Inspection on 02/05/06 for Byron Court

This inspection was carried out on 2nd May 2006.

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

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

Byron Court 08/03/10

Byron Court 21/01/10

Byron Court 29/01/08

Byron Court 06/03/07

Byron Court 26/08/05

Byron Court 18/05/05

Byron Court 06/01/05

Byron Court 06/10/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Byron Court Gower Street Bootle Liverpool Merseyside L20 4PY Lead Inspector Mrs Joanne Revie Unannounced Inspection 2nd May 2006 10:00 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 Byron Court DS0000017267.V291779.R01.S.doc Version 5.1 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. Byron Court DS0000017267.V291779.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Byron Court Address Gower Street Bootle Liverpool Merseyside L20 4PY 0151 922 0398 0151 933 5687 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) Byron Court Limited Care Home 52 Category(ies) of Old age, not falling within any other category registration, with number (52), Sensory impairment (1) of places Byron Court DS0000017267.V291779.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service Users to Include up to 52 (OP) and up to 1 (SI) Service user category SI - Sensory Impairment relates to one 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. 18th May 2005 Date of last inspection 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 1 Resident who requires assistance with personal care only (no nursing needs) Byron Court is owned by a private organisation which is known as Byron Court Ltd. Accommodation is situated over three 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. Byron Court DS0000017267.V291779.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and was undertaken by two inspectors over an eight-hour period. Discussions were held with five service users and staff who were on duty at the time of the visit. Discussions were also held with the owner’s personal assistant and the registered manager for the service. Regulatory activity, which has occurred since the last inspection, was also revisited by the inspectors prior to the inspection taking place. Therefore references to past events are made throughout the report. A variety of documentation was viewed which is referred to in the evidence section of the report. A tour of the environment was undertaken which included all communal areas a selection of bedrooms and all bathrooms and toilets. What the service does well: All new residents receive a full assessment from the manager before admission takes place. This means that the home can plan to make sure that they can meet the resident’s needs. This reduces the risk of resident living in a home that can’t care for them. The home employs a long-standing team of care staff. This means that the residents regularly receive care and support from staff that they know. Over half of the care staff have achieved an NVQ qualification in Care. This means that they should have a good understanding of how to meet the resident’s needs. The home presents as a pleasant place to live. It is warm and clean with different décor schemes, which helps to add to a homely atmosphere. Byron Court DS0000017267.V291779.R01.S.doc Version 5.1 Page 6 Residents believe their health care needs are being met. One resident commented that” they sort everything like that out for you”. Qualified staff are able to manage wound care well and have undertaken training in this area. Residents also commented that their visitors are always made to feel welcome. The home has an open visiting policy and visitors are free to visit when they choose. The home has a nicely decorated dining room and staff try hard to make Mealtimes a relaxing experience. Residents spoken with confirmed they enjoyed the food offered – “ especially the fried breakfasts”. Residents are encouraged to make their bedrooms their own by personalising them with small items of furniture, personal possessions etc. What has improved since the last inspection? What they could do better: The service has documentation called a Statement of Purpose, which should be a comprehensive guide to life at the home. A further document called the Byron Court DS0000017267.V291779.R01.S.doc Version 5.1 Page 7 Service Users guide should be produced as a summary of this. These two documents were found to be confusing and did not meet the criteria of the Care Home regulations 2001. The manager must ensure that this is addressed. Although efforts have been made to develop care plans residents are still not involved in their formulation. This must be addressed so that residents are encouraged to feel in charge of their lives. Each care plan contained detailed risk assessments. This included whether the use of bedrails would help to maintain a residents safety. Bedrails are necessary however in some circumstances the use of this equipment can be viewed as restraint. No records existed to show that the residents had been consulted about the use of this equipment. This must be addressed. Although great progress has been made in the management of medication it was noted that the pulse is not always recorded before administering Digoxin. This must be addressed to maintain the residents well being. Some instructions had been crossed out and