Inspection on 21/01/10 for Byron Court

This inspection was carried out on 21st January 2010.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Byron Court 08/03/10

Byron Court 29/01/08

Byron Court 06/03/07

Byron Court 02/05/06

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 16/05/2010.

Key inspection report Care homes for older people Name: Address: Byron Court Gower Street Bootle Liverpool Merseyside L20 4PY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Claire Lee     Date: 2 1 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 37 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 37 Information about the care home Name of care home: Address: Byron Court Gower Street Bootle Liverpool Merseyside L20 4PY 01519220398 01519335687 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mary George Ltd care home 52 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category/ies of service only: Care Home with nursing - Code N To people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (44) Dementia - Code DE (8) The maximum number of people who can be accommodated is : 52 Date of last inspection Brief description of the care home 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 that require nursing care. Byron Court is owned by a private organisation. Accommodation is situated over three floors and there are three lounges and one dining room. An enclosed lounge is available for those people who wish to smoke. 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. Care Homes for Older People Page 4 of 37 Over 65 0 44 8 0 Brief description of the care home 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. The fee rate for accommodation is as follows: Residential rate of 383 pounds a week to the dementia nursing rate of 531 pounds a week. Care Homes for Older People Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: An unannounced visit took place as part of the inspection and this was carried out over one day for a duration of eleven hours. The site visit was conducted by two inspectors. Forty one residents were accommodated at this time. The term resident is used in this report as this is what the people staying there like to be called. During the time spent at the home different areas were looked at and a number of care, staff and health and safety records were checked to see what care the residents living there received. Discussion took place with eleven residents, two relatives, ten staff, a health care professional, the manager and operations manager. The last key inspection took place on 29th January 2008 and requirements and recommendations from these inspections were examined at this time. During the inspection three residents were case tracked (their files were looked at and Care Homes for Older People Page 6 of 37 they were asked for their views of the home). Other residents also took part in the inspection and all the key and other standards were assessed during the visit. Reference is made to them in the report. To find out more about the care provided at the home survey forms called Have your Say About..... were distributed to a number of residents and staff prior to the site visit. A number of comments were received and some of them have been included in this report. An AQAA (annual quality assurance assessment) was completed for the inspection. The AQAA comprises of two self-questionnaires that focus on the outcomes for people. The self-assessment provides information as to how the manager and staff are meeting the needs of the current residents and a data set that gives basic facts and figures about the service, including staff numbers and training. The manager completed the AQAA to a good standard. Care Homes for Older People Page 7 of 37 What the care home does well: What has improved since the last inspection? What they could do better: Where a risk had been identified in relation to the care provision, a risk assessment had been completed. The risk assessments seen did not provide staff with information about the action they needed to take to minimise the risk. The risk assessments should contain more detail about the action that staff need to take, so that the risk is properly managed. This helps to ensure the health and safety of the residents. At lunch time it was noted that a number of residents needed their meal pureed. Pureed foods were served as one meal. With respect to the resident and to ensure meals look appetising, pureed foods should be served individually on the plate. Taste and colour are then maintained. The dining room is a focal point in the home for residents to enjoy their meals. A large amount of rubbish was located outside the dining room window and this could be seen by the residents from the dining room tables. This does not provide a pleasant outlook Care Homes for Older People Page 8 of 37 for the residents. The rubbish should be removed, as a view of rubbish detracts from what should be a sociable occasion for the residents. The manager said a lot of the rubbish had come from other homes within the group. None of the windows in bedrooms on the upper floors were fitted with blinds or nets and most of them were overlooked from outside. Daily activities undertaken by the residents can therefore be seen. All bedroom windows should be fitted with blinds or nets as a mark of respect and to help maintain privacy for the residents. Limited information was found in the residents care files with regard to social interests and family contacts. These should be developed, so that residents receive the social support they need to maintain their preferred lifestyle and interests. An activities programme should be developed in accordance with the residents wishes and this should be displayed. This helps to ensure residents are given appropriate opportunities to take part in activities of their choice. A resident who was relaxing in the dining room was asked by a member of staff to leave and return nearer meal time. This is the residents