Inspection on 25/07/08 for Bybrook House Nursing Home

This inspection was carried out on 25th July 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bybrook House Nursing Home 16/12/08

Bybrook House Nursing Home 19/09/07

Bybrook House Nursing Home 17/05/07

Bybrook House Nursing Home 02/06/06

Bybrook House Nursing Home 30/09/05

Bybrook House Nursing Home 29/04/05

Bybrook House Nursing Home 08/10/04

Bybrook House Nursing Home 02/07/04

Bybrook House Nursing Home 11/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Bybrook House Nursing Home Middlehill Box Wiltshire SN13 8QP Lead Inspector Susie Stratton Unannounced Inspection 9:10 25th July 2008 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.V364002.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.V364002.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 Mrs Rosemary Ann Goff 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.V364002.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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 19th September 2007 3. 4. 5. 6. Date of last inspection Brief Description of the Service: Bybrook House provides care and accommodation for up to 30 older people. At the time of the inspection visit, there were 19 people resident in the home. 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. There is car parking on site. All residents have single rooms. There are three bedrooms which are large enough for double occupancy by married couples or partners. 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 facilities. There are five baths for general use, with at least one per floor. Fees charged to residents range from £700 to £1,200 per week. Information for prospective residents is provided in the main entrance hall, in their rooms and on request. The home also has a website with brief introductory details and a selection of photographs. Bybrook House Nursing Home DS0000015894.V364002.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 0 star. This means the people who use this service experience poor quality outcomes. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. As part of the inspection, 20 questionnaires were sent out to residents and their relatives and seven were returned. Comments made by people in questionnaires and to us during the inspection process have been included when drawing up the report. As part of this inspection, the home’s file was reviewed and information provided since the previous inspection was considered. We also received an Annual Quality Assurance Assessment from the home. This was their own assessment of how they are performing. It also gave us information about what has happened during the last year. We looked at the quality assurance assessment, the surveys and reviewed all the other information that we have received about the home since the last inspection. This helped us to decide what we should focus on during the visit to the home. The site visit took place on Friday 25th 2008, between 9:10am and 4:10pm. The newly appointed manager was on duty and was available for the feedback at the end of the inspection. During the site visits, we met with ten residents, two visitors and observed care for four residents for whom communication was difficult. We reviewed care provision and documentation in detail for four residents, one of whom had been admitted recently and considered specific matters for a further seven residents. As well as meeting with residents, we met with two registered nurses, two carers, the chef, the housekeeper and a cleaner. We toured all the building and observed practice, including a lunch-time meal. We observed systems for storage of medicines and observed medicines administration round. A range of records were reviewed, including the complaints log, accident records, staff training records, staff employment records and maintenance records. What the service does well: Bybrook House has a very loyal and dedicated staff group, who have remained working in the home during a period of considerable change particularly in managers. The chef works hard to ensure that residents get the meals that they like and ensures that meals are attractively presented. He is aware of the Bybrook House Nursing Home DS0000015894.V364002.R01.S.doc Version 5.2 Page 6 importance of a well-balanced diet for older people and encourages residents to have their five portions of fruit and vegetables a day. The housekeeper is keen to ensure that Bybrook House continues to provide a homely atmosphere for residents to live in and her staff were highly motivated in their roles. The registered nurses and carers showed a good knowledge of the needs of their residents and were observed to be keen to support them. Residents and their supporters commented favourably on the home. One person reported “the home is friendly & welcoming & the staff v kind”, another “I’ve never been unhappy here,” another “I just can’t speak too highly”, and another “It’s been such a wonderful experience.” People commented particularly on the staff. One person reported, “It was care and support above and beyond the call of duty”, another “staff are wonderful. Their priority is always the residents care, but we are greeted in a friendly and professional way. They never appear in a hurry with residents”, another “I’m looked after well” and another described the “good, kind, long-serving staff there at all levels – kitchen staff, cleaners, the house-keeper, care staff and senior nursing staff”. What has improved since the last inspection? What they could do better: At this inspection, 21 requirements were made and 25 good practice recommendations. The provider needs to ensure that the health and safety of residents, visitors and staff is fully up-held. Areas which need attention include, the safety of windows on the first and second floors of the home, protecting people from the risks associated with hot surface temperatures, ensuring that people are protected from risks of scalding, ensuring that people are not at risk of tripping injury and regular maintenance on wheelchairs. A range of improvements relating to prevention of spread of infection are needed. These include cleanliness and maintenance of parts of the laundry, improved systems for the Bybrook House Nursing Home DS0000015894.V364002.R01.S.doc Version 5.2 Page 7 management of certain laundry, provision of adequate facilities for the disposal of clinical waste in residents’ rooms and appropriate facilities for the storage of bed pans. Fire safety also needs to be addressed, so that all fire doors close properly into their door frames. Equipment is needed to ensure heath and safety, this includes facilities to secure oxygen cylinders, the provision of appropriate variable height beds for residents with manual handling needs, a review of mattresses and commode chairs, to ensure they are fit for purpose and a review of bathing facilities for disabled people. As some of these issues have been identified at previous inspections, it is recommended that the home increases hours for maintenance and appoints a senior manager in the organisation, who can take the lead on health and safety. Some improvements are needed to ensure that residents with additional mental health needs are safeguarded and that residents’ dignity is up-held. Residents