altered with no indication of who had advised this or when it was done. This does not reflect current good practise and must be addressed. The service has a fridge for storage of medication. Staff were recording the fridge temperature on a daily basis to make sure that the fridge was functioning correctly but this had not been done since early April This must be addressed. Issues, which affect the resident’s dignity and self-esteem, were identified and discussed with the manager. As many staff have already achieved recognised care qualifications an action plan must be produced identifying how these serious concerns are going to be addressed. It is a matter of serious concern that the service has not complied with a requirement made following the last inspection. Activities must be provided to ensure residents feel fulfilled and “ in touch” with the outside world. During discussions residents commented that “ nothing goes on” and “we never go anywhere”. The service briefly employed activities organiser following the last inspection who started to address these concerns however she is no longer employed and has not been replaced. This must be addressed as a matter of urgency. Mealtimes are a pleasant experience within the home however residents do not know what food is to be offered until they enter the dining room. Choice is available but this is only offered if the set meal is declined. The manager must address this by developing a system so that residents are aware of the choices available prior to the meal taking place. Records must also be developed detailing what meals were served when. Byron Court DS0000017267.V291779.R01.S.doc Version 5.1 Page 8 The service has a complaints procedure but is not adhering to it. The service was asked to investigate two complaints by CSCI. Both were out of timescale and the investigations produced were inadequate. It is vital that residents and relatives can feel confident that their concerns are listened to and actioned. This must be addressed. The home has a smoking area, which is not enclosed and opens directly on to the foyer. Many of the residents like to sit in this area. An extractor fan has been provided but was not working. This must be addressed and a risk assessment must be carried out to identify risks to resident’s health and personal choice. Bathrooms and toilets were found to be in need of attention. An audit must be undertaken to identify all works and an action plan produced identifying when and how these will be addressed. None of these areas contained liquid soap or paper towels. This must be addressed to reduce the risk of cross infection occurring. Generally furnishings were found to be of a good standard however the chairs in the ground floor lounge were mismatched and worn which detracted from the rooms overall appearance. The manager stated that plans have been developed to address this and this should be carried through. It was noted that the home has an inadequate supply of bed linen. Empty rooms have been made ready for occupancy which means that they are presented nicely however this has impacted on the homes linen supply and must be addressed. Serious concerns were raised about staffing levels. The home reduced staffing levels in the past without consultation with CSCI.A requirement was made following the last inspection that a system was to be developed which identified how many staff were needed according to the residents needs rather than reducing staff numbers because of empty beds. This has not complied with. It was disappointing that the service has reduced staff again and has still failed to meet the above requirement. Staff are not paid for their lunch break. This means that for a two hour period the staffing levels can potentially be reduced by two carers, which could have a significant impact on the health and Safety and Care of the residents. These concerns must be addressed as a matter of urgency. It could not be determined whether the residents were in safe hands as not all the required documentation for each member of staff was available in their staff file. This must be addressed. The registered manager is new to her role, and although some improvements have occurred this report evidences that the service is still not meeting the National Minimum Standards for Older People or the law that governs care homes. The organisation need to evidence that they have put clear mechanisms in place to support the registered manager in developing the service to meet the above. Byron Court DS0000017267.V291779.R01.S.doc Version 5.1 Page 9 Random unannounced visits by the provider or nominated person as required by regulation 26 of the Care Home Regulations 2001 are not taking place. This is further evidence of non-compliance with the law and must be addressed. Attempts have been made in the past by management to encourage residents to express their views about the home. This occurred some time ago and must be revisited. Systems need to be urgently developed to safe guard resident’s monies. A deficit of thirty pounds was found for one resident, which the service was asked to urgently address. The manager complied with this by undertaking an investigation and concluded that the deficit was due to human error. The company reimbursed the deficit. The service must ensure that the home sets up a system for regular