CARE HOMES FOR OLDER PEOPLE
Bybrook House Nursing Home Middlehill Box Wiltshire SN13 8QP Lead Inspector
Tim Goadby Unannounced Inspection 19th September & 10th October 2007 09:05 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bybrook House Nursing Home DS0000015894.V347788.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bybrook House Nursing Home DS0000015894.V347788.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Bybrook House Nursing Home Address Middlehill Box Wiltshire SN13 8QP 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) 01225 743672 01225 744281 pen.b@talk21.com Avon Care Homes Limited Vacant Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30), Physical disability over 65 years of age of places (6), Terminally ill over 65 years of age (2) Bybrook House Nursing Home DS0000015894.V347788.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. 6. No more than 30 persons aged 65 years and over may be accommodated at any one time No more than 28 persons aged 65 years and over may be in receipt of nursing care at any one time of which no more than 2 persons may be in receipt of terminal illness care No more than 6 persons with a physical disablement aged 65 and over may be accommodated at any one time. These persons may not also be in receipt of nursing care Rooms 25, 26, 27 & 28 may not be used for nursing care due to unsuitable access The staffing levels set out in the Notice of Staffing Levels issued by Wiltshire Health Authority on 20 March 2000 must be met at all times Only the one, named, female service user referred to in the application dated 31 August 2004 may be aged 64 years and under 17th May 2007 Date of last inspection Brief Description of the Service: Bybrook House provides care and accommodation for up to 30 older people. Most service users have nursing care needs. The home is privately owned by Avon Care Homes Ltd. The company owns other services, including a nursing home in Wells, Somerset, where its administrative operations are based. The principal company director is Mrs Maria Cristina Bila, who regularly visits Bybrook House. The home is in a rural area, close to the village of Box. The city of Bath is approximately five miles away. The house is an older building set in extensive grounds, with views of surrounding countryside. All service users have single rooms. There are three bedrooms which are large enough for double occupancy by married couples or partners. These rooms can also be occupied as singles, for a higher fee. There is a passenger lift serving the home’s three floors, but some rooms can only be accessed by small flights of steps. A number of bedrooms have en-suite toilets, and two have baths also. There are five baths for general use, with at least one per floor. There is an adapted bath on the first floor. Fees charged to service users vary, depending on assessed needs and whether nursing care is being provided by the home. Service users staying for shortBybrook House Nursing Home DS0000015894.V347788.R01.S.doc Version 5.2 Page 5 term care can be charged at a daily rate. Information for prospective service users is available on request from the home. It includes a brochure and a service user guide. The home also has a website with brief introductory details and a selection of photographs. Prospective service users and their representatives are encouraged to visit Bybrook House. At the home, various relevant information is on display in the entrance hallway. This includes contact details for the CSCI, and a copy of the home’s most recent inspection report. CSCI contact details are also contained in service users’ contracts, and in the home’s complaints procedure. These contact details have been updated following closure of a local CSCI office. Bybrook House Nursing Home DS0000015894.V347788.R01.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. This key inspection was completed in October 2007. It included a review of what we know about the service since its last main inspection in May 2007. The home sent us an improvement plan telling us how it was going to act on the issues identified in that inspection. We had a meeting with a representative of the registered owners and with the new manager to discuss those plans. We also received regular updates from the home about its progress and reports about any significant events. Before this inspection we asked the home to complete an Annual Quality Assurance Assessment (the AQAA). This document gives us various information about a registered service. It also requires each service to audit its own performance and identify any areas for improvement. We sent out surveys for staff of the home and received five responses. We did not send out surveys for service users or their relatives this time, because we had a good response at the previous key inspection earlier in the year. We carried out two visits to the home. The first of these was unannounced. The second took place by appointment, to meet with the home’s new manager, conclude the inspection process and give initial feedback. A total of ten hours were spent in the home over the two visits. During the visits we met with service users, staff and management; looked at a sample of records, including case tracking of some service users; sampled a meal; looked at arrangements for medication; and toured the premises. The judgements made in this report are based on all of the evidence gathered, including the visits to the home. What the service does well:
Service users can feel confident that they will receive appropriate and effective nursing care. Health care at Bybrook House has consistently been complimented by service users and families as a particular strength. The home has also taken steps to develop specific areas of expertise, such as end of life care, through links with a local hospice. Bybrook House Nursing Home DS0000015894.V347788.R01.S.doc Version 5.2 Page 7 Service users can be confident that a decision about moving into the home will be based on suitable assessment. The home has an effective assessment system, and clear information about which needs it can or can’t meet. These are explained in its Statement of Purpose. Service users have their privacy and dignity upheld by the way in which staff provide care. This is done respectfully. Intimate care is always provided in private. Personal wishes and preferences are shown in individual care plans. Service users are able to maintain relationships with their families and other significant people. Visitors are made welcome, and have opportunities to meet with service users in private. Service users also have the option of having their own telephone line in their bedrooms. Service users have opportunities to make choices in their daily lives. This includes in areas such as when to get up or go to bed, what to have to eat and where they would like to spend their time. The home provides a pleasant environment for service users. It is attractively furnished and decorated in most areas, and is kept clean. Individual rooms reflect the tastes of their occupants. There is also a choice of communal areas, including two lounges and a small conservatory. Service users who gave comments during the inspection told us that they are very happy at the home and feel well cared for. What has improved since the last inspection?
A large number of requirements were set at the inspection of May 2007 and we had concerns about a number of issues which placed service users at risk. This is why another key inspection took place within a few months. This time we saw evidence that the home has addressed the issues of concern. Most of these have now been resolved, or progress is underway towards doing so. Steps have been taken to protect service users from the risk of harm from hot water. Valves which regulate delivery to a safe temperature have been adjusted so that they operate effectively. The home now needs to ensure effective monitoring and prompt action to resolve any problems identified. Risk assessments have been carried out on safe working practice topics, to enhance the safety of service users and staff. They address carrying out personal care tasks with service users in their own bedrooms, where limited space is available. The most risky situations have been improved by rearranging furniture in the affected rooms, after consultation with service users and families. Some remaining steps could enhance safety still further. Bybrook House Nursing Home DS0000015894.V347788.R01.S.doc Version 5.2 Page 8 Staff report that the atmosphere and teamwork is much improved, so that service users should benefit from more effective support. Steps have been taken to address issues that were of concern earlier in the year. Staff have greater confidence in the new management and leadership of the home. They feel that they are being treated more fairly. Whilst some concerns remain, staff overall are far more positive about the direction of progress. Staffing levels have been reviewed to provide clearer evidence of how these fit the assessed needs of service users. The situation is kept under regular review. Staff feel that they are still working under pressure on some shifts, but acknowledge that the situation has improved in recent months. Service users are receiving opportunities to fulfil their social and recreational needs. Six hours per week are now provided for a specific lead on activities, and it is planned to increase this. Other staff also help out in providing engagement for service users. Effective records are being kept which show a mix of group and individual input. They are helping to identify which activities are most appropriate for each service user. There has been a complete overhaul of care plans and other service user records. This has provided a more effective and comprehensive record of care for each individual. There is clear information in place about all of their assessed needs and how to support these. Significant progress has been made in a short space of time. Staff are very positive about these changes. There is a training plan which shows the overall position regarding what staff have done and what they still need to do. It also shows which courses are coming up in the near future. This helps to demonstrate that service users will benefit from the support of suitably trained staff. Quality assurance measures have been updated, with completion of the AQAA and a new business plan for the home. Development targets include actions based on the findings of recent surveys. Complaints records are available for inspection in the home. The format for recording the investigation and outcome of complaints is also to be reviewed. This will give service users and others greater confidence in the home’s arrangements for responding to concerns. A programme of necessary repairs and redecoration is underway, improving the quality and safety of the environment for service users. The home is taking steps to ensure that induction of any new care staff will be in line with the relevant national standards. This will help to equip new employees with the necessary knowledge and skills to support service users most effectively. Bybrook House Nursing Home DS0000015894.V347788.R01.S.doc Version 5.2 Page 9 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. The summary of this inspection report can be made available in other formats on request. Bybrook House Nursing Home DS0000015894.V347788.