must always be left with access to their call bell. Where this is not possible, there must be clear care plans in place to state how risk is to be reduced for the person. If a resident has behaviours associated with their call bell, a care plan must be drawn up to direct staff on how to mange these behaviours, so as to ensure the person’s safety. Where a resident user has additional mental health care needs, full risk assessments must be carried out and all steps taken to ensure that the resident can continue to live the life they wish, in a safe environment. Systems need to be put in place to prevent the communal use of clothing, particularly underclothing. Procedure in relation to administration of medicines needs to be tightened up. All medicines administration records must always be fully completed at the time of administration, to provide evidence that the resident has been given their drugs as prescribed. Where a resident is prescribed a drug on an “as required” basis, there must always be a protocol/care plan drawn up about this, to direct staff. Where residents have oxygen in their rooms, they must always have an up-to-date prescription about this on their medicines’ administration record and a care plan must always be in place to direct staff on indicators for its use. Risk assessments for self-medication should be reviewed at the same time as other care plan reviews or when a person’s condition changes. Where a resident is prescribed a drug which can affect their activities of daily living, such as an aperient, painkillers or mood altering drugs, a care plan should always be drawn up, so that the resident’s response to such drugs treatments can be evaluated. Where residents are prescribed creams and lotions, a documentary systems should be in place so that it can be demonstrated that they have been applied in accordance with GPs’ instructions. Improvements are advisable in the home environment. All scraped and damaged areas in corridors should be repaired and made good. All parts of the garden should be fully maintained. The carpet in the front entrance hall and corridors should be replaced. Bybrook House Nursing Home DS0000015894.V364002.R01.S.doc Version 5.2 Page 8 Some improvements are needed in care plan documentation. Where daily records indicate changes in a resident’s condition, including actions taken, the person’s care plan should be promptly reviewed, rather than waiting for the next monthly review. Clear, measurable terminology should always be used in care plans and the type of continence aid to be used should be documented. Risk assessments for the use of bed safety rails should be reviewed as part of regular care plan reviews or when a resident’s condition changes. All residents should have care plans about their individual recreational and activities needs. Information and assessment processes prior to admission need to be tightened up. The service user’s guide must include a copy of the summary of the most recent inspection report, together with information on how the full report can be accessed. The service users’ guide should include reference to the home’s policy on self-medication and its staffing levels and skill mix on each shift. The home’s admission assessment record should include all areas detailed in our standards. Some areas relating to staffing need further development. Photographs of staff must be clear enough for them to be used as proof of identity. Induction of new care staff needs further review, as does training and development. The home needs to further develop supervision systems for all staff. There should also be written evidence that the people who perform checks on bed safety rails have been trained to do so. 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.V364002.R01.S.doc Version 5.2 Page 9 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.V364002.R01.S.doc Version 5.2 Page 10 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): 1 & 3. Bybrook does not admit for intermediate care, so 6 is N/A Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents and their supporters have nearly all the information they need to make a decision about admission to the home. Residents have their needs assessed prior to admission. EVIDENCE: Bybrook House has a statement of purpose and service users’ guide, both of which are available in the front entrance hall and each resident’s room. All seven of the people who responded to the questionnaire reported that they felt they had had enough information about the home prior to admission. One person reported, “The brochure, like many others was fine, but we asked more questions as well”. The service users’ guide does not include a copy of the summary of the current inspection report, together with information on how the full report can be accessed as is required, to fully inform people. A copy of the full inspection report is available in the front entrance area. The home does Bybrook House Nursing Home DS0000015894.V364002.R01.S.doc Version 5.2 Page 11 support people in managing their own medication, if they wish, but this is not referred to in the guide. It is also advisable that the information details the number of staff on duty for each shift, so that prospective residents are fully informed. Many of the residents met with reported that they had been in the home previously for respite care, and so knew it well. Other people reported that they had been too frail to visit the home prior to admission but that family members had done this for them. One person reported, “It was warmly recommended by […….] and we were able to visit it several times”, another “We looked at various homes and this was also the most welcoming, relaxed homely feel” and another “looked at various possibilities, looked at a few and this was chosen”. We looked at records relating to a newly admitted resident. The information had been completed in detail and gave a clear indication of the person’s nursing and care needs and reflected what we observed. The form used by the home does not include all areas documented in our standards and it is advisable that it does, so that all areas relating to resident care are assessed. Staff spoken with, including the chef, reported that they were fully informed of residents’ needs before admission, so that they could plan how to meet the person’s needs. One relative reported, “I am very impressed at how well staff have helped [….] to settle in”. Bybrook House Nursing Home DS0000015894.V364002.R01.S.doc Version 5.2 Page 12 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. Residents will have their personal and healthcare needs met. Most of medicines management is safe, but more attention needs to be paid to documentation. People are treated with respect, although improved systems are needed to prevent communal use of residents’ clothing. EVIDENCE: Bybrook House has an established system for assessing and planning care. All residents have full assessments of need, which are regularly reviewed. If a need or a risk is identified, a care plan is put in place to direct staff on how the individual’s needs are to be met. Care plans are highly individual and generally document how peoples’ needs are to be met. One resident reported, “I’m looked after well”, a relative reported “care is anticipatory and of an excellent