home and the residents should be allowed to move freely around the home as long as it is safe for them to do so. If it is not safe for them to move around independently, then this should be recorded in their care plan, with the reason why. Residents should be allowed to exercise choice around where and how they wish to spend their day. The copy of the menu should be placed on the dining room tables to help ensure residents know the choices available over a period of time. They should also be given to residents who wish to remain in their own room, as they would not see the menu in the hall. Records should be kept in the kitchen of dietary preferences, so that everyone is aware of what residents prefer to eat or need as part of their medical condition. For example, residents who have diabetes. These records help to ensure they receive meals they enjoy or are required to have to keep them healthy. The complaints policy and procedure should be should be displayed, so that residents, their families and the staff can easily access this information and are aware of how to raise a concern. Seftons local guidelines for the protection of vulnerable adults should be made available for the staff. This document provides information for everyone at the home on how to respond in an appropriate way to protect people. Work has commenced to improve the accommodation, however a tour of the building showed that a number of areas needed painting and decorating, with emphasis on the bedrooms. A number of bedrooms had torn floor coverings, the bedroom furniture was chipped and handles were missing on chests of drawers and wardrobes. A bathroom was found to be dirty and there was chipped paintwork along corridors. Work must be carried out to improve the accommodation and the standard of cleanliness for the residents. This must include decoration and refurbishment of bedrooms. Residents must live in safe, clean and well maintained accommodation. Care Homes for Older People Page 9 of 37 A vacant bedroom and bathroom were being used to store wheelchairs and other items not in use. Both rooms were unlocked and this posed a risk to residents who may wander. They should therefore, be kept locked if not used. The dementia care unit had signs on the bathroom doors to assist the residents. Names on bedroom doors would further help to familiarise them with their own room. The use of different textures on the walls would provide stimulation for the residents within the environment. Concerns were raised as to the number of staff allocated to work on the residential floor of the home. The manager should review how staff are deployed, as this will help the staff team to work effectively when providing the necessary care and support to the residents. Staff require training in safe working practices such as, moving and handling, first aid, infection control and food hygiene. These courses are required to ensure they have the skills and knowledge to undertake their work safely. It was difficult to establish training given as training records and certificates seen were out of date. A training plan should be made available for the staff to evidence courses they have undertaken and those planned. Staff should receive regular supervision of their job role. This will give them more opportunities to express their concerns and opinions, improve communication and help provide support with training. The AQAA gave details of a number of policies and procedures. These should be reviewed to ensure they are up to date in accordance with current legislation and best practice. The homes insurance certificate for the business should be displayed and certificates for services to the home should be available for inspection and for checking services are working safely to protect people. Staff should receive guidance and training with regard to how to deal with an incident that affects the health and safety of a resident. Staff need to be confident on how to react if something untowards occurs in the home. This should be addressed through the homes training plan and support for the employee provided on a one to one basis. New Deprivation of Liberty safeguards have been introduced under the Mental Capacity Act 2005. These safeguards are put in place to help people who may lack the capacity to make certain decisions. Deprivation of Liberty training should be provided for the staff. This will help to ensure they are aware of what is required from them to help people who may lack the capacity to make certain decisions. Care Homes for Older People Page 10 of 37 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 11 of 37 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 12 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples care needs had been assessed to ensure the home was the right place for them to live. Evidence: Three residents were case tracked. This involved looking back through their records to check that their care need requirements were properly assessed before they decided to move in. This has to be done to make sure the home was the right place for them to live. The residents records showed their care need requirements were fully assessed by a qualified person before they moved into the home. The assessments were detailed and covered areas of the persons life, such as health and personal care, mobility, communication, finances and risk management. Intermediate care is provided at the home and the residents are supported by an intermediate care team who oversee the care they need. This service is provided for people who have primarily been discharged from hospital and need a period of Care Homes for Older People Page 13 of 37 Evidence: rehabilitation prior to going back to their own home. Care Homes for Older People Page 14 of 37 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff must be more aware of how to respect residents privacy and dignity with regard to different aspects of their daily living. Evidence: Residents had an individual