auditing of Residents monies, this will help to reduce inaccuracies, and ensure monies are managed safely. Although Improvements were noted in some areas relating to Health and Safety, some shortfalls still require addressing. These were: Monitoring of water temperatures, which were occurring randomly. Records showed consistent maintenance of temperatures however testing water by hand showed one supply to be cool whilst another was very hot. The home must put a system into place to check all water temperatures regularly and take action if they are not at or near to 43 degrees. The door to the Lift mechanism is within a bathroom and has a sign stating “danger” and the “door must be kept locked at all times”. On the day of the visit the door was open and the key could not be located. This must be addressed. The service has bought equipment and ensured that the handy man has received training in Portable Appliance testing. This will ensure the safety of small electrical appliances. The manager stated that this work was scheduled to start in the near future. This must be carried through. The service tests that the fire alarm is working on a weekly basis however no records could be found to show that the emergency lighting is also tested. This must be carried out. The service has purchased and is using an accident book, which complies with the changes in recent data protection. However the completed forms are not being stored confidentially in the resident’s files. This must be addressed. It was noted that the hoisting equipment, which is used to move residents, has not been serviced since March 05. This needs addressing as a matter of urgency. 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 DS0000017267.V291779.R01.S.doc Version 5.1 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Byron Court DS0000017267.V291779.R01.S.doc Version 5.1 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 the following standard(s): 1, 3 Quality in this outcome area is adequate, however Service users do not have access to up to date information about the home. The service makes sure it can meet a service users needs before admissions takes place EVIDENCE: The Statement of Purpose and Service Users guide was viewed. This documentation was confusing as some elements had been repeated and others were contained in one document when they should have been within the other. The Statement of Purpose had no review date or up to date list of staff names and qualifications. The summary section of the most recent CSCI report was within this document but not the whole report. Three service users plans were viewed. Each contained a copy of the homes pre admission assessment form. Each had been completed by the homes manager. One plan also contained a social services assessment. A discussion was held with another resident who confirmed that he remembered the manager visiting him in hospital prior to admission taking place. Byron Court DS0000017267.V291779.R01.S.doc Version 5.1 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 the following standard(s): 7,8,9,10 Quality in this area of the service is adequate however Care plans are produced without resident’s input and do not identify/ cover all their needs. Residents believe health care needs are met and Medicines are managed safely, however residents are not supported to maintain their personal appearance, which greatly reduces their dignity EVIDENCE: Three service users plans were viewed. Some efforts have been made since the last inspection to address the resident’s social needs by producing a pen picture of the resident. This information was only available in one plan viewed. No specific need for social activities had been recorded in any of the plans viewed. No evidence could be found on the three plans viewed of the resident’s involvement in drawing the plans up. The manager later stated that she had approached some relatives about their involvement. The plans gave clear instructions on how to meet the resident’s health needs and efforts had been made to review these instructions. In some cases this had been on a monthly basis however two of the plans had been reviewed less frequently. Byron Court DS0000017267.V291779.R01.S.doc Version 5.1 Page 13 Each plan had risk assessments identifying the risk of pressure sores developing and falls occurring. Some residents had been identified as needing bedrails to keep them safe however no permission had been sourced from the resident or their representative for this equipment. One resident stated that she had commenced a weight reducing diet. No record could be found of this residents weight and the resident confirmed that this had not been checked. The Manager confirmed that this was true. Weight records were not available in the other plans viewed however a member of staff was viewed weighing resident during the visit. The manager stated that weights are recorded separately in a designated book. Wound care records were viewed in one plan. Staff were monitoring the wound regularly until healing had been achieved. Staff were monitoring the size of the wound by measuring its size regularly. One set of wound records had photographs as further evidence. The manager confirmed that this hadn’t been done on all wound records, as no camera was available. Each plan contained a Multidisciplinary sheet for