standard” and another relative commented on the “specialist nursing knowledge and experience”. Bybrook House Nursing Home DS0000015894.V364002.R01.S.doc Version 5.2 Page 13 The manager, who had only been in post for a few weeks at the time of the inspection, reported that she has concentrated on matters relating to documentation, to ensure that all residents have care plans in place and ensure consistency in approach. An individual daily record is also maintained for each resident. Generally if these records indicated that a resident’s condition had changed, their care plan was revised. This did not happen in all cases. One resident’s daily records indicated that they were falling more often and that consultations had been held with their GP, however their falls risk assessment and care plan had not been reviewed. Another resident with additional mental health needs showed changes in these needs in their daily records but their care plan was not revised in the light of these changed needs. Where residents are assessed as being at risk of pressure damage, they have care plans in place to direct staff on how risk is to be reduced. Not all care plans documented how often each individual needed to have their position changed. This is needed to ensure staff are fully directed in what interventions are needed. Most care plans documented the type(s) of equipment to be used, but not all, some only stating “pressure relieving mattress”. It is advisable for the actual mattress be specified. The home does maintain records of care given to very frail residents, to document how often a person has had their position changed, fluids offered and meals given. These charts are largely fully completed but there is some lack of consistency in methods of documenting and all staff should document care given in the same way, so that the managers can ensure that care has been given as needed. Many of the residents experience continence needs. Where this is the case, care plans are put in place to direct staff on how the person’s continence needs are to be met. It is advisable that continence care plans document the type of aid to be used for each resident. If commodes are to be offered, the plans should state how often the person is to be offered a commode in measurable terms, rather than “on a regular basis”. Where a resident is assessed as needing to have an indwelling urinary catheter, the clinical reasons for this is documented and there are full records of changes of catheter maintained, in accordance with guidelines. Where residents have wounds, there are clear records relating to the management of the wound, including photographs. The tissue viability nurse is contacted as necessary. Where residents have additional mental health care needs, there are care plans in place. Some care plans and records could benefit from more precision with the actual behaviours documented not just that a person is “aggressive”. There was evidence that the home works closely with mental health services for such residents. The home also has close working links with the local palliative care team for residents who have terminal conditions. One relative described how the palliative care for their resident was “anticipatory of future needs and absolutely fabulous.” All staff spoken with reported on the effective working relationships with the local GP service. Bybrook House Nursing Home DS0000015894.V364002.R01.S.doc Version 5.2 Page 14 All medicines were securely stored. A medicines administration round was observed and it was performed in a safe manner. A review of the medicines administration records showed 22 non-completed records. All medicine administration records must always be completed at the time of administration, so that the home can demonstrate that the resident has been given the medication that they need at the time that they need it. Some residents were prescribed drugs on an “as required” basis, where this is the case, protocols need to be drawn up, to direct registered nurses on when and why these drugs are to be given. Three people had oxygen in their room. Staff spoken with were able to inform us of when the oxygen was needed for each individual, however these were no care plans about this and this is indicated. Additionally, there was no current record of a prescription for oxygen on the residents’ medicines administration record. One resident was self-medicating. They had a lockable drawer to their bedside cabinet. They reported that they told the registered nurse each time they were getting low in their drugs and that the registered nurse put in a repeat order for them. A risk assessment for self-medication had been completed. It is recommended that risk assessments for self-mediation be reviewed on a monthly basis or if the person’s condition changes. Several residents were prescribed medication which can affect their daily lives, such as painkillers, aperients or mood altering drugs. Some residents had care plans about these drugs, but some did not. This is indicated, to assist in the evaluation of medicines treatments and regimes. Residents were prescribed lotions and skin creams. Where this happened, there was generally a care plan in place to direct staff on their use, however a record was not made of applications and this is needed, so that managers can verify that such treatments are being given by staff. We observed that all staff consistently knocked on doors and awaited a response before entering a room. One relative reported “Care is anticipatory and of an excellent standard” and another on the “patience and respect shown by the nurses”. Frail residents appeared to be well cared for with clean fingernails and spectacles. One resident who used a wig had it in place as soon as they were out of bed. The home does not have full systems to ensure that communal use of clothes is not taking place. There was a bag of un-named new underwear in one cupboard, clothes relating to people who were no longer in the home were stored in a cupboard on the second floor and un-named underclothes, socks and tights were placed in named residents’ containers in the laundry. There did not appear to be a consistent system for naming of clothes, some clothes were named with the room number, others with the resident’s initials and others with their name. This could cause confusion if a resident changed rooms. Some names were gradually being washed out and were difficult to read. Bybrook House Nursing Home DS0000015894.V364002.