care file and this had written information relating to their health and social care needs. Care files for three residents were looked at in detail as part of the case tracking process. This was done to make sure the residents care needs had been set out in a care plan and that their needs were being met. Care files included a plan of care and staff had been provided with clear information about how to meet the identified needs. Information about residents preferred routines with regards to their health and personal care was also available. There were records to show that each care plan has been regularly reviewed and updated each month with the involvement of the resident and or their relatives. Family members spoken with said they were invited to take part in reviewing their relatives care plans. Risk assessments were also part of each of the residents care plans. Risk assessments had been carried out and put in place for a particular task or activity, Care Homes for Older People Page 15 of 37 Evidence: which posed a risk to the resident or staff. This helps to minimise the risk of harm to them. Equipment used to keep residents safe had also been risk assessed to ensure that it was used correctly and safely. Risk assessments, which were looked at, identified the area and level of risk but they did not provide staff with information about the action they need to take to minimise the risk. This was discussed with the manager during the inspection and she was advised to improve them by providing information about the action that staff needed to take. This ensures the risk is properly managed to help protect the health and safety of the residents. Care files viewed had charts for recording and monitoring the residents general health, their well being and health conditions they had. Staff spoken with showed a good understanding of care plans and they made the following comments, which supported this, They tell us all we need to know about the resident and how to care for them in the best way and Care plans are important as they tell us all we need to know about the person. Staff spoken with had a good knowledge and understanding of the needs of the residents and they were confident about dealing with and reporting any changes in their health. A district nurse who was visiting a resident at the time of the inspection said, The staff are really good at following our instructions and they communicate with us very well. Residents care files, which were looked at, included records detailing visits to health care professionals. For example, doctors, dentists, chiropodists and opticians. Records showed visits also to specialist services, such as dieticians and speech therapists. Where required arrangements had been made for residents to receive medical appointments at the home. It was evident that their health was being monitored to keep them well. Equality and diversity was addressed through the residents initial assessment process and their individual care plans. Individual needs were recorded in respect of daily living and residents had access to a good standard of equipment to help them maintain their independence. Medicines were being well managed and staff were observed to give out the medicines in a safe manner in accordance with the homes medicine policy. Medicines had been signed as being given by the staff and a spot check of a number of medicines showed this to be correct. There were no residents who wished to administer their own medicines. Should they wish to do so, then staff were aware of how to risk assess and manage this practice safely. A number of comments were received from the residents in relation to staff being Care Homes for Older People Page 16 of 37 Evidence: polite and and a staff member said, Residents should be treated with respect all the time. We did however observe the following practices, which have an impact for the residents: A number of residents needed their meals pureed, as they required some assistance with their food. We noted that pureed food was served as one meal. The meal looked unappetising and bland. With respect to the resident and to ensure meals look appetising, pureed foods should be served individually on the plate. Taste and colour are then maintained. The dining room is a focal point in the home for residents to enjoy their meals. A large amount of rubbish was located outside the dining room window and this can be seen by the residents from the dining room tables. This does not provide a pleasant outlook for the residents. The rubbish should be removed, as a view of rubbish detracts from what should be a sociable occasion for the residents. The manager said a lot of the rubbish had come from other homes within the group. None of the windows in bedrooms on the upper floors were fitted with blinds or nets and most of them were overlooked from outside. Daily activities undertaken by the residents can therefore be seen by people outside the care home. All bedroom windows should be fitted with blinds or nets as a mark of respect and privacy for the residents. Care Homes for Older People Page 17 of 37 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were able to decide how they wished to spend their day and they were offered a choice of nutritious well balanced meals. Evidence: Visitors received a warm welcome from the staff and they were able to meet their relative in one of the lounges or in their bedroom if preferred. A resident said they were pleased with the chiropody and hairdressing service offered to them at the home. These social links play an important part in maintaining daily life activities that are important to the individual. The AQAA reported, Religious ministers visit the home regularly. This enables the residents to continue to practice their chosen faith. Social activities were being organised on an informal basis. Residents enjoy films, singing and entertainment. An activities organiser is due to commence employment this month and she will help