CARE HOMES FOR OLDER PEOPLE
Byron Court Gower Street Bootle Liverpool L20 4PY Lead Inspector
Joanne Revie Unannounced 18/05/05 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Byron Court F53 F03 S17267 Byron Court V228308 180505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Byron Court Address Gower Street Bootle Liverpool L20 4PY 0151 922 0398 0151 933 5687 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Byron Court Limited Mrs Marie Davidson Care Home 52 Category(ies) of Old Age (52) registration, with number Sensory Impairment (1) of places Byron Court F53 F03 S17267 Byron Court V228308 180505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Service users to include up to 52 (OP) and up to 1(SI) Service user category SI - Sensory Impairment relates to 1 service user only, should this service user leave, the category SI would be removed. One named female out of category service user receiving non-nursing care, should this service user leave then the condition will cease to apply. Mrs Davidson to obtain an NVQ IV in Management or equivalent by 2005 Date of last inspection 10/01/2005 Brief Description of the Service: Byron Court is a purpose built care home registered for the care of a maximum of 52 Residents. The Home provides care to older persons, male and female, over retirement age who require nursing care. The Home also provides care to 5 Residents who require assistance with personal care only( no nursing needs) Byron Court is owned by a private organisation which is known as Byron Court Ltd. This has recently changed ownership. Accommodation is situated over two floors and there are three lounges and one dining room. There are landscaped gardens to the front of the establishment that are easily accessed. There are 47 bedrooms comprising of 42 single rooms and 5 double rooms. None of the rooms have en-suite facilities. Byron Court is situated off a main road in the Bootle area, opposite some small local shops. Public transport is easily accessible.At the time of writing this report the home was managed by Ms Jill Boughey. For the purpose of this report Ms Boughey will be reffered to as the Manager. Byron Court F53 F03 S17267 Byron Court V228308 180505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. What the service does well:
On the day of the visit residents appeared well cared for. Good examples of interaction between staff and residents were witnessed with comments being made by residents such as “they’re very kind”, “ Staff are excellent” and “ the girls work very hard”. One resident was found to have developed a pressure sore (bed sore) but this had occurred outside the home. Staff were managing the wound well which had improved since the residents admission. The service ensures that it has the full information about a potential residents needs before a decision is reached about an admission. This reduces the risk of a resident having to move again because their needs are not being met. A resident who recently moved to the home said that staff had tried very hard to make him welcome and “although it was nerve racking to move to a home it could have been much worse if the staff hadn’t been so kind”. The home does accept emergency admissions also but only if a comprehensive care plan is first received from another Health Care professional such as a social worker. This means that the home then has a professional opinion about the resident being admitted so that a decision can be reached about whether the home can meet their needs. During discussions all residents agreed that staff respect their privacy and dignity. During discussions with staff, examples were given of how this is achieved. Two relatives spoken with confirmed that they are free to visit the home whenever they wish and that staff are always welcoming. Some examples of choice being offered to residents included residents confirming that they are free to choose when they go to bed and get up and Staff were seen to offer residents other choices such as choice of food for forthcoming meals. Discussions were held with residents regarding the standard of food offered. One resident who requires a special diet stated that the chef always knew what she “could and couldn’t have.” The Chef showed that he understood the resident’s needs during a discussion. The kitchen was found to be clean, well organised and well stocked. The Kitchen is deep cleaned once a month with general cleaning being done on a daily basis. This minimises the risk of
Byron Court F53 F03 S17267 Byron Court V228308 180505 Stage 4.doc Version 1.30 Page 6 infection. This was confirmed during the recent Environmental Health visit as the officer following the visit made no recommendations for improvements. The home has two communal lounges. One of these is decorated to a good standard and has a homely atmosphere. The management team have identified that the second requires refurbishment and this is scheduled to take place in the near future as well as replacing the stair carpet. Resident’s bedrooms were viewed. It was evident that these had been personalised according to their individual tastes. Residents confirmed that they were encouraged to make the bedrooms feel like “their own”. On the day of the visit the home was clean and no unpleasant smells were evident. One visitor commented, “Its always clean no matter what time you come”. During discussions when asked what the residents liked about the home several commented about the good standard of cleanliness- “ nothings too much trouble, they work really hard”. The service employs a long-standing team of domestic staff who work on a daily basis. All of the residents spoken with during the visit were complimentary about the care staff. Many staff have been employed by the service for a long time therefore they are familiar with the residents needs and trusting relationships have developed between residents and staff. Two staff had purchased a budgie and a cage as a present for one resident who doesn’t like to leave his room. Although staff training needs to be developed the Manager is enthusiastic about staff development and staff confirmed this to be true. Residents and Staff commented positively on the Managers abilities and qualities. Some areas of the home were found to be maintained regularly such as the passenger lift and the emergency lighting systems. Portable electrical appliances such as TVs, radios etc had also been tested for safety. Discussions with staff, residents, and the Maintenance person confirmed that the fire alarm is tested regularly. During the visit this was rung proving it was in working order on the day. What has improved since the last inspection?