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bybrook House Nursing Home DS0000015894.V347788.R01.S.doc Version 5.2 Page 11 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3&4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users have their needs assessed and can be confident that the home makes suitable decisions about whether it can meet these. Standard 6 is not applicable to this service. EVIDENCE: There are effective pre-admission and assessment processes. The format used by the home has been updated recently. It covers all required areas. Service users are re-assessed following hospital admissions. Assessments are carried out by one of the home’s nursing staff, depending on who is available. Decisions are discussed with the home manager if necessary. Bybrook House Nursing Home DS0000015894.V347788.R01.S.doc Version 5.2 Page 12 The home has clear information about which needs it can or can’t meet. These are explained in its Statement of Purpose. Steps are now taken to ensure that any necessary additional resources or facilities are put in place before admitting a service user. The manager is clear about the need for all decisions to be based on appropriate clinical judgements. Some service users may have additional need areas, such as those arising from a level of dementia. If so, their individual care records contain clear information about these. The records we saw have an appropriate level of detail. They explain how the condition affects an individual and display empathy for their perspective in setting out how to support them. They focus on upholding the service user’s dignity and autonomy as much as possible. Records of care show how service users’ reactions are observed to make judgements about what type of activities they may benefit from. Service users also have support from a community psychiatric nurse. Bybrook House Nursing Home DS0000015894.V347788.R01.S.doc Version 5.2 Page 13 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have their abilities, needs and goals reflected in their individual plans. Service users are supported to address their personal and health care needs effectively. Service users are protected by the home’s procedures for the handling of medicines. Service users have their privacy and dignity respected. EVIDENCE: There were around 20 service users living in the home at these inspection visits, including some people staying for short term care. We looked at four sets of service user records in detail, along with parts of some others.
Bybrook House Nursing Home DS0000015894.V347788.R01.S.doc Version 5.2 Page 14 The home has completely revised its care plans since the previous inspection. A lot of work has been put into this over a short period. Most service users’ records have been transferred into a new format, and their old ones archived. All staff who gave us comments are very positive about the changes. Service users’ files are well ordered. They include a photo of the person and key details such as their age, needs and next of kin. There is detailed life history information, obtained from the service user themselves or their relatives. Assessments are carried out for topics such as moving and handling, continence and pressure areas. Care plans cover a range of issues, such as personal and healthcare needs, communication and spirituality. All assessments and plans have been updated recently, as part of the transfer to a new format. Progress is evaluated regularly, including daily notes about any ongoing support issues. Bybrook House has consistently been praised by service users and relatives for the quality of care it provides. The home has developed particular areas of expertise. For instance, there are good links with the Dorothy House hospice, which Bybrook has used to develop its ability to offer end of life care. Support given by staff is carried out respectfully. Intimate care tasks are always carried out in private. The needs and preferences of service users are set out in their individual care plans. Assessments on key topics are in place and up to date. Daily notes provide detail and evidence of the care provided in response to developing issues. Health care needs are identified and followed up. There is clear evidence of input from various professionals. For instance, prompt referrals are made to GPs whenever issues are identified. We saw GPs visiting service users and discussing care issues with nursing staff during these visits. People with more complex needs have access to advice from specialist nurses and consultants. Care plans also address emotional and psychological needs, such as supporting people through bereavement, or identifying the activities they may enjoy. The pharmacist inspector looked in detail at arrangements for the handling of medicines at our inspection in May 2007. We carried out a shorter review this time. Systems for storage and recording were seen to be appropriate. The home will change to a new pharmacist and system of dispensing in December 2007. This will include changing where medicines are kept. Bybrook House Nursing Home DS0000015894.V347788.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are being provided with a developing range of activities and opportunities, to help fulfil their recreational interests. Service users are able to maintain and develop appropriate relationships with family and friends. Service users are supported to exercise choice and control in all aspects of their daily lives. Service users are offered healthy, nutritious and enjoyable meals, in line with individual needs and preferences. EVIDENCE: Bybrook House had a long period without someone to lead on activities, despite continual efforts to recruit for this role. However, progress is now being made. One staff member spends six hours per week on activities, in two afternoon sessions. The plan is to increase this. Other staff also participate in providing input at other times.