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. Residents are not currently supported in their recreational activities, however there are strong links with the local community and people are given meals which they enjoy, with staff who are keen to promote choice at mealtimes. EVIDENCE: Bybrook House does not currently have an activities coordinator in post. The newly appointed manager reported that she was currently recruiting to the post. A review of records indicated that no organised activities had taken place since May 2008, although discussions with staff indicated that “spot” entertainments did take place. For example a violinist was playing for residents who wished to listen, on the afternoon of the inspection visit. One person reported “I’m getting very fed up, I’ve got cards, but that’s all.” Some residents had care plans in place about their recreational needs, others did not. As there has been no member of staff to lead activities, staff agreed that care plans relating to activities have not been met. The new manager reported that once they have someone in post, this will be an area which can Bybrook House Nursing Home DS0000015894.V364002.R01.S.doc Version 5.2 Page 16 be progressed, to prevent isolation and further develop a community spirit in the home. Several visitors were observed during the inspection visit. One resident reported on how much they appreciated visits from their family, saying “They help me, visitors come and go when they want to.” One person was taking their relative out to lunch, another person’s relative was very frail and they reported how much they appreciated that they and the rest of their family could stay as long as they wished to. Staff reported on good links with the local village of Box and how they were supported by the community. Many of the people who are admitted for respite care come from the village and they and their relatives also came into the home at times to visit, as happened during the afternoon of the inspection. We saw that when this happened, there was clearly a good rapport between such people and the staff. There were reported to be good working links with the local churches, who visit the home on a regular basis. Residents reported that they could generally do what they wished, within the confines of being in a home. Many people had brought in several of their own possessions and furniture, giving rooms an individual appearance, reflecting their likes and preferences. One person commented “You can do all sorts of things here, but I prefer not to join in much”, another “you can get up at 6:00am if you want to”, another “I go out as much as I can and they let me”, another “staff do what you ask”, and another resident reported that they had been feeling “off colour” that day and staff had allowed them to stay in bed, as that was what they wanted to do. One resident reported that they had been in various rooms in the home, choosing each time when they wanted to move. During the inspection, we observed a mealtime and met with the chef. The chef is highly motivated in his role and showed a detailed knowledge of each resident and their likes and preferences. One resident reported “we’ve a very good chef.” Where somebody had particular likes and preferences he reported that he always made a point of going to meet them. One relative reported on how much they appreciated this, saying that he had taken much time and effort, speaking to the spouse of their relative, trying to find out from them what the resident would like to eat. The chef reported that he regularly reviews the menu, to provide a well balanced meal that residents would like. He said that he was always prepared to cook individually for people if they did not like the meal on the menu. He was also aware of the importance of colour, texture and portion size for frail elderly people. A relative reported “the pureed food looks like an artist’s palette. Very different colours and so visually attractive”. One resident who reported that they were allergic to certain foods said that the chef always gave them what they could eat. Residents would eat in the dining room or their own room as they preferred. Staff were available to support residents who were not able to give themselves their own meal, sitting with them and trying to make the meal a social Bybrook House Nursing Home DS0000015894.V364002.R01.S.doc Version 5.2 Page 17 occasion. Where a resident had needs relating to memory loss, staff were noted to observe the resident and were ready to remind them to eat if their concentration lapsed. Of the seven people who responded to this section of the questionnaire, one reported they always, four usually and one sometimes liked the meals. Comments ranged from “The food could be better”, through “food all right not brilliant but alright”, to my relative “is complimentary about the food” and that the food is “wholesome and on the whole good which should be taken as high praise” to “Wonderful” and “I feel catering is a real strength of the home”. A resident reported “If I don’t like it I can chose something else” and a relative reported “the catering staff have gone to great lengths to find out [my relative’s] likes/dislikes and to provide alternatives if […] does not appear to like the food”. Bybrook House Nursing Home DS0000015894.V364002.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. The home has a complaints policy, which the new manager is seeking to make more responsive. Whilst staff are trained in safeguarding adults, the interests of frail and vulnerable people are not supported by all the systems and home environment. EVIDENCE: The home has a complaints policy, which is displayed in the main entrance area and is available in the service users’ guide. Of the six people who responded to this section of the questionnaire, all reported that they knew how to make a complaint. One person reported that they brought up issues with “the first person who comes in”, another “I’d talk to Matron – she’s very helpful” however another person reported “if I’m not happy, I don’t know who to tell”. No complaints have been made to us about the service since the last inspection. The new manager reported that she had reviewed the complaints log and was aware that it needed up-dating and revision, as it may not document all the areas which she had been made aware of. She also plans to ensure that verbal comments made by residents and their supporters were noted, so that she could ensure that actions were taken to address concerns and more minor complaints. Bybrook House Nursing Home DS0000015894.V364002.R01.S.doc Version 5.2 Page 19 All staff spoken with were aware of issues relating to safeguarding adults, this included the chef and housekeeper. Staff reported that they had been recently trained in safeguarding adults, since the new manager came in post. This was supported by records. No safeguarding referrals have been made about this service since the last inspection. Some areas and systems in the home need attention, to ensure that vulnerable people are safeguarded. Some people who appeared to be unable to summon assistance by other means had not been left with access to their call bell. For some of these people, there was a care plan and risk assessment relating to this, stating that they were to be checked upon at certain specific intervals, however their records did not indicate that they were being checked at these intervals. Other people who may not have been able to use the call bell did not have a care plan to direct staff on how they were to be safeguarded. One person who did not have their call bell to hand had records which indicated that they had used it frequently when they did have access to it. Even if it is a simple omission in care, leaving a frail person without access to means of summoning assistance is never in their best interests. If a person has behaviours associated with call bell, these should be assessed and a care plan put in place to meet their needs. During the inspection, we observed one person who had prime needs for their medical condition but had complex dementia care needs including