Some effort has been made by Nursing Staff to include the resident’s individual choices in their care plan. This means that the plans are more specific to the individual than they were. The Manager encourages care staff to read the care plans also which is important as more often than not care staff are giving direct support to the residents such as washing dressing, bathing etc. Since the last inspection attempts have been made to implement risk assessments for each resident. A Risk assessment should identify the risk of a potential injury or accident happening and should contain instructions on how this risk can be reduced. This means that residents are safer. Care plan documentation is being reviewed as the new management team have agreed that the old style computerised plans are too rigid. New software is being sourced which will enable the plans to be more individual and specific to each resident rather than using a template, which treats all residents as having the same needs. The management team have also recognised that having only one computer means that staff cannot access plans when needed. It is important that this is addressed as changes may have occurred in the resident’s care that the member of staff may not be aware of. Having only one computer means staff
Byron Court F53 F03 S17267 Byron Court V228308 180505 Stage 4.doc Version 1.30 Page 7 may feel discouraged from checking care instructions at busy times during the day. Since the last inspection the Manager has attempted to implement some activities into the home. These include monthly visits from a visiting cinema, occasional entertainers and fundraising so that a gazebo can be purchased for the residents ’use in the garden. The dining room of the home has recently been redecorated and new flooring has been fitted. On the day of the visit new dining furniture had been ordered and was due to arrive in the near future. Although staff training needs to be addressed some nursing staff have undertaken training on speciality subjects such as Tissue Viability (management of wound care and prevention of pressure/bedsores). This means that staff are up to date with current practice. Since commencement in her role the Manager has reviewed several areas of the service and has drawn up plans to address shortfalls. This shows that she has an understanding of her role as manager and is familiarising herself with the service. What they could do better:
Although risk assessments are in place for reducing the risk of injury from equipment such as Bedrails, staff are giving standard answers, which could apply, to all residents rather than giving clear instructions on what action to take according to the risk identified for each Individual. This means that there is a chance that a risk will remain unidentified and the possibility of an injury still occurring as each resident is different with different needs. Although attempts have been made to ensure the present care plans comply with the National Minimum Standard for Older Persons little evidence could be found of input from residents or their representatives. Residents confirmed this by stating that they didn’t know that staff “ wrote things about me” or made comments such as” what’s a care plan?” It is important that this is addressed, as residents must be encouraged to feel in charge of their own lives. All of the residents spoken with were not satisfied with the provision of activities. Comments included” we don’t go out at all”, “they haven’t got the staff”, “ there aren’t enough carers” Although Staff are fundraising and some activities have been encouraged discussions must be held with residents on how they would like to spend their day and funds must be made available to enable this to happen. Residents who require support to go out do not do so unless family or friends are available. The general agreement from both residents and staff was that there were not enough staff to be able to act as escorts. It is vital that this is addressed, as residents must be supported to feel included in the outside world. On the day of the visit the Manager stated that she was intending to organise meetings for the residents to attend. This must be carried through, so that these topics can be discussed, as it will help residents to feel empowered so that they have a “say” on what goes on in the home. Many of the residents are entitled to receive a sum of money each week known as their personal allowance. Some residents are experiencing difficulty in
Byron Court F53 F03 S17267 Byron Court V228308 180505 Stage 4.doc Version 1.30 Page 8 obtaining this which means that often they are left for a period of time with no money. Head Office deals with all finances. Often residents will have to wait for a period of two to three weeks before their money is given to them. This is not acceptable practise and must be addressed immediately as many residents are reliant on the personal allowance being their only source of money. During discussions with staff an incident was disclosed which could have been viewed as verbal abuse. This was discussed with the Manager who had not been made aware of any such incident. The home has a whistle blowing policy but it would appear that staff are unsure or unaware of how to use it. The Operations Manager for the company did state that the company