to organise the social arrangements for the residents. An activities programme should be developed in accordance with residents wishes. This helps to ensure residents are given appropriate oppotunities to take part in activities of their choice. Limited information was found in the residents care files with regard Care Homes for Older People Page 18 of 37 Evidence: to social interests and family contacts. These should be developed so that residents receive the social support they need to maintain their preferred lifestyle and interests. Residents were watching TV on the first floor lounge and staff were seen talking with them in groups or a one to one basis. A resident who was relaxing in the dining room was asked by a member of staff to leave and return nearer meal time. There was no justified explanation for this. This is the residents home and the residents should be allowed to move freely around the home as long as it is safe for them to do so. If it is not safe for them to move around independently, then this should be recorded in their care plan, with the reason why. Residents should be allowed to exercise choice around where and how they wish to spend their day. Residents interviewed said they could stay in bed in the mornings if they wanted and there was no problem with staying up to watch TV in the evenings. Staff who work with the residents who have dementia said they undertake reminiscence therapy and they want to provide memory boxes for the residents. These will contain information relating to past lifestyle, family, friends and hobbies. The boxes help to stimulate conversation between the residents and staff. Development of activities in the home should include dementia awareness, as this provides an important part of their social care. Lunch time was spent with the residents in the dining room, which is on the ground floor. Residents were offered several choices for their lunch, one resident said We always get a choice at meal times. At the time of the inspection staff were informing the residents of the menu of the day and a copy of the menu was seen on the hall noticeboard outside the dining room. A copy of the menu be placed on the dining room tables to help ensure residents know the choices available over a period of time. They should also be given to residents who wish to remain in their own room, as they would not see the menu in the hall. The main meal of the day is served in the evening and a lighter meal at lunch time. Home made meals are prepared by a chef who has a certificate in food hygiene. This helps to ensure food is prepared in a safe manner. The chef confirmed there was no information recorded in the kitchen with regard to dietary preferences for the residents. These records should be kept so that everyone is aware of what residents prefer to eat and what is needed as part of their medical condition. For example, residents who have diabetes. This helps to ensure they receive meals they enjoy or need to keep them healthy. The dining room is spacious, so that residents can sit in comfort and there is room for Care Homes for Older People Page 19 of 37 Evidence: wheelchairs. Dining room tables were laid for lunch with table cloths and flower arrangements. The majority of residents take their meals in this room though if preferred they can have their meals in their room. Meals were discussed with the residents and a number of comments were received. These included, The food is alright, The staff tell us what is being cookedand It is not like your own but they do well. Care Homes for Older People Page 20 of 37 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service were protected by the complaints and safeguarding procedures, which were understood by the staff. Evidence: There was a complaints policy and procedure for residents and their families located in the office. The complaints policy and procedure should be displayed, so the residents, their families and the staff can easily access this information and are fully aware of how to raise a concern. The AQAA reported that five complaints had been received internally and one upheld following an investigation. The AQAA reported, We actively encourage service users (residents) and/or family/ visitors to approach the staff if they have any concerns. Residents spoken with said they could talk with the staff privately and/or attend resident meetings to voice their concerns. The AQAA reported that a suggestion box is available for the residents and their families. This is useful for residents, relatives and staff who may be shy and do not wish to voice their opinions at a meeting. Residents spoken with said they would complain if they were unhappy about something. Staff who were interviewed said they knew about the homes complaints procedure and would not hesitate to complain if they needed to. A relative said they were given a copy of the homes complaints procedure and would definitely make a complaint if they needed to. Staff had access to an abuse policy to help protect people. Although staff interviewed were aware of how to report an alleged incident, it is recommended that Seftons local Care Homes for Older People Page 21 of 37 Evidence: guidelines for the protection of vulnerable adults be made available for the staff. This document provides local information for everyone at the home with regard to how to respond in an appropriate way to protect people. The manager could not locate the document at the time of the site visit. Staff training files looked at showed staff had received safeguarding training and this should continue so that all staff are fully aware of how to help protect and keep residents safe. The AQAA reported that there had been no referrals to the protection of vulnerable adults list. The manager made two safeguarding referrals with regard to incidents in the home that affected residents safety. One was upheld following an investigation and one is still under investigation. Staff communicated effectively