staff to record visits from Health Professionals such as G.Ps, chiropodist etc. This has been implemented since the last inspection. One resident confirmed that she regularly sees the optician and has seen a dentist in the past. The pre inspection questionnaire states that the home has access to both of these on a regular basis. Medication administration records and systems for storing obtaining and disposing of medications were viewed. All medications are kept within appropriate cupboards and trolleys within a locked room. These were found to be well organised with minimal stock. The home has a fridge for the purpose of storing certain medications. Staff were monitoring the temperature of this on a daily basis however records viewed showed that this has not occurred since early April. Medication administration records showed that generally these are well managed. Some shortfalls were noted as follows: One resident who receives digoxin had not had their pulse monitored. Another resident’s medication had been altered from twice to once daily with no clarification of who had done this and why. The home uses a blister pack system for medication administration, which reduces the risk of a mistake occurring. Each record contained a photo of the resident for identification purposes. The home has a contract for disposal of medication with White Rose. This was viewed and was current. In discussion with two Residents who need help with their personal care it was noticed that both had dirty fingernails. This was discussed with the Manager who said that she reminds staff to help Residents with this and also writes reminders in the staff communication book. During the lunch time meal one member of staff was seen advising another that a resident could not eat a pudding they had been given due to their healthcare needs, a short discussion between the staff took place during which the pudding was removed. At no time did either member of staff speak with the Resident. Each of the care plans viewed identified the need to maintain residents dignity. One resident was noted to have facial hair and food around their mouth Byron Court DS0000017267.V291779.R01.S.doc Version 5.1 Page 14 following the lunchtime meal. This was discussed with the manager who said that she had made staff aware of the importance of maintaining residents dignity. Byron Court DS0000017267.V291779.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,,13,14,15 Quality in this area is poor. The service has not complied with previous requirements. Residents are not supported to undertake fulfilling activities, nor are they supported to visit the local community. Visitors are made to feel welcome and residents enjoy the food offered however choices could be better planned. EVIDENCE: Three care plans were viewed. These contained no details of what the resident preferred to do or how their social needs were being met. One resident stated that “ nothing goes on” However in discussion one confirmed that they did go on occasional outings and that a visiting cinema and singer came monthly to the home. Although occasional trips occur two residents stated that they “ never go anywhere. The manager stated that no replacement had been found since the activities organiser had left which had greatly impacted on the resident’s social needs. A requirement was made following the last inspection, which has not been addressed in relation to activities. The manager confirmed that staff do try to do occasional activities when they have time but that this is not organised into a regular rota. During interviews staff expressed concerns regarding the lack of activities provided for residents. On the day of the visit no activities were occurring or had been planned. Byron Court DS0000017267.V291779.R01.S.doc Version 5.1 Page 16 ”. The home has a visitor’s book, which showed that visitors visit at a variety of times through out the day. Two residents stated that their visitors are always made to feel welcome. It was noted that a recent visit had taken place by a local minister to give communion. Lunchtime was observed to be a quiet, pleasant time with staff taking time to sit, talk with and support Residents. The dining room was pleasantly decorated with condiments and the table settings were nicely laid out. Throughout, Residents were offered drinks and given time to enjoy their meal. There was a cook working in the home 7 days a week, Residents explained that they have the option of a fried breakfast, main lunchtime meal and lighter evening meal with supper later in the evening. The Main kitchen was clean, with clear records kept of food and fridge / freezer temperatures. The cook stated that he is happy with the food budget, makes alternative meals on request or for people on different diets and usually makes homemade soups and desserts. Residents confirmed that there is a choice at mealtimes, however this is not routinely offered, but offered only if they don’t like the meal prepared. As they don’t know what the meal is until they enter the dining area they have to wait for the alternative. The home should set up a system for identifying Resident mealtime choices prior to the mealtime. A set menu is in place and copies of this are available, the home does not record the meals and alternatives that are offered on a daily basis. This would help to