were aware that they were behind in training. Never the less Abuse Awareness is a vital topic of training for staff when they are providing care to vulnerable elderly people.” Whistle blowing” plays an important part of abuse awareness as it encourages staff to speak out and voice concerns. The Manager has completed an audit, which identifies what training has been undertaken by staff. This has identified large gaps in training needs with only few staff holding current certificates in some areas of basic training. Much of the past training completed by staff is now out of date. A training plan must be developed to rectify this. The plan must include when training is to be delivered to staff. A staff member has voiced an interest in maintaining the gardens of the home, but unfortunately the company had not provided gardening equipment to enable this to happen. The garden appeared neglected with flowerbeds that needed weeding and overgrown grass. The Service must ensure that this is addressed so that the residents have somewhere pleasant to sit in warm weather. It appeared that the home was staffed sufficiently however one resident said, “the girls have too much to do”, another said, “ “they could do with more staff”. These comments coupled with those expressed by residents about lack of staff for activities should be explored further during residents meetings. A selection of Staff files was viewed as part of the inspection process. Since coming to post one new staff member has been employed by the Manager. A current police check was not available for this person and during discussion the Manager stated that she had been told at a recent care conference that this was not necessary. The Manager must source up to date guidance from the Criminal Records Bureau and ensure that this situation is not repeated. The Manager is a qualified nurse who is new to post and as yet has not applied for registered managers status with the CSCI. This means that until this process is completed it cannot be commented on whether the Manager is suitable to undertake the role and fulfil her duties as manager. During discussions with the Manager it became apparent that she is undertaking duties such as wages. This would normally be carried out by an administrator and the service should question whether this is an appropriate use of her time. It is a matter of concern that some discussions have taken place within the management team which would suggest that the Manager will have to work several shifts a week as a nurse. As areas of the service (as identified within this report) require development it would be more beneficial to the service if the Managers time was` spent solely as a manager, particularly as the home has no receptionist or secretarial support.
Byron Court F53 F03 S17267 Byron Court V228308 180505 Stage 4.doc Version 1.30 Page 9 As stated in the description of the service the home has recently changed owners and therefore a new management team is in place. As yet no completed application has been received at C.S.C.I.detailing whom the responsible individual for the organisation will be. Every home is required to have a registered manager and a named person who acts as the responsible individual. The responsibility for upholding the resident’s rights and promoting their welfare rests with these two people therefore it is of great importance that this matter is addressed. On occasions during the visit it became apparent that some members of the management team were not familiar with the inspection process or the legislation that governs care homes. In view of this the management team should familiarise themselves with the National Minimum Standards For Older Persons and the Care Home Regulations 2001. This would help to prevent future misunderstandings and would enable the team to develop the home in a structured manner. The Operations manager is new to post and is also a qualified nurse. The Operations Manager is undertaking a formal monthly visit to review practices at the home but is available most days for support to staff and the Manager. A third person has been employed to also assist with the development of the business as well as input from a relation of the owner. During staff discussions it was commented that staff often receive differing instructions from various members of this team, which causes confusion. The team should explore these comments and ensure that all instructions are directed through the Manager to save further confusion, which could impact on residents care. Shortfalls were identified in areas of Health and Safety in the home. An Electrical Safety certificate was available but this was` dated 1997. These are valid for three years only. A fire logbook was not available to evidence that the fire alarm was being tested regularly. However the Manager had identified this shortfall also and had arranged for a fire officer to visit the week after the inspection. A gas safety certificate was available but this was dated December 03. These certificates are valid for one year only. . 