and in a timely manner following the incidents and reported them to the relevant agencies, including the Commission. Care Homes for Older People Page 22 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements must be made to ensure residents live in a clean, well maintained and comfortable environment. Evidence: Byron Court is situated over three floors and divided into three areas, nursing, residential and nursing with dementia care. A number of doors were key coded to help ensure the safety of the residents. There is a main reception area and and staff were available to welcome people on entering. A tour of the building showed that parts of the home need improving to enhance the comfort and dignity of the residents. With regard to bedrooms seen, floor coverings were ripped, chest of drawers and vanity units chipped, a window did not shut correctly and handles were missing on bedroom furniture. A number of wooden frames of armchairs were scuffed and in need of repairing or replacing. Items of bedroom furniture was showing general signs of wear and tear due to age. The paint work in the home needed attention as it was scuffed. This was especially noticeable on the corridor to the dementia unit. The paintwork was marked by the wheelchairs. The standard of cleanliness in some areas was found to be poor. A number of mirrors Care Homes for Older People Page 23 of 37 Evidence: above the vanity units in the residents rooms were found to be water marked. The bathroom on the dementia unit was dirty. This included the floor, the radiator and surrounding paint work. The manager was asked to remove a jug from on top of a cupboard, as this was being used for sluicing purposes. Communal use of this posed an infection control risk. There is no sluice on this floor, staff working on this floor have to use the sluice on the first floor. The adjacent toilet floor was also dirty and the toilet cradle, which residents use, was chipped and stained. The dining room floor had some remains of breakfast under the dining room tables at 11.30am prior to lunch being served. The dining room floor should be vacummed regularly to help ensure a good standard of cleanliness. The AQAA reported that an estates manager has been employed and some work has already been carried out in the home. The overall standard of accommodation does however, still need to be improved. The manager and operations manager who was visiting agreed that new furniture was required, bedrooms needed decorating and a number of areas needed painting. There was no refurbishment plan in place to evidence required improvements to the environment. The operations manager agreed that standard of cleanliness in the building needed to be improved. Changes are being made to the domestic hours to help provide domestic cover at the busiest times of the day. Having only one domestic on duty for some days was noted to be a concern at the last key inspection in 2008. The dementia care unit had signs on the bathroom doors to assist the residents. Names on bedroom doors would further help to familiarise them with their own room. The use of different textures on the walls would provide stimulation within the environment. The maintenance person had been called to assist in another home at the time of the inspection. This has an impact on the time spent at Byron Court for the completion of day to day jobs. The maintenance person was able to attend the home late afternoon to assist with finding the hot water records and to conduct a fire alarm test. Residents had the use of bathrooms and showers that have been adapted so that they could bathe comfortably and safely. One bathroom on the first floor was not in use and was being used for storage purposes. The room was unlocked. The manager was aware that this room needed to be cleared and made available for the residents. The manager stated that plans were in place to improve this facility with a bath hoist. We were informed that this may not be possible due to the existing placement of the bath Care Homes for Older People Page 24 of 37 Evidence: and sink. This needs to be discussed further with senior management, as all bathrooms should be accessible for the residents. It was also noted that room 29 was vacant and being used to store wheelchairs and other items not in use. The door was unlocked and therefore, both rooms posed a risk to residents who may wander. These rooms should be locked if not in use. The AQAA reported that four lounges have been decorated. The lounge on the ground floor had new armchairs for the residents. There is a separate lounge for residents who wish to smoke. The dementia care lounge was having a new floor laid at the time of the inspection. Bedrooms had a call bell for the residents to use when they required assistance from the staff. Bedrooms seen were ventilated and warm. A number of bedrooms had special beds and mattresses to help residents who need to spend time in bed due to poor physical health. Gloves, liquid soap and hand towels were seen in the bathrooms and toilet areas for the staff and residents. This helps to reduce the risk of cross infection for hand washing. With regards to fire compliance, an external fire door to the side of the building was found to be open all day. Staff use this to access the grounds for their breaks. A fire door on the first floor landing was also found not to close fully. Advice should be taken from fire safety with regard to checks on fire doors, as part of maintaining fire prevention in the home. Other fire doors seen closed correctly. Emergency lighting was being checked in house to ensure it was working effectively. Care Homes for Older People Page 25 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents need to be assured that their are sufficient staff on all floors of the home to meet their needs and that they have training to provide the care and support they need. Evidence: At the time of the inspection, the staffing rota evidenced the number of