wandering behaviours. This was well documented in their records. They did have a brief risk assessment and disclaimer from their relatives about this, but the risk assessment did not consider all areas of risk and ensuring safety for the resident in the home environment, whilst enabling them to wander, as they clearly wished to do. Another resident was observed to show wandering behaviours on the ground floor. The office is by the front door, and the manager would be able to see if someone was exiting the building by that means. However none of the fire escape doors are contact point alarmed. The fire escape stairs are steep and as they are made of metal, would be slippery in wet weather. There are staff areas behind the kitchen, which also have open access to the outside and these are also not contact alarmed. The use of devices as contact point alarms would alert staff if a person were exiting the building by an unobserved route. As frail elderly people may often have a dual diagnosis, the home must be in a position to ensure their safety, whilst respecting their wishes to be able to move around. Bybrook House Nursing Home DS0000015894.V364002.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, 20, 21, 22, & 26 Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. Residents live in a home which potentially could provide a highly attractive, comfortable environment to live in, however some areas of maintenance are not regularly attended to, not all required equipment needed by frail people is provided and not all areas and practice ensure that risk of cross infection is minimised. EVIDENCE: Bybrook House has maintenance support for a few hours, once a week from the maintenance staff of a sister home. The housekeeper maintains a very clear and detailed log of areas which need to be addressed. These are then prioritised for when the maintenance support comes each week. This means that some areas are not addressed promptly or not addressed at all, as they are not a priority. For example, redecoration of two of the public rooms had Bybrook House Nursing Home DS0000015894.V364002.R01.S.doc Version 5.2 Page 21 commenced but not been finished off, due to pressure of other work. Many of the corridor areas, particularly doors showed scrapes and scratches and while they do not present a risk to residents, they are unsightly in appearance and detract from the home’s ambiance. More seriously, there are a range of issues relating to health and safety which have not been addressed (see Management below) and these have the potential to put residents, their visitors and staff at risk. The home has an attractive sitting room, with a small conservatory to the side. These look out over the garden areas, some of which are very attractive. One person commented on the “lovely garden.” Other garden areas are somewhat overgrown and detract from the rest of the pleasant atmosphere. The main entrance also has seating in it and some residents prefer to sit there. One person commented “I’ve a lovely room, beautiful view – I like the wild rabbits in the garden.” Not all rooms have an en-suite facility, however the home does have a range of bathrooms and assisted wcs. Most of the assisted baths are low and whilst they are provided with hoists, it would not be possible to bathe anyone with complex manual handing and care needs in them. There is one Parker bath, which is suitable for more disabled people, but only if they are able to bend at the waist and knees. There are no disabled showers. As the population in care homes with nursing are becoming more dependant, this is an area which needs consideration, so that the home can meet the needs of the future population. This is a matter which has been recommended at previous inspections. Four rooms do not have level floor access. At the time of this inspection, three of these rooms were unoccupied. The resident in the fourth room reported that they could manage the stairs independently, this was supported by staff and their records. All of the rooms on the second floor were not in use as the home were awaiting works on the boiler, to ensure hot water and heating to these rooms. The home has some equipment to meet the needs of disabled people. Hoists are provided for people who are unable to move independently. The home has wheelchairs to assist people who are not able to mobilise far. However there was no written evidence that these wheelchairs were regularly serviced and checked for safety by a trained persons, as is required, to ensure peoples’ safety. The home does have a range of pressure relieving equipment to support people who are assessed as being at risk of pressure damage. Two of the standard mattresses in unoccupied rooms were deteriorating, with thinness (known as “bottoming out”). Mattresses like this can present a risk of pressure damage to frail people. As we could not check mattresses in occupied residents’ rooms, all mattresses need to be checked for such deterioration and any which could present a risk should be disposed of and replaced. The home provides commodes for people who are unable to access toilets independently. Some of these commodes need attention, as the plastic Bybrook House Nursing Home DS0000015894.V364002.R01.S.doc Version 5.2 Page 22 coating is deteriorating and they therefore could not be wiped down, to prevent potential micro organism growth. All commode buckets inspected were clean. All commode chairs should be surveyed and any which have deteriorating fabric should be replaced. It appeared that commode chairs were used communally. As good practice there should be enough commode chairs for each individual to be allocated one and for it to be used only for that person. The home has very few variable height beds. Several of the people with complex manual handling needs were cared for in fixed height beds and most of the people with some manual handling needs were cared for in such beds. This is a risk to both residents and staff and all people with manual handling needs need to be cared for in height adjustable beds. Additionally if more profiling beds were used, the need for safety rails (which are regarded as a risk to frail elderly people), could be much reduced. During the inspection, we met with a domestic and the housekeeper. Both were highly motivated in their roles and keen to promote dignity for their residents. For example in promptly removing any spills. One domestic reported that she had all the chemicals she needed to perform her role and had recently been provided with a carpet shampooer, which had further helped her in her role. Of the six people who responded to this part of the questionnaire, five reported that the home was always and one usually fresh and clean. One person commented “the room was cleaned seemingly whenever I was there – almost daily, it appeared. Fresh flowers in the public rooms enhanced the appeal” and another “and beautiful flowers!” All the flat linen is sent out to a commercial laundry. The home has a laundry for residents own linen and clothes. This has a washing machine with a sluice wash programme for infected and potentially infected items. Such linen is laundered separately. All other linen is placed in linen skips and then separated in the laundry. This is not best practice, as current guidelines are that as