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. Byron Court F53 F03 S17267 Byron Court V228308 180505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Byron Court F53 F03 S17267 Byron Court V228308 180505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 The service ensures that it has the full information about a potential residents needs before a decision is reached about admission. This reduces the risk of a resident having to move again because their needs are not being met. EVIDENCE: The home does not provide intermediate care therefore standard 6 is not applicable. Assessment documentation was viewed and discussions were held with a resident, a relative and the Manager. The Manager undertakes all assessments before a resident is admitted to the home. The documentation viewed was clear and gave a good pen picture of the residents needs. Copies of assessments that had been undertaken by Health Care professionals prior to admission were also available. Byron Court F53 F03 S17267 Byron Court V228308 180505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,10 Residents believe that Staff are meeting their care needs however documentation, (Care plans, Risk assessments) produced by the home does not reflect this. EVIDENCE: Discussions were held with Residents relatives, and Staff. Observations showed that residents appeared well cared for and all spoken with agreed that staff respect their privacy and dignity. Good examples of interaction between staff and residents were witnessed. A care plan was viewed which showed that staff were managing the healing process of a pressure sore well which reflected current good practice. Care plan documentation was viewed and discussions were held with staff, the Manager and the Management team. The home uses computerised care plans, which poses problems due to the inflexibility of the software and availability of computer monitors. Viewing the plans evidenced that since the last inspection staff have tried to adapt some areas of the plans and some efforts have been made to address a requirement, which was made regarding this matter. However following a discussion with the management team it has been accepted that until the new software is purchased it is unlikely that the service will be able to resolve this problem. Some staff did confirm that the Manager
Byron Court F53 F03 S17267 Byron Court V228308 180505 Stage 4.doc Version 1.30 Page 13 encourages the care staff to read the residents care plans, which promotes good practice. During discussions with residents and viewing of care plan documentation it was confirmed that residents have no or little involvement in the formulation of their plan of care. Risk assessments viewed were found to contain blanket statements for reducing the risk of injury from equipment such as Bedrails. Staff are giving standard answers, which could apply, to all residents rather than giving specific instructions on what action to take according to the risk identified for each Individual. Viewing care plan documentation also identified concerns in the use of language used by some staff regarding resident’s behaviours. Some of the language viewed could be misleading. Examples of this include using words such as “ Childlike” and “ moody”. Some important information regarding a resident’s condition had not been added to the care plan yet the resident discussed this problem openly with an inspector. Byron Court F53 F03 S17267 Byron Court V228308 180505 Stage 4.doc Version 1.30 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 Residents are not offered sufficient activities or opportunities to go on outings Choice is offered to resident’s regarding bed, rising times and meals. Residents have a variety of opinions regarding the standard of food provided. EVIDENCE: During discussions the Manager confirmed that she has attempted to implement some activities into the home since the last inspection. Staff also confirmed this. All 8 of the residents spoken with were not satisfied with the provision of activities. Comments included” we don’t go out at all”, “they haven’t got the staff”, “ there aren’t enough carers”. Discussions with 2 relatives and 4 staff also supported this view. Activities provided by the home include a visiting cinema once per month and the occasional use of an outside entertainer. During discussions it became apparent that some staff are enthusiastic about providing activities but others spoken with felt it was a waste of time as residents were not interested. One staff member had arranged for a local dance troupe to visit as a form of entertainment. Two relatives spoken with confirmed that they are free to visit the home whenever they wish and that staff are always welcoming. Residents who are physically able confirmed that they visit the local shops, church etc on their own. However during discussions it became apparent that residents who require support to go out do not do so unless family or friends are available. Staff