Bybrook House Nursing Home DS0000015894.V347788.R01.S.doc Version 5.2 Page 16 Signs and pictures are on display in the home to show the type of activities that are offered. These include cooking, art, flower arranging and games. Service users are also given the opportunity for some one-to-one support, when they can choose what they would like to do. Records show that this leads to a variety of input, reflecting the different interests of service users. Service users who spoke with us confirm that there are now at least two activity sessions each week. Some also explained how they occupy themselves with hobbies such as reading or doing tapestries. Service users’ records include information about social interests and hobbies. There is guidance on promoting activity and stimulation for each individual. Activities logs are kept with individual records for each service user. They make a note of any participation in group sessions or one-to-one input. They also note if there is a reason for not giving input, such as if the service user is unwell or sleepy. The records are used to show possible areas of interest for each person that could be developed further. The activities logs show that almost all service users are getting opportunities for engagement. The only exception is one person who has specifically made clear that they wish to opt out. Service users have regular contact with family and friends. People visit Bybrook frequently and are always made welcome. Most service users tend to receive guests in their own rooms. All service users’ rooms have their own phone lines with a separate extension number for making and receiving calls. Service users continue to do things outside the home if they are able. Often they may go with their families. The home also arranges trips and outings occasionally. Some service users go to events in the local village, such as concerts at the church. Service users choose where to spend their time and what to do. They comment that staff are good at responding to their needs and wishes. Individual reviews are an opportunity for service users and their relatives to have input into decisions about overall care. Relatives are also kept informed and consulted about important developments. We saw nursing staff discussing such issues with family members, either in person or over the phone. The home had one cook working five days per week at this inspection. Efforts are being made to recruit for the other two days. In the meantime, agency cooks are being used to cover these. Bybrook House Nursing Home DS0000015894.V347788.R01.S.doc Version 5.2 Page 17 Each service user is asked, during the morning, which menu options they would like for lunch and tea. Choice is always available. The main midday meal on the first day of this inspection visit was sampled, in the company of nine service users. Most service users appeared to enjoy the meal, although some were not impressed with the dessert on this occasion. Any service users who need staff support with eating have the same person sitting with them throughout the mealtime. Support is given appropriately, at a pace suitable to the service user. People can have meals in their own rooms if they prefer. Service users also confirm that drinks and snacks can be requested at any time, including cups of tea during the night if they are unable to sleep. Bybrook House can support people with special dietary needs and preferences. This may include vegetarians and people with diabetes. Service user records include nutritional risk assessments and information about particular issues, such as swallowing difficulties. Bybrook House Nursing Home DS0000015894.V347788.R01.S.doc Version 5.2 Page 18 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Procedures designed to uphold the protection of service users are in place but are not always applied effectively. EVIDENCE: The home’s complaints procedure is displayed in the main entrance hall, and included in the service user guide. Contact details for the CSCI are shown. These need updating to reflect recent closure of the local CSCI office. Complaints records are kept in the home and are available for inspection. The new manager intends to review the process so that more detailed records will be kept for any future complaints. There are procedures to show how the service responds to possible abuse. They include a link to Wiltshire’s multi-agency procedures for safeguarding vulnerable adults. Information about these is available in the home. Staff have relevant training and also get a copy of a leaflet on the local procedures. Bybrook House Nursing Home DS0000015894.V347788.R01.S.doc Version 5.2 Page 19 A recent complaint to the home included allegations about possible missing money belonging to a service user. Although the complaint lacked some details, by implication it was an allegation about the conduct of staff, and of a possible criminal offence. Therefore, the issue should have been notified to the CSCI and alerted under safeguarding adults procedures. The manager agreed to take these steps after we discussed the issue during the inspection. The service also has a procedure about how staff may raise any concerns they have about practice. This is usually referred to as ‘whistle blowing’. The procedure discusses the channels that are available for staff to take up concerns within the organisation, such as approaching the manager or the company director. It was reviewed in August 2007. Bybrook House Nursing Home DS0000015894.V347788.R01.S.doc Version 5.2 Page 20 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 & 26 Quality in this outcome area is adequate but improving. This judgement has been made using available evidence including a visit to this service. The environment does not yet provide a level of safety and comfort that meets all the service users’ needs. EVIDENCE: Bybrook House provides pleasant accommodation for service users in most parts, both in individual rooms and communal areas. It is attractively furnished and decorated. A range of improvements has been carried out in recent years, benefiting the overall quality of the environment. Further work has taken place since the inspection in May 2007 and was ongoing around the time of these visits. This includes repairs to the roof to prevent rainwater leaking in on the top floor. A damaged window frame on this floor is also being repaired in stages, and this bedroom will not be occupied until the work is complete.