much as possible linen should be handled as little as possible and separated at source, in the resident’s room, with appropriate linen containers being provided. The plinths for the washing machines had deteriorated and the under-concrete is showing through. All such areas need to be intact and easily wiped down, to prevent risk of cross infection. The areas behind the machines showed considerable deposits of dust and debris. As micro organisms can live in such an environment and then be carried round the home on staff uniforms and peoples’ feet, all dust and debris in laundry rooms, particularly behind washing machines must be promptly and regularly removed. An immediate requirement notice was sent to the home following the inspection about this matter. The laundry has a sink, but it does not have a hand wash basin, which is recommended, so that staff can easily wash their hands if they become contaminated. Bybrook House Nursing Home DS0000015894.V364002.R01.S.doc Version 5.2 Page 23 The home has two sluice rooms, both of which have bedpan washers, which can properly cleanse sanitary items. All of the bedpans inspected were clean. In one sluice room, the bedpan rack was deteriorating, with much of the under surface showing through. As such it is not possible to be wiped down and it needs to be replaced, to prevent potential risks of cross infection. The home has systems for management of clinical waste, however for one resident who had an infection, a foot pedal operated clinical waste bin was not provided. Foot pedal operated bins are needed to prevent the risk of cross infection associated with placing potentially infected waste in bins by hand. Staff reported that they had a good supply of disposable gloves and aprons and were observed to use them during the inspection. Registered nurses reported they had a good supply of sterile gloves for aseptic procedure. Bybrook House Nursing Home DS0000015894.V364002.R01.S.doc Version 5.2 Page 24 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 adequate. This judgement has been made using available evidence, including a visit to this service. Residents had a mixed reaction to how the home was staffed, however they are supported by a very stable team of staff. The new manager is, as part of her induction is fully reviewing training programmes. EVIDENCE: Bybrook House employs a range of registered nursing, care and ancillary staff. Many of the staff have been in post for several years and show high levels of loyalty to residents and each other. The new manager reported that only one new member of staff has been employed for a considerable period of time, and this person commenced their employment nearly the same time as herself. A review of their file showed that all correct checks including police checks, references, past employment history, proof of identity and health questionnaires had been completed. The manager reported that she is now starting to recruit staff and has several people waiting to complete preemployment checks. Staff files showed that proof of identity included photocopies of photographs on passports or driving licences. These were often not clear enough to provide actual proof of identity and photographs should be used. Bybrook House Nursing Home DS0000015894.V364002.R01.S.doc Version 5.2 Page 25 As would be expected in a care home where a range of people with different conditions are treated, we received a range of comments about the staffing. These varied from “the staff are thick on the ground” and “I have always been able to find a member of staff quickly if I need them” and “if I ring my bell, they come promptly” to “If I ring my bell, they come as soon as they can” and “Staff occasionally slow – I don’t think they’ve got enough staff” to “I cannot always find someone to talk to when I visit” and “I don’t’ see the girls much”. The new manager reported that she has commenced a process of reviewing staff records, including induction, National Vocational Qualifications and inhouse and external training. She is developing an action plan of areas to be addressed and aims that by the next inspection, she will be fully aware of areas for deficit and areas where the home are meeting guidelines. It is appreciated that the new manager had only been in post for a few weeks and that she clearly knows what needs to be considered. The manager reported that Avon Care Homes employs a training manager and that she will be working closely with her as her plans are developed. The previous acting manager reported in the Annual Quality Assurance Assessment that dementia training is being organised for staff. She also reported that training in the Mental Incapacity Act is being planned. Bybrook House Nursing Home DS0000015894.V364002.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, 33, 35, & 38 Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. Residents will be supported by a newly appointed manager, who is aware of the responsibilities of her role. There are a wide range of matters relating to health and safety which need to be addressed, to ensure the health safety and welfare of residents, their visitors and staff in the home. EVIDENCE: The new manager has only been in post a few weeks before this inspection. The home has been without a period registered manager for an extended period of time as previous manager(s) have not remained in post. During the earlier part of this year, a temporary experienced manager was appointed, until the current manager was identified. One relative reported “I don‘t know Bybrook House Nursing Home DS0000015894.V364002.R01.S.doc Version 5.2 Page 27 why but there seemed to me most difficulty over the years with keeping ideal matrons or even finding them”. The effect of this is that there are a range of matters which need to be addressed. The newly appointed manager is an experienced manager and registered nurse. In the short time that she has been in post, she has begun reviewing a range of areas across the home, including residents’ care and records, staff training records and systems for management of complaints. Discussions with her indicate that she is aware of actions to take to meet our standards and regulations. The previous acting manager submitted an annual quality assessment as part of this inspection. This was adequate, relating particularly to staff development needs, however it did not note areas relating to health and safety and maintenance, as detailed above and below. The home is visited regularly by a senior manager, however their reports also have not documented the issues relating to maintenance and health and safety, which should be included. It is recommended that a senior manager within Avon Care is trained in health and safety and that this is always considered during monthly visits, to ensure that the home meets its obligations in this area. The current manager as part of her review of staff has performed a staff survey and reported that she is planning to take action on the results of her findings. The home does not look after any residents’ moneys and all additional payments such as chiropody and hairdressing are dealt with by monthly invoicing systems. The home needs to concentrate on ensuring that basic principals of health and safety are up-held. A range of areas were identified at this