Byron Court F53 F03 S17267 Byron Court V228308 180505 Stage 4.doc Version 1.30 Page 15 confirmed this to be true. During discussions the concluding agreement from both residents and staff was that there were not enough staff to provide escorts. Staff were observed making efforts to ensure that residents are offered choice in their daily lives. Residents meetings are not being held within the home however the Manager stated her intention to rectify this. The Residents confirmed that they are always offered choices regarding bed and rising times. Staff were seen to offer residents choices of food for forthcoming meals. Menus were viewed which reflected this. Discussions were held with residents regarding the standard meals provided. All stated that the cook was very helpful and would offer further choices if they didn’t feel like something or if they changed their mind. However the comments regarding the standard of food varied greatly from “poor” to “reasonably good” to “good”. Discussions were held with the chef who appeared very knowledgeable about the residents needs. One resident who suffers from diabetes and therefore needs a special diet confirmed this to be true. Byron Court F53 F03 S17267 Byron Court V228308 180505 Stage 4.doc Version 1.30 Page 16 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 17,18 Resident’s rights are not protected, as they do not receive their entitled personal allowance on time. Staff are not able to fully protect residents rights, as they have not had training on how to do so. EVIDENCE: On the day of the visit discussions were held with 8 Residents, 5 staff and 3 representatives/ relatives regarding their views of the service. During these discussions both parties raised concerns about the residents personal allowances. The concerns raised were that some residents are experiencing difficulty in obtaining their personal allowance which means that often they are left for a period of time with no money. It was also stated that Head Office deals with all finances and often residents will have to wait for a period of two to three weeks before their money is given to them. This is not acceptable practise. During discussions with staff an incident was disclosed which could have been viewed as verbal abuse. This was discussed with the Manager who had not been made aware of any such incident. The home has a whistle blowing policy but it would appear that staff are unsure or unaware of how to use it. A training audit was viewed which had been undertaken by the Manager. The Operations Manager for the company stated that the company were aware that they were “behind in training”. The training audit identified that many staff have not received basic mandatory training such as Manual Handling, first aid, fire safety, abuse awareness, food hygiene. Many of the staff that had received training had received it some time ago and now require refresher training. Byron Court F53 F03 S17267 Byron Court V228308 180505 Stage 4.doc Version 1.30 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,24,26 Most of the communal areas of the home appear comfortable and “ homely” however some areas are in need of refurbishment. Residents are encouraged to make their bedrooms feel like home. EVIDENCE: Touring and viewing the communal areas and bedrooms of the home gathered the majority of the evidence for these standards. Some discussion did take place with Residents regarding their personal bedrooms. Other discussions were held with management regarding the refurbishing programme. The dining room of the home has recently been redecorated and new flooring has been fitted. The Manager stated that new dining furniture had been ordered and was due to arrive in the near future. The home has two communal lounges. One is decorated to a good standard and has a homely atmosphere the other appeared dark and was not particularly welcoming. This lounge has been identified for refurbishment by the service. Stair carpeting is becoming worn in places and this has also been identified for replacement.
Byron Court F53 F03 S17267 Byron Court V228308 180505 Stage 4.doc Version 1.30 Page 18 The service employs a maintenance person who works full time at the home. The Manager has sourced a staff member who is willing to provide gardening services but it was stated the service had not provided gardening equipment to enable this to happen. The garden appeared neglected with flowerbeds that needed weeding and overgrown grass. Residents were happy for their bedrooms to be viewed. Many of the rooms were very personal to the occupant with lots of personal possessions. Residents confirmed that they were encouraged to make the bedrooms feel like “their own”. The home was clean and tidy. Relatives, visitors and residents during discussions commented positively on the standard of cleanliness. Viewing the off duty showed that the service employs a long-standing team of domestic staff on a daily basis. The Manager also confirmed that this was true. A discussion with the chef and viewing of the kitchen confirmed that regular cleaning is undertaken. The chef stated that the Kitchen is “deep cleaned” once a month with general cleaning being done on a daily basis. Viewing a recent environmental health report confirmed that a visit has recently been undertaken by an Environmental Health Officer who didn’t raise any concerns. Byron Court F53 F03 S17267 Byron Court V228308 180505 Stage 4.doc Version 1.30 Page 19 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 The service employs a long-standing team of staff who have formed close relationships with the residents. Residents do not believe that there are enough staff to meet their needs. Staff have not received refresher training in basic subjects required to undertake their duties safely. Recruitment procedures for new staff are not as safe as they could be. EVIDENCE: All 8 of the residents spoken with during the visit were complimentary about the care