Bybrook House Nursing Home DS0000015894.V347788.R01.S.doc Version 5.2 Page 21 Bybrook House has access to maintenance staff from another home in Wiltshire which Avon Care Homes recently purchased. They are carrying out the above works. They also plan to address other tasks over the coming months, including redecoration of much of the home in December 2007. Service users comment on how much they like their rooms. They can bring in personal items, such as furniture and pictures, to make their room feel homely and comfortable. One service user staying for short term care appreciated having been able to choose their own room. They liked having en-suite facilities. They were also impressed that fresh flowers are placed in the room. Some service users also confirm that they enjoy using communal areas, such as the lounges and dining room. Bybrook House also has grounds and gardens available for service users to relax in. Some service users enjoy the opportunity to use these for short walks. They also like simply having nice views from their windows. One service user has had a bird feeder placed outside their room so that they can enjoy watching the birds and other wildlife that are attracted to this. The home hopes to promote greater use of its gardens for next year. A gardener has been employed to improve the look of the area for 2008. Not all bedrooms are accessible to all service users, because some can only be accessed by small flights of stairs. This is reflected in the home’s current conditions of registration. When existing service users become more frail, it is occasionally possible that they may need to move to a different room. This is done by agreement with the individual or their family. There are a number of bathrooms at the home, including some en-suite facilities. The increasing care needs of most service users mean that some existing bathrooms are no longer suitable. However, the home has sufficient provision to meet all of its service users’ needs. Installing an accessible shower for service users is planned as a possible development during 2008. The home appeared clean and hygienic in all areas seen during these two visits. Bybrook House employs domestic staff who carry out a range of tasks, including cleaning and laundry. Flat linen, such as bedding and tablecloths, is sent to be washed by an outside contractor. All other laundry is done at Bybrook House. There are appropriate arrangements for collecting items for washing, and dividing them into loads. Infection control risks are minimised by the approach used. For instance, heavily soiled items are placed in special bags, which then go straight into the Bybrook House Nursing Home DS0000015894.V347788.R01.S.doc Version 5.2 Page 22 washing machine. This reduces the need to handle the laundry. The washing machine has a suitable programme to get such items clean and disinfected. Work has started on unblocking and repairing a drain to the rear of the home, which had been affected by damage from tree roots. Paths in this area have been cleared as well and new lighting installed, to improve the safety of access to the staff car park. The home’s lift was out of action for a few days between the two inspection visits. It could not be repaired immediately because a new part was required. The home took suitable steps to care for service users affected by the difficulty. The lift was back in full working order by our second visit. Problems with the temperature of hot water at outlets accessible to service users have been addressed. Valves are fitted to regulate this to a safe level, and suitable steps are now being taken to make sure these operate effectively. At our first visit we found that some temperatures were still significantly above the safe level of around 43°C. For instance, one bath’s hot water reached 55°C. This was put right as soon as we had raised it. By our second visit further remedial action had been taken. Hot water temperatures were at a suitable level on this occasion. The home’s records for the period leading up to this inspection showed that water temperatures were being checked regularly. But they did not show any suitable action being taken when a reading was obtained above the safe level. Bybrook House Nursing Home DS0000015894.V347788.R01.S.doc Version 5.2 Page 23 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have their needs supported by suitable numbers of staff. Steps are being taken to provide them with appropriate training. Service users are protected by effective practices in staff recruitment. EVIDENCE: Bybrook House was registered under previous care and nursing home legislation. This means it has to maintain staffing at least at the same level set before April 2002. Staff numbers vary, depending how many service users are in residence. At the occupancy level at the time of this inspection, the home was usually running on four staff in the mornings; three for afternoons and evenings; and three waking staff overnight. Because the home is registered to provide nursing care, a qualified nurse is on duty at all times. Sometimes there are two nurses on the same shift, depending on the particular skill mix. Nursing staff are supported by a team of carers. Cover is maintained by staff working extra hours, and some use of agency employees if necessary.
