health & Safety Executive in respect of the requirements of the quality of laundry facilities and they must seek to adhere to this legislation. This requirement is now met. The laundry room has been completely refurbished and includes industrial washing and drying machines, flooring and walls that are washable and waterproof. There are also separate storage facilities for soiled and clean laundry. The home has two sluice rooms. We noted that one needs attention as the flooring and walls are damaged and are not waterproof. We also noted that the sink was badly stained and that this facility was being used to store items such as vases. The managing director informed us this priority would be given to addressing these issues. The homes AQAA states that all staff have received infection control training. This information is not accurate. During our visit to the home we were supplied evidence that only seven of the thirty three staff employed have received training in this area. Baytrees Nursing Home DS0000024113.V376381.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 and 36. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported by caring staff. Monitoring systems do not ensure sufficient numbers of staff are trained to care for residents. In the main recruitment practices offer safeguards to residents. EVIDENCE: The nurse in charge informed us that one nurse and eight care staff are allocated to the morning shifts and one nurse and four care staff of an afternoon. At night there is one nurse and two care staff. They also informed us that laundry and kitchen staff are employed seven days per week. Rota’s that we looked at in the main confirmed this information. With regard to staffing the homes AQAA states ‘We strive to employ caring and reliable individuals. We are equal opportunities employers. Staff receive support training and back up in a team environment. Recruitment procedure is excellent’. Baytrees Nursing Home DS0000024113.V376381.R01.S.doc Version 5.2 Page 23 Evidence gained during our visit to the home supports some elements of this but not others. For example we examined the recruitment records for the three newest staff to commence working at the home. They included both a POVAfirst and enhanced criminal records bureau disclosure and completed application form. One did not contain two references and another only one. We noted that the recruitment records for a qualified nurse contained information for a PIN that has expired. The managing director made arrangements for this to be updated when we brought this to her attention. All residents that we spoke with expressed satisfaction with staff working at the home. For example one person stated, “Staff are fantastic, we all love one another, like one big family” and another “staff are very friendly”. There was evidence that some staff have received training in areas such as food hygiene, first aid and manual handling and safeguarding adults. When asked what proportions of staff have received training in these areas, when this took place and how the home ensures suitable numbers of qualified staff are on duty on each shift the deputy informed us we would have to look through each persons certificates to obtain this information. She confirmed there is no monitoring system in place. While we were looking at other areas we asked the deputy to collate this information with regard to moving and handling, infection control and safeguarding. The information we were given states that thirty three staff work at the home, seventeen of whom there is no record that they have received training in moving and handling, twenty six with no record of infection control training and twenty one with no record of safeguarding training. We discussed the shortfalls with regard to training with the managing director and deputy both of whom agreed improvements to monitoring and the provision of training must take place. Records were available that demonstrate staff meetings take place twice a year. This is below the National Minimum Standard for Younger Adults which recommend a minimum of six per year. Baytrees Nursing Home DS0000024113.V376381.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management and monitoring systems are not meeting all of the needs of residents safely and consistently with regards to some residents’ health care needs, staff training, medication and recruitment practices. EVIDENCE: The registered manager was not present when we visited the home. We were informed that the nurse on duty and deputy were responsible for managing the home in the registered managers absence. The managing director of the home was also present during our visit. All assisted by providing written documentation and answering questions relating to the inspection process. Baytrees Nursing Home DS0000024113.V376381.R01.S.doc Version 5.2 Page 25 The homes AQAA states ‘we monitor quality via questionnaires and residents meetings’. Evidence gained during our visit to the home does not support this information. The managing director confirmed that quality monitoring processes include obtaining the views of residents and their families have not been obtained since 2008. The home sent us its AQAA when requested. The contents of this are not detailed, informative and do not demonstrate quality monitoring of all aspects of the service being undertaken by the home. We discussed this with the managing director who assured us greater detail would be included when next completed. As mentioned in other sections of this report this inspection has identified non compliance with the Care Home Regulations 2001 with regards to health care monitoring, staff training, recruitment and medication. These issues were not identified by the home within its own quality monitoring systems. We viewed a number of health and safety servicing records such as those for portable electrical equipment, fire detection, emergency call systems and gas appliances. All were in good order and up to date. Baytrees Nursing Home DS0000024113.V376381.R01.S.doc Version 5.2 Page 26 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 3 2 3 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 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 2 34 2 35 1 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 1 2 X 2 X 1 X X 3 X Version 5.2 Page 27 Baytrees Nursing Home DS0000024113.V376381.R01.S.doc No. Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA19 Regulation 15 Requirement The registered person must be able to demonstrate through records maintained in the home that residents receive the care they require as described in their care plans. This must happen to ensure resident health needs are met safely and consistently. The registered person must provide a medication storage facility that is constantly maintained at a maximum temperature of 8 degrees Celcius. This must be provided in order that medication is stored safely and in line with the manufacturers guidelines. The registered person must ensure that in the interests of safe medication handling all medication is administered directly from the original labelled container to the resident and not placed into any secondary container for later administration. DS0000024113.V376381.R01.S.doc Timescale for action 07/08/09 2. YA20 13(2) 07/08/09 3. YA20 13(2) 07/08/09 Baytrees Nursing Home Version 5.2 Page 28 4. YA34 19 Schedule 2. This must happen to ensure medication practices are safe. The registered person must obtain two written references, one of which must be from the most recent employer, for anyone who is employed to work at the home. 07/08/09 5. YA34 19 Schedule 2. This must happen to ensure the homes recruitment practices offer sufficient safeguards to residents. The registered person must 17/07/09 ensure all nurses are currently registered with the NMC in order to work as a nurse in the home. 6. YA35 This must happen in order that residents are supported by suitably qualified staff. 18(1)(a)(c) The registered person must 07/09/09 ensure that a system is introduced that ensures suitable numbers of staff receive training in all required areas. This must include moving and handling, infection control, safeguarding, food hygiene, first aid and health and safety. This must happen in order that residents are supported by suitably qualified staff at all time. The registered person must ensure quality monitoring is regularly undertaken, including obtaining the views of residents. This must happen in order that residents receive a consistent and safe service in all areas. 7. YA39 24 07/08/09 Baytrees Nursing Home DS0000024113.V376381.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Baytrees Nursing Home DS0000024113.V376381.R01.S.doc Version 5.2 Page 30 Care Quality Commission The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT National Enquiry Line: 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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