staff. On viewing the off duty rota and the service staffing notice it appeared that the home was staffed according to the minimal staffing notice imposed by a previous regulatory authority. However one resident said, “the girls have too much to do”, another said, “ “they could do with more staff”. These comments coupled with those expressed by residents about lack of staff may indicate that there is a need to increase staff numbers. A selection of Staff files was viewed as part of the inspection process. The Manager confirmed that since coming to post one new staff member has been employed by the Service. A current police check was not available for this staff member and during discussion the Manager stated that she had been told at a recent care conference that this was not necessary. A discussion with the Operations manager confirmed that this is not usual practice for the home and viewing the services recruitment policy confirmed this. An audit of staff files, which was undertaken by the Manager, was viewed. This showed who has undertaken which training. This audit identified a large gap in training needs with only few staff holding current certificates in some areas of basic training. Much of the past training completed by staff is now out
Byron Court F53 F03 S17267 Byron Court V228308 180505 Stage 4.doc Version 1.30 Page 20 of date. This was evidenced further during staff discussions. Some staff commented that they had not received any training “ for ages”. Others commented that they had recently completed NVQ training in Care awards. Discussion and viewing of a certificate confirmed that one senior staff member has recently undertaken training on Tissue viability and the prevention of pressure sores. The Manager stated that she is enthusiastic about staff development and staff confirmed this to be true. Byron Court F53 F03 S17267 Byron Court V228308 180505 Stage 4.doc Version 1.30 Page 21 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,38 The management team are new to post and need to develop clear lines of communication and key areas of responsibility. Health and Safety issues are not being monitored closely which means that residents and staffs safety could be compromised. EVIDENCE: Viewing records confirmed that the Manager is a qualified nurse who is new to post as Manager and as yet has not applied for registered managers status with the CSCI. This means that until this process is completed it cannot be commented on whether the Manager is suitable to undertake the role. At the time of writing this report no responsible individual existed for the service. Using an overview of the inspection process the Manager appears to have reviewed many areas of the service. Documentary proof was shown of her intention to implement Quality Assurance Procedures through questionnaires to staff, residents, relatives and visiting health care professionals. Audits identifying needs in Staff training, Staff supervision and appraisals and audits
Byron Court F53 F03 S17267 Byron Court V228308 180505 Stage 4.doc Version 1.30 Page 22 on paperwork systems were also shown. Residents and Staff commented positively on the Managers abilities. However it is a matter of concerns that the Manager stated that some discussions have taken place within the management team, which would suggest that she would be working, several shifts a week as a nurse on a regular basis rather than “`managing” the service. This is also a concern as part of her day-to-day duties the Manager is already undertaking administrative tasks, as the service does not employ a receptionist or secretary. This was observed during the visit and confirmed by the Manager. As stated in the description of the service the home has recently changed owners and therefore a new management team is in place. On occasions during the visit it became apparent through their actions that some members of the team were not familiar with the inspection process or legislation. The Operations manager is new to post and is also a qualified nurse. During discussions with staff concerns were raised about how the team communicate with staff. It was commented that staff often receive differing instructions from various members of this team, which causes confusion. During a discussion with the Manager and viewing of certificates it was evidenced that areas of Health and Safety need to be addressed. An Electrical Safety certificate was available but this was` dated 1997. These are valid for three years only. A fire logbook was not available to evidence that the fire alarm was being tested regularly. However the Manager stated that she had identified this and a visit with a fire officer had been arranged for the week after the inspection. A gas safety certificate was available but this was dated December 03. These certificates are valid for one year only. Other areas were found to be maintained regularly such as the passenger lift and the emergency lighting systems. Portable electrical appliances such as TVs, radios etc had also been tested for safety. Discussions with staff, residents, and the Maintenance person confirmed that the fire alarm is tested regularly. During the visit this was rung proving it was in working order on the day. Byron Court F53 F03 S17267 Byron Court V228308 180505 Stage 4.doc Version 1.30 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 1 14 2 15 2