identify that choices are offered. Two residents spoken with confirmed that the food offered is good. Residents spoken with said that they enjoy the meals provided, particularly the fried breakfasts Byron Court DS0000017267.V291779.R01.S.doc Version 5.1 Page 17 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 the following standard(s): 16,18 Quality in this area is poor. Complaints are not appropriately responded to and timescales are surpassed, however staff have had training to enable them to protect residents from abuse. EVIDENCE: The home keeps a record of complaints made about their service, this was looked at from January 2006 to the day of the inspection. In that time four complaints had been made about the service. Of these, three related in parts, to the attitude of staff towards Residents and or relatives. One complaint which the CSCI asked the home to investigate dates back to January 2006 and has not been concluded as the home have not given sufficient information. The home completed a pre inspection questionnaire, which stated that all complaints are dealt with within timescale, which contradicts this. The home uses a separate form to investigate each complaint, which is good practice. However none of the complainant’s had received a written response from the home stating the outcome of their investigation and any action to be taken. The Manager stated that she had spoken with the member of staff regarding their attitude, however there was no formal record of this. It is Byron Court DS0000017267.V291779.R01.S.doc Version 5.1 Page 18 concerning that three complaints were made in a short space of time to the home and no formal action to address these appears to have been taken. The home has a copy of the local authorities adult protection procedures and polices available. No adult protection investigations regarding the home have taken place since the last inspection. Training records and discussions with staff showed that the majority of staff have had training in Adult Protection within the last few months. Records and amounts of monies for some Residents were checked and it was found that one of these did not tally. More information about this can be found further in this report under standard 35. However it was clear that the homes practices in looking after Residents monies were not safe. Byron Court DS0000017267.V291779.R01.S.doc Version 5.1 Page 19 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 the following standard(s): 19,21,23,26 The quality of the service in this area is adequate. The home presents as a clean, comfortable, homely place to live although some areas, particularly bathrooms and toilets require attention. Residents are encouraged to make their bedrooms their own. EVIDENCE: The home has accommodation over three floors with a passenger lift to the second and first floor, however this was recently broken for several weeks, restricting Residents access to parts of the building. To the front there is a flagged area, which has seating and provides a pleasant place to sit in warmer months, to the side there is a car park and small-grassed area. The outside of the home is well maintained with care taken to provide planting that provides an attractive entrance and outside area. Byron Court DS0000017267.V291779.R01.S.doc Version 5.1 Page 20 All Residents currently use the downstairs dining room. This has been recently decorated to a good standard with enough room for Residents and staff to use comfortably. There are several lounge areas dotted about the home. Downstairs there is a small lounge area off the foyer. People who smoke use this lounge and several Residents spend a large part of their day choosing to sit in the foyer area. Although comfortable and nicely decorated the extractor fan in the lounge was not working and staff advised that it is broken. As the room is open to the foyer there is nothing to stop the smoke drifting into other areas. The home must carry out a risk assessment of this area, to include the risks to others health and the choices of people who use the foyer. Any risks or choices must be taken into account and action taken to address these. A second larger lounge is available on the ground floor with a smaller lounge on each of the upper floors. These were all seen to be clean, warm and nicely decorated. In the larger ground floor lounge furniture was mis-matched and worn which detracted from the overall appearance of the room, however the Manager said that there are plans to replace this within the next year. The home has five bathrooms and 8 separate toilets dotted around the building. Separate sluice areas are provided and commodes are provided in bedrooms. All were clean and warm with working call systems and lights. None had liquid soap or paper hand towels available which could lead to a spread of infection, however both the Manager and Handyman said that these had been obtained and would be fitted shortly. The Handyman and Manager explained that there have been on-going difficulties with toilet cisterns and plans are in place to replace these. Various inadequacies were noted in some bath and toilet areas, this included rusting taps in bathroom 1, cisterns not working properly, stained ceiling tiles and parts of toilet seats missing. The home must carry out an audit of all bath and toilet areas and provide