Bybrook House Nursing Home DS0000015894.V347788.R01.S.doc Version 5.2 Page 24 Bybrook House also employs staff for other key tasks, such as catering, cleaning, and maintenance. At the last inspection in May 2007 staff reported difficulties in meeting the needs of service users at current staffing levels. The new manager has reviewed staff levels and deployment, in line with assessed service user needs. The situation is kept under review as service user occupancy changes. Some staff still feel that they would benefit from having more numbers on duty on some shifts, especially in the mornings. However, overall they say that things have improved, and that rotas are fairer to all staff than previously. The company which owns Bybrook House has a staff member based at its home in Wells who oversees training across the group. The home now has a training matrix which shows which courses staff have been on and which ones they still need to do. It also shows what training is coming up over the next few months. Individual staff training files are also kept. These are due to be reorganised soon. Staff training includes courses, distance learning packages and in-house discussions on relevant topics, sometimes with external speakers. Some training sessions also take place in the company’s nursing home in Wells, and staff from Bybrook House can attend these. The home has also obtained a DVD player so that staff can watch training materials on topics such as food hygiene, health and safety, and safeguarding vulnerable adults. Staff have commented in the past that induction for new starters was not always effective. Some staff felt that they did not know enough about the needs of service users before they had to start working with them. At previous inspections, care staff induction was not linked to the relevant national standards for the social care workforce, which are a pathway into National Vocational Qualifications (NVQs). Records were not maintained to provide evidence of each employee’s induction. There have been no new care staff appointed since a requirement was set about this topic, so it has not yet been possible to assess compliance. But we discussed the issue with the manager. The company is revising its induction pack, under the guidance of its training co-ordinator, to update this in line with the most recent national induction standards. The home now has four care staff who have achieved NVQs in care at Level 2, representing around 50 of the hours covered by this group. Other care staff are working towards this. There are also plans in the longer term for some to study for the award at Level 3. Bybrook House Nursing Home DS0000015894.V347788.R01.S.doc Version 5.2 Page 25 Recruitment is ongoing. Many of the nursing care hours at Bybrook House are covered by a nurse bank. The home has recently appointed a new permanent member of nursing staff and would like to recruit more. Efforts are also being made to recruit more carers and catering staff. We looked at recruitment records for the newly appointed staff member, who was due to start shortly after our visits. These show that all required checks are being carried out. There have been no other new appointments recently. We looked at a sample of existing staff records. These were mostly satisfactory. However, we noticed that two members of nursing staff who had checks of their criminal records carried out in 2004 had not had these done at the ‘Enhanced’ level, as required. The home is now repeating checks for these two employees. Bybrook House Nursing Home DS0000015894.V347788.R01.S.doc Version 5.2 Page 26 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a well run home, and will be further protected once the manager is registered. Improvements are being made to the development and supervision of the staff team which should enhance the quality of service. Measures are being implemented for quality assurance which will help to ensure that the service is developed in line with the interests of service users. Service users are having their health and safety protected by the measures now being put in place. Bybrook House Nursing Home DS0000015894.V347788.R01.S.doc Version 5.2 Page 27 EVIDENCE: The home’s new manager is Ms Janet Rowland, who took up post in July 2007. She is due to apply for registration as manager. The home is also seeking to recruit a new deputy manager. The principal director of Avon Care Homes, Mrs Maria Cristina Bila, acts as the ‘responsible individual’ for the company. Mrs Bila meets the statutory requirement of completing monthly reports on the conduct of the home, based on her visits to Bybrook House, and meetings with service users, visitors and staff. These reports address a number of criteria prescribed by regulations. Copies are supplied to the CSCI. They provide useful evidence of how progress in the home is being monitored and reviewed. Staff report generally positive first