COMPLAINTS AND PROTECTION 2 2 x x x 3 x 3 STAFFING Standard No Score 27 3 28 x 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x 1 1 1 x x x x x x 1 Byron Court F53 F03 S17267 Byron Court V228308 180505 Stage 4.doc Version 1.30 Page 24 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15.(1)(2)(a)( b) Requirement The service must now produce an action plan with fresh timescales detailing how and when the new software for Careplans will be implemented by. The new plans must show evidence of the Residents or Representatives agreement that they are happy with the care that is being delivered. Residents individual likes/ dislikes and what is important to them must also be included. Details of how this is to be adressed must be included in the above action Plan Risk assessments must be specific to the individual Resident and not contain blanket statements which could apply to anyone The service must produce evidence in the form of an action plan detailing that they have consulted Residents about how they wish to spend their day and how the service will support them with this. This must include the provision of outings. Residents must be supported to Timescale for action 31st July 2005 2. OP7 15.-(c )(d), 31st July 2005 3. OP7 13.(4)(b)(c ) 8th August 2005 4. OP12 16.-2 (m)( n) 31st July 2005 5. OP13 16.-(n) 8th August
Page 25 Byron Court F53 F03 S17267 Byron Court V228308 180505 Stage 4.doc Version 1.30 6. OP14 24.-(3) 7. 8. OP17 OP17 13.-(6) 20.(1)(a)(b)( 3),25.(3)(c , 20.(1)(a)(b)) vsist the local community so they do not feel excluded from the outside world The intention to organise residents meetings must be carried through, as it will help residents to feel that they are in charge of their own lives and that they have some “say” on what goes on in the home. All residents must receive the money that they are entitled to when they are entitled Copies of the residents personal finance accounts must be made available to the inspector either by forwarding to the CSCI office or by arranging an appointment. The Manager must ensure that the details of the alledged verbal abuse are investigated appropriately and CSCI are informed of the outcome. Abuse awareness training must be sourced and delivered to all staff without further delay. The service must carry through its intentions to recarpet the stairs. 2005 8th August 2005 31st July 2005 8th August 2005 9. OP18 Immediate 10. 11. OP18 OP19 12. 13. OP20 OP29 14. 0P30 15. OP31 5th September 2005 23.-(2)(b) Produce action plan by 8th August 2005 23.-(2)(b) The service must ensure the 8th August garden areas are maintained to a 2005 satisfactory standard 19.The Manager must source upto 31st July (1)(a)(b)(i date guidance from the Criminal 2005 ) Records Bureau on police checks for new staff 18.A training plan must be 8th August (1)(i),13.- developed identifying when all 2005 (4) staff will be attending manual handling, first aid, food hygiene, abuse awareness, Fire safety, and Health and Safety Training. 9.-(1) The manager must forward her 31st July completed application to the 2005 CSCI office to prove her 13.-(6)
F53 F03 S17267 Byron Court V228308 180505 Stage 4.doc Version 1.30 Page 26 Byron Court suitability to manage the home. 16. OP31 7.-(2)( c) A completed application form providing details of the proposed responsible individual must be forwarded to the CSCI Office. Copies of a current Gas Safety Certificate, NICEIC(Electrical ) safety certificate must be forwarded to the CSCI office. Suitable records must be dev eloped to record testing of the fire alarm, manitenance of fire fighting equipment and fire training for staff. 5th August 05 31st July 2005 31st July 2005 17. op38 23.(2)(b), 12.-(1)(a) 13.-(4)( c) 18. OP38 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard OP7 OP15 OP19 op27 OP31 0P31 Good Practice Recommendations Training and guidance should be sought for staff around the use of appropriate language when describing residents behaviours in care plans. The Manager should explore the comments made by the residents regarding meals. The service should carry out its intentions to refurbish the ground floor lounge The service should explore the comments made by residents regarding staffing levels It is recommended that the Manager spend her working time managing and not nursing so that the areas identified within this report can be developed. The management team should familarise themselves with the National Minimum Standards For Older Persons and the Care Home Regulations 2001. This would help to prevent future misunderstandings and would enable the team to develop the home in a structured manner. The management team should explore the comments made by staff regarding the differing instructions from each management team member. The team should ensure that all instructions are directed through the Manager to save further confusion.
F53 F03 S17267 Byron Court V228308 180505 Stage 4.doc Version 1.30 Page 27 7. OP31 Byron Court Commission for Social Care Inspection 2nd Floor Burlington House Crosby Road North Waterloo L22 0LG National Enquiry Line: 0845 015 0120 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 Byron Court F53 F03 S17267 Byron Court V228308 180505 Stage 4.doc Version 1.30 Page 28 - 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!