an action plan to address any environmental issues noted. Four bedrooms were looked at, with the permission of the residents. All provided enough space for Residents use and were clean, comfortable and nicely decorated. The Manager explained that many of the rooms have been redecorated and it is practice within the home to do this regularly however this is done as required and not on a rolling programme. All rooms looked at had working lights and call systems, a lockable drawer and bedroom door. It was clear that Residents are encouraged to bring personal possessions for use in their rooms, which helps to personalise these and add to the individuality of each room. All bedrooms had nicely made beds, however a member of staff explained and the Manager confirmed that, as spare beds are made up, at times there is not enough bedding available. The Manager should make sure there is sufficient bedding to meet Residents needs at all times. Byron Court DS0000017267.V291779.R01.S.doc Version 5.1 Page 21 The home was warm, clean, well lit, clean and free from odours throughout. The home has a separate laundry area with two industrial washers with sluice facility and a large dryer. Liquid soap, disposable gloves and bags are available and a member of staff works in the laundry 7 days a week. There is a clear system in place for dealing with laundry. These practices help to minimise the risk of cross infection and ensure laundry is dealt with efficiently and quickly. Byron Court DS0000017267.V291779.R01.S.doc Version 5.1 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this area is poor- Staff may not be provided in sufficient numbers over the lunch time period and no system exists to prove that service users needs are being met by staffing numbers. Staff have been trained to undertake their duties and over 50 have achieved an NVQ in Care qualification however recruitment procedures are not as robust as they could be which could affect the safety of the residents. EVIDENCE: Staff explained that the organisation lowered staffing levels two weeks ago, as the home is not full. CSCI had not been made aware of this. At the time of the inspection there were 26 people living at Byron Court. The staff rota for 24th April – 7th May 2006 was looked at. This showed that, there is one Registered Nurse 24 hours a day, 4 Carers during the day and 2 Carers 8 pm – 8 am. An extra Carer works from 7 am – 10 am and usually from 7 pm – 10 pm. In addition the Manager works 5 days a week, there is a part time Handyman, and a cook, laundry assistant and 2 cleaners 7 days a week. Staff opinion was divided as to whether there are enough staff to meet Residents needs. Some staff felt that based on the people living in the home at the time there were enough staff, others felt that ‘there is not enough time for niceties’, explaining that as most Residents need support from 2 staff, there Byron Court DS0000017267.V291779.R01.S.doc Version 5.1 Page 23 is not time to talk with people and that often the lounge area has no staff in which could cause a risk to Residents. National Minimum Standards for care homes state that numbers of care staff should be based on Residents assessed needs. When asked the Manager could not provide evidence that residents needs had been assessed before the current staffing levels were decided upon. This is a matter of serious concern as following the last inspection the home was asked to provide dependency levels of the residents as staff had been reduced but this has not been produced. CSCI were not made aware of the most recent staff reduction. Several members of staff spoken with confirmed that Carers are entitled to an unpaid lunch break of an hour and two staff take that this at a time. This reduces staffing levels for a two-hour period from 1 Registered Nurse and 4 Carers to 1 registered Nurse and 2 Carers, although at times the Manager is on the premises this is not always the case. This reduction in staffing levels each day could pose a risk to Residents health and safety during the lunch time period. Staff in the home have worked hard in the past few months, to achieve a care qualification (NVQ). As a result the home are meeting the national standard of having over 50 of carers qualified to this level. Staff files were looked at for 4 members of staff. The home had two written references for all newer staff and copies of application forms. Some files viewed contained copies of the terms and conditions of work and identification of the staff member however others did not. Some, but not all had Criminal Records Bureau checks (CRB), although most had a copy of their CRB number. Some staff advised that they had not received up to date terms and conditions of their employment when their hours of work were reduced. It was evidenced through discussion with staff and viewing staff files that a lot of time and effort has gone into providing training for staff in the past few months, as a result 100 of the team have recent training in, fire, moving and handling, health and safety and basic food hygiene. Most staff have received Adult Protection training also. Byron Court DS0000017267.V291779.R01.S.doc Version 5.1 Page 24 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 The quality in this area is poor. The organisation does not manage the service well. Residents are not