inspection. Some related to prevention of cross infection and equipment provision (see Environment below), others related to matters which have been in the public domain for an extended period of time. As well as us, agencies who provide guidelines in these areas include the Health and Safety Executive, NHS Estates, the Medicines and Healthcare Regulatory Authority (MHRA) and fire brigades, all of whom have accessible websites which may be consulted for detailed advice. The home cares for people over three floors. Where this is the case, windows must be restricted above ground floor level, to prevent risk to frail elderly people. Risk presented to elderly people from unsecured windows is well documented and has been the subject of many investigations. NHS Estates state that windows for services for elderly people need to be restricted to 100cm and must be equipped with locking devices, which may only be unlocked using a specific tool. At Bybrook House, many of the windows did not have restrictors, others had restrictors which were not robust or did not comply with guidelines and others had restrictors which were not in use. This was discussed with the manager, who arranged for an audit of all the windows above ground floor level on the day of the inspection and put in an action plan for the matter to be addressed. An immediate requirement notice was sent to Bybrook House Nursing Home DS0000015894.V364002.R01.S.doc Version 5.2 Page 28 the home after the inspection, with the deadline that all windows must be made safe by 29th July 2008. Many of the radiators were not low surface temperature or not provided with protection. This is a matter which has been identified at previous inspections for Bybrook House and the providers were reported to have an action plan to deal with the matter, however this inspection shows that it is a matter which still needs to be addressed. The risk to elderly frail people of sustaining burns from contact with hot surfaces has been well documented for a period of time. At the time of the inspection, most of the radiators were not turned on, although one frail elderly person did have their radiator on. It was hot to touch. In order to prevent risks to frail elderly people, all radiators in occupied bedrooms must be either low surface temperature or provided with protection by the time the heating is turned on and all other radiators in areas where residents have unsupervised access, made safe within six months. Elderly frail people are at risk of scalds from hot water temperatures. Therefore guidelines state that hot water temperatures must be at or below 43°C at outlet. The home maintains records of checks on hot water outlets. This showed that several outlets were repeatedly over 43°C. This appeared not to have been noted during monthly visits. On the day of the inspection, we observed that the temperature in a general bath on the first floor was 48°C. An immediate requirement notice was issued about this after the inspection. This is a matter which has been noted at previous inspections and requirements set, therefore it is of concern that it has been identified again at this inspection. Some people in the home use the bath in their ensuite or are assisted by staff to do so. Where this happens, there is a procedure on the wall, stating that staff must check the bathwater temperature. However bath thermometers were not visible in such bathrooms. The home has recently reviewed its fire risk assessment, as it stated it would in their Annual Quality Assessment. The manager reported that she is planning that two care assistants will be trained to become fire officers for the home. During the inspection, we observed that several of the fire doors did not close properly into the door surrounds. We sent an immediate requirement notice to the home about this, requiring that they survey all fire doors and ensure that they do provide a safe barrier, in the case of fire. A review of the fire log book showed that standard checks on fire safety, including checks on the fire alarm system, checks on emergency lighting and checking means of escape had not always been carried out at the frequency set out by fire safety officers. This matter has been referred to the fire brigade. As noted in Health and Personal care above, two residents had oxygen cylinders in their rooms. They had appropriate warning signs on their doors. However none of the cylinders were restrained. Oxygen cylinders are very heavy and due to their shape may easily topple over. Therefore they must always be restrained or placed in secure carriers, to prevent risk of injury to Bybrook House Nursing Home DS0000015894.V364002.R01.S.doc Version 5.2 Page 29 frail residents, their visitors and staff. An immediate requirement notice was sent to the home about this matter after the inspection. The carpet in the main entrance area and corridors has been in place for an extended period of time. Due to its age, some frayed edges and seams are beginning to appear. This detracts from the appearance of the areas. However, of more concern is that the carpet is not secure in certain areas. This could present a risk of tripping to frail residents, visitors and staff. This has been an area which has been the subject of a nationwide campaign by the Health and Safety, to prevent serious injuries caused by trips and slips. As noted in Environment above, where safety rails are used, the home completes risk assessments for their use. It was reported that staff are responsible for performing regular checks on safety rails, but at the time of the inspection, it was not clear how they had been trained in this role. As people’s conditions change, it is advisable that such assessments be reviewed when care plans are reviewed on a monthly basis and there be documentary evidence of staff training in performing bed safety rail checks. Bybrook House Nursing Home DS0000015894.V364002.R01.S.doc Version 5.2 Page 30 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 3 2 2 X X X 1 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 1 Bybrook House Nursing Home DS0000015894.V364002.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? NO 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 OP1 Regulation 5(1)(d) Requirement The service user’s guide must include a copy of the summary of the most recent inspection report, together with information on how the full report can be accessed. All medicines administration records must always be fully completed at the time of administration. Where a service user is prescribed a drug on an “as required” basis, there must always be a protocol/care plan drawn up about this. Where service users have oxygen in their room, they must always have an up-to-date prescription about this on their medicines administration record and a care plan must always be in place to direct staff on indicators for its use. Systems must be put in place to prevent the communal use of clothing, particularly net underwear, stockings and socks. All service users must be left with access to their call bell. DS0000015894.V364002.R01.S.doc Timescale for action 30/09/08 2. OP9 13(2) 31/08/08 3. OP9 13(2) 31/08/08 4. OP9 13(2) 31/08/08 5. OP10 12(4)(a) 31/08/09 6. OP18 13(4)(c) 31/08/09 Bybrook House Nursing Home Version 5.2 Page 32 7. OP18 13(4)(c) 8. OP18 13(4)(a) 9. OP19 23(2)(c) 10 OP22 23(2)(n) 11. OP22 23(2)(n) 12. 