impressions of the new manager and the changes she has brought in. They are happy that issues of concern they had earlier in the year are being addressed. Some staff feel that some problems still remain, but they believe that things are moving along the right lines. They think that the atmosphere within the staff team is much improved. Staff confirm that a meeting took place shortly after the new manager began working at Bybrook House. Records show that nine staff attended. The timing of the meeting was not convenient for everyone. Staff would like further opportunities to meet and discuss issues about the running of the home. The manager said that her plan is to hold at least three meetings a year. It is also planned to hold residents and relatives meetings. These will probably take place twice a year. The manager reports that systems for individual supervision of each staff member have been implemented, with everyone having already had at least one session. We saw records to support this. However, some of the staff who spoke with us said that they have not yet had supervision sessions. The home completed an Annual Quality Assurance Assessment (the AQAA) for this inspection. This document enables a service to evaluate its performance and identify future goals. For Bybrook House, these include developing the range and frequency of activities for service users; implementing regular supervision sessions for all staff; and improvements to the premises, including further repairs and redecoration and work on the grounds and gardens. The service has also carried out some recent surveys. The results of these were being collated around the time that we visited. Since the inspection, this process has been completed. The home has produced its new business plan. This includes actions based on the comments received. Bybrook House Nursing Home DS0000015894.V347788.R01.S.doc Version 5.2 Page 28 The home does not get involved in managing service users’ money. If service users are no longer able to do this for themselves, they need to have a relative or someone else who will help them. All service users have lockable storage in their rooms, where they can keep any money and valuables. Risk assessments are carried out for individual service users on various topics, depending on their particular needs. The possible risks addressed include falls, leaving the home unaccompanied and issues associated with bathing. Risk assessments have also been carried out on supporting some service users with personal care in their own rooms. These have led to changes, such as moving furniture. We saw examples of how this has improved the situation in some bedrooms. Service users and their families have been informed and consulted about any changes, and given explanations of the reasons. Some further steps are needed to resolve outstanding risk issues. For instance, in one bedroom we saw that access at one side of a service user’s bed is impeded by trailing wires, due to the number of electrical items plugged into a nearby socket. Fire safety measures in the home are all up to date. Staff have received recent training, including a practice evacuation. Training is also ongoing on a range of other health and safety topics. Bybrook House Nursing Home DS0000015894.V347788.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 3 X 3 Bybrook House Nursing Home DS0000015894.V347788.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes 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 OP18 Regulation 37-1g Requirement All allegations of possible staff misconduct must be notified to the Commission and also alerted under local procedures for safeguarding vulnerable adults. Repairs must be made to all rotten wood and areas affected by water leaks. COMMENT: Work is underway. The timescale from the previous inspection has not yet expired. Timescale for action 10/10/07 2 OP19 23-2b 31/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP25 Good Practice Recommendations Systems for the regular testing of hot water temperatures should include measures to resolve any problems identified, so that service users are protected from risk. Bybrook House Nursing Home DS0000015894.V347788.R01.S.doc Version 5.2 Page 31 2 OP30 Induction of new care staff should be in line with relevant national standards, so that service users benefit from the support of staff with suitable knowledge and skills. The home should continue with the implementation of regular individual supervision meetings for all staff, so that service users benefit from a staff team that is suitably supported and developed. Further risk management steps should be taken following the risk assessments of safe working practice topics, to enhance the protection of service users and staff. 3 OP36 4 OP38 Bybrook House Nursing Home DS0000015894.V347788.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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