consulted about their views. Resident’s monies are not managed well. The home is not a safe place to live EVIDENCE: The organisation has employed a new operations manager since the last inspection. On the day of the inspection the operations manager made it known that she would not be overseeing the service as another employee had been given management duties, which she believed compromised her professional status. During discussions it was noted that the manager on two occasions was not managing the staff when they didn’t comply with instructions. The service has no responsible individual. A representative of the organisation is required by regulation to visit the home unannounced each month and talk with Residents, visitors and staff, inspect Byron Court DS0000017267.V291779.R01.S.doc Version 5.1 Page 25 the premises and records and prepare a report. They are also required to send a copy of this report to the CSCI. No reports of these visits being carried out have been obtained by the CSCI. These visits would provide the organisation with the opportunity to identity many of the matters noted at this inspection and take action to improve the service provided. A requirement regarding the necessity to carry out these visits and regularly consult with Residents and their representatives has been made as part of this inspection. The home does have a quality assurance file to look at the quality of their service and how this can be improved. However the last time Residents and relatives were surveyed to get their views was in February 2005. No analysis of the results of this or development plan was available and the refurbishment plan was last updated in January 2005. This is a concern as a requirement was made following the last inspection that residents and staff are offered the opportunity to be involved in the development of the service and how this will impact on them. This has not been addressed. An external quality audit of the service was carried out in November 2005 and the home was awarded 3 stars. Residents were given time and privacy to talk with Inspectors during the inspection. The home have not always met CSCI requirements within timescales given; this could impact on the health and safety of Residents. The home acts as appointee for some Residents benefits and provides a safe for storage of their money. Records and amounts held for two Residents were checked on the day. These were correct for one Resident. However there was a discrepancy for the other Resident with records showing they should hold over £30 more than the actual amount available. An immediate requirement was given to the home stating that they must investigate the shortfall and inform CSCI of the outcome within 24 hours- if necessary other outside authorities (police, social services) were to be informed also. It was not easy to audit Residents monies as receipts were not numbered or always available and there were not always two signatures obtained to verify the purchase. The Manager stated that she is aware of this and had recently set up a system whereby a small ‘float’ is available 24 hours a day but the key to the safe is held by herself. Some shortfalls regarding Health and Safety were identified during the inspection. A large number of fire doors were wedged open, Bathroom 1 has a door, which provides access to the workings of the lift- this is clearly signed ‘danger, unauthorised access prohibited’. This door was unlocked and the Handyman advised that the key could not be located. The home tests samples of water temperatures in sinks and baths monthly. This can mean that some water outlets are not tested for several months at a time. Some temperatures were tested by hand during the inspection and the Byron Court DS0000017267.V291779.R01.S.doc Version 5.1 Page 26 following was noted, the water in bathroom 1 felt cold, the water in bathroom 2 felt very hot as did the sink in bedroom 9. Records showed that all recorded temperatures were below the recommended 43 degrees, however one recorded at 38 degrees, which may be too cold for a Resident to comfortably, use. Fire records were viewed which showed that the alarm is tested on a weekly basis. The manager stated that this test includes emergency lighting but no record could be found of this. As detailed in the staffing section staff have received training on Fire training. A certificate viewed showed that all Fire fighting equipment was serviced in March 2005. The handyman has recently completed training on how to undertake Portable appliance testing to ensure electrical items are safe within the home. The manager stated Equipment has been purchased to enable this to happen and that the intention is to carry this out in the near future. Accident records were viewed. The home has purchased book to enable records to be removed and stored confidentially to comply with Data Protection. This was discussed with the manager. Contracts were viewed which showed that all hoisting equipment within the home had been serviced but this had occurred in March 05 and had not taken place since. A copy of a current electricity and gas certificate was viewed which showed that the service had safe supplies in both. The home has a contract with a pest control organization, which is current. Byron Court DS0000017267.V291779.R01.S.doc Version 5.1 Page 27 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 1 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 1 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 3 3 X 1 X 3 X X 2 STAFFING Standard No Score 27 1 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 1 X X 1 Byron Court DS0000017267.V291779.R01.S.doc Version 5.1 Page 28 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 OP12 Regulation 16.