13. OP26 OP26 13(3) 13(3) Where this is not possible, there must be a clear care plan in place to state how risk is to be reduced for them and evidence that staff are complying with this plan. If a service user has behaviours associated with their call bell, a care plan must be drawn up to direct staff on how to mange these behaviours, so as to ensure the service user’s safety. Where a service user has additional mental health care needs, full individual risk assessments must be carried out. There must be a full written assessment of the risks associated to people with additional mental health needs presented by the home environment and an action plan drawn up to identify when these risks will be reduced. A system for regular maintenance of wheelchairs by a suitably qualified person must be put in place. All service users with complex manual handling needs must be cared for in a variable height bed. All service users who have any manual handling needs must be cared for in a variable height bed. The plinth to the washing machines must be fully intact and wipable. Dust and debris must be promptly removed from behind washing machines and dryers. n.b. an immediate requirement notice was issued about this at the time of the inspection. All deteriorated bed pan racks DS0000015894.V364002.R01.S.doc 31/08/08 31/08/08 30/09/09 31/10/08 30/06/09 31/08/09 04/08/08 14. OP26 13(3) 30/09/09 Page 33 Bybrook House Nursing Home Version 5.2 15. 16. OP26 OP38 13(3) 13(4)(a) must be replaced. All clinical waste must be placed in foot-pedal operated bins. All windows above the ground floor must have restrictors fitted. Restrictors must be robust and fit for purpose. n.b. an immediate requirement notice was issued about this after the inspection. All radiators in service users’ rooms must be either low surface temperature or have protection provided. This is a matter which has been identified at previous inspections. All radiators in areas where residents have unsupervised access must be either lo surface temperature or have protection provided. This is a matter which has been identified at previous inspections. All hot water temperatures in areas accessed by service users must be maintained at or below 43°C. This is a matter which has been identified at previous inspections. n.b. an immediate requirement notice was issued about this after the inspection. Where a service user uses or is assisted to use a bath, a thermometer must always be provided to enable staff to comply with home policy on testing for hot water outlets. All fire doors must be made safe and fit into their door surround. DS0000015894.V364002.R01.S.doc 31/08/08 29/07/08 17. OP38 13(4)(a) 30/09/08 18. OP38 13(4)(a) 31/01/09 19. OP38 13(4)(a) 08/08/08 20. OP38 13(4)(b) 31/08/08 21. OP38 23(4)(c,i) 08/08/08 Page 34 Bybrook House Nursing Home Version 5.2 22. OP38 13(4)(a) n.b. an immediate requirement notice was issued about this after the inspection. All oxygen cylinders must be secured or placed in secure carriers. n.b. an immediate requirement notice was issued about this after the inspection. All carpeting must be safe and not present a risk of tripping injury. 04/08/08 23. OP38 13(4)(a0 30/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP1 OP3 OP7 Good Practice Recommendations The service users’ guide should include reference to the home’s policy on self-medication and its staffing levels and skill mix on each shift. The home’s admission assessment record should include all areas detailed in our standards. Where daily records indicate changes in a service users’ condition, including actions taken, the service users’ care plan should be promptly reviewed, rather than waiting for the next monthly review. Clear, consistent, measurable terminology should always be used in care plans and documents. Generalistic words like “regularly”, “aggressive” and “pressure relieving mattress” be avoided. The type of continence aid to be used should always be documented in continence care plans. Risk assessments for self-medication should be reviewed at the same time as other care plan reviews or when a person’s condition changes. Where a service user is prescribed a drug which can affect their activities of daily living, such as an aperient, painkillers or mood altering drugs, a care plan should DS0000015894.V364002.R01.S.doc Version 5.2 Page 35 4. OP7 5. 6. 7. OP7 OP9 OP9 Bybrook House Nursing Home 8. OP9 8. 9. 10. 11. 12. 13. 14. 15. 16. 16. 17. 18. 19. 20. 21. OP10 OP12 OP19 OP19 OP19 OP19 OP21 OP22 OP22 OP26 OP26 OP26 OP26 OP30 OP30 always be drawn up, so that the service user’s response to such drugs treatments can be evaluated. Where service users are prescribed creams and lotions, a documentary systems should be in place so that it can be demonstrated that they have been applied in accordance with GPs’ instructions. Procedures should be put in place to ensure that all service users clothing is effectively named. All service users should have care plans about their individual recreational and activities needs. The number of hours allocated to maintenance should be increased. All scraped and damaged areas in corridors should be repaired and made good. All parts of the garden should be fully maintained. The carpet in the front entrance hall and corridors should be replaced. A review of bathing facilities should be carried out, to identify how more suitable facilities can be provided for frail and disabled service users. All standard mattresses across the home should be assessed and any which are not suitable be disposed of and replaced. More profiling beds should be provided to reduce the use of safety rails. All commode chairs should be assessed and any which no longer have intact, wipable surfaces be disposed of and replaced. Enough commode chairs should be provided to avoid their communal use. Suitable equipment should be provided so that service users’ laundry can be sorted at source and not re-sorted in the laundry. A hand wash basin should be provided in the laundry. Photographs of staff must be clear enough for them to be used as proof of identity. 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. Recommended at the last inspection. This could not be reviewed at this inspection. A senior manager within the organisation should be trained in the principals of health and safety and reference to the area be made during monthly visits. The home should continue with the implementation of regular individual supervision meetings for all staff, so that DS0000015894.V364002.R01.S.doc Version 5.2 Page 36 22. 23. OP33 OP36 Bybrook House Nursing Home service users benefit from a staff team that is suitably supported and developed. Recommended at the last inspection. This could not be reviewed at this inspection. Risk assessments for the use of bed safety rails should be reviewed as part of regular care plan reviews or when a service user’s condition changes. There should be written evidence that the people who perform checks on bed safety rails have been trained to do so. 24. 25. OP38 OP38 Bybrook House Nursing Home DS0000015894.V364002.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bybrook House Nursing Home DS0000015894.V364002.R01.S.doc Version 5.2 Page 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!