(2)(m)(n) Requirement The service must ensure residents are offered fulfilling activities of their choice. This must include outings.31st November 2005 Outstanding Staffing levels must be reviewed across the home. Evidence must be forwarded to CSCI that assessments of residents needs have taken place and that staffing levels match these needs.31st November 2005Outstanding The service must ensure that all residents are offered the opportunity and all staff are involved in the development of the service and how any future changes will impact on their care or role.31st November 2005Outstanding The manager must ensure that Statement of Purpose and a Service Users guide is produced which meets the criteria of the Care Home Regulations 2001. Timescale for action 30/06/06 2 OP13 18. -(1)(a 30/06/06 3 OP14 12. -(2) 30/06/06 4 OP1 4. (1)(a)(b)( c), (2)(3)(a)( b) 5. (1)(a)(b)( c)(d)(e)(f) 30/09/06 Byron Court DS0000017267.V291779.R01.S.doc Version 5.1 Page 29 (2)(3) 5 OP7 15.-(1)(2) The manager must ensure that residents/ representatives are consulted about the care plans and their contents. The manager must ensure that residents/representatives are consulted about the use of bedrails and permission sought where necessary. The manager must ensure that the pulse is taken before digoxin is administered and that if instructions on MARS are to be altered, the alterations include dates and signatures of authority. The manager must ensure that the temperature of the medications fridge is recorded daily. The manager must produce an action plan identifying how the residents are going to be supported to maintain their dignity The manager must ensure that choice is offered before meals take place and that records are kept of what meals were served. The manager must familiarise herself with the complaints procedure and ensure all complaints and concerns are appropriately investigated, actioned and responded to within timescale The manager must ensure that an action plan is produced following an audit to identify works to bathrooms and toilets. The manager must ensure that Liquid soap and paper towels are provided in all toilets and bathrooms. The manager must ensure that the extractor fan to the smoking DS0000017267.V291779.R01.S.doc 31/08/06 6 OP8 13.- (7) 31/08/06 7 OP9 13.-(2) 31/05/06 8 OP9 13. -(2) 31/05/06 9 OP10 12. - (4) (a) 31/05/06 10 OP15 12. -(2) 30/06/06 11 OP16 22. -(1) (2) (3) (4) (5) (6) (7) (8) 23. -(2) (b) 13. - (3) 31/05/06 12 OP21 31/05/06 13 OP21 31/05/06 14 OP25 23. -(2) (c) 31/05/06 Page 30 Byron Court Version 5.1 15 16 OP24 OP27 16. -(2) (c) 18. - (1) (a) 17 OP29 19. - (5) (a) (b) (c) (d) 9. -(1), 10. - (1) 18 OP31 19 20 OP33 OP33 26. -(1) (2) (3) (4) (5) 24. -(1) (a) (b) 13. -(6) 21 OP35 22 23 24 OP38 OP38 OP38 23.-(2) (b) 12.-( 1) (a) 23.-(2) ( c) 23.-( 2) ( c) 17.-(2) 25 26 OP38 OP38 area is repaired. A risk assessment must be carried out on this area. The manager must ensure that there is an adequate supply of bedding within the home. The manager must ensure that staff are supplied in sufficient numbers over the lunch time period to meet the residents needs. Staff files must be audited and any missing documentation put in place. This includes proof of CRB checks. Mechanisms must be developed to support the manager to meet the national minimum standards and the Care Home regulations 2001. Regulation 26 visits must occur and CSCI informed of the outcome Residents must be consulted about their views of the service. Quality Assurance systems must be implemented. The manager must ensure that clear auditing systems are developed to safe guard resident’s money. The manager must ensure that the door to the lift mechanism is locked at all times The manager must ensure that a thorough monitoring of water temperatures takes place. The manager must ensure that the plans to commence portable appliance testing are carried through The manager must ensure that the emergency lighting system is checked regularly. The manager must ensure that accidents records are stored in line with Data protection. DS0000017267.V291779.R01.S.doc 30/06/06 31/05/06 30/08/06 30/06/06 30/06/06 30/08/06 31/05/06 31/05/06 30/06/06 30/06/06 31/05/06 31/05/06 Byron Court Version 5.1 Page 31 27 OP38 23 2 b The manager must ensure that 31/05/06 hoisting equipment is serviced as a matter of urgency 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. Refer to Standard OP7 OP24 Good Practice Recommendations The manager should continue to remind staff to update care plans monthly. The manager should ensure that the plans to replace the chairs in the ground floor lounge are carried through. Byron Court DS0000017267.V291779.R01.S.doc Version 5.1 Page 32 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool 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 DS0000017267.V291779.R01.S.doc Version 5.1 Page 33 - 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. 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