staff on duty and the hours they were working to care for and support the residents. As the home provides nursing care, registered nurses are on duty at all times. During the day, the manager was present with two registered nurses, six carers, domestic and kitchen staff. At night there are two registered nurses and three care staff. Registered Mental Nurses are also employed to help oversee the care of the dementia care residents. Residents said the home was busy, however the staff do the best they can. A number of comments from the residents included, The care is of a high standard, Need more staff, I get what I need and Help me maintain my independence. Four staff files were looked at for recruitment and training purposes. These showed that staff had completed an application form for their position and references had been sought from past employers. Police checks had also been obtained. These measures help to protect people in the home. The manager said that new staff receive an induction and three of the four files Care Homes for Older People Page 26 of 37 Evidence: evidenced an induction with an external company. A checklist was also available with regard to internal procedures and being shown round the home. The manager confirmed that the induction had been completed with the staff member whose certificate was not available. The manager also stated that the formal induction into care included training in safe working practices. There was no record of this and it was therefore difficult to establish the content of training provided for the staff. Staff training records were out of date and there was no evidence of future training dates or a training plan. Staff must be given training in safe working practices, so that they have the skills and knowledge to undertake their work safely for the people they care for. Staff should have a training plan to evidence courses they have attended and training which is now due. Three staff were interviewed on a one to one basis and general discussion took place with a number of other staff during the visit. Staff were observed to interact well with the residents when providing help with different aspects of care and support. Discussion with staff regarding their training confirmed that some had undertaken courses and others had not. Some staff said they had received infection control, dementia care, POVA (Protection of Vulnerable Adults) and medicine training. Others said they needed training in health and safety and fire prevention and that they did not feel well trained. As previously stated, it was difficult to ascertain what training had been given to the staff, due to the lack of recorded information. The requirement for this is stated under Standard 38 of this report. All the staff spoken with said they love their job and many of them have worked at the home for many years. Staff spoken with showed a real good understanding of the needs of the residents and they were able to clearly describe their roles and responsibilities. A member of staff said they could do with more staff on the residential floor, as there is only one member of staff rosted on shift to provide care and support for all of the residents on the floor. The member of staff said it is sometimes difficult to manage on your own particularly when they are seeing to personal care needs of a resident and another resident calls for assistance. A relative also said they felt there more staff were needed on the floor because They always seem very busy and dont get much time to sit and talk to the residents. The relative also commented that staff dont seem to be allowed to help out on other floors and felt that this is something they should be able to do as it would help in difficult situations. Another member of staff said she felt that more staff are needed on the residential floor and sometimes on the nursing floor because they are always very busy and it is sometimes difficult to cope with the work. Care Homes for Older People Page 27 of 37 Evidence: In light of the comments received, the manager should review how staff are deployed on the floors. This will help the staff team to work effectively when providing the necessary care and support to the residents. Formal care training is provided for the staff. They undertake NVQ (National Vocational Qualification) in Care for the staff. The AQAA reported that of the 28 permanent care staff, 17 have achieved a NVQ at Level 2 and above. A number of staff have also achieved a formal qualification in dementia care and palliative care (end of life care). Care Homes for Older People Page 28 of 37 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff require training in safe working practices, so they have the skills and knowledge to provide care and support to people safely. Evidence: The manager, Mrs Karen Wilcox-George has the necessary NVQ management qualifications to manage the home and she is registered for this position with the Commission. Different processes are in place to assess the quality of the service. Residents opinions had been sought by the completion of satisfaction surveys and they had also attended meetings. This enables them to express their opinions of the home. The AQAA reported that when comments are received, Action is taken to improve and maintain the service. The home has also been awarded two external awards for the quality of the service. Formal written reports were seen about the home. These were completed by the Care Homes for Older People Page 29 of 37 Evidence: operations manager each month following a visit to the home. The visits included talking with residents, staff, relatives, looking round the environment and viewing different records relating to the service. Again this helps to ensure the home is providing a good service. Standard 34 was assessed in relation to the insurance certificate, which provides cover for the building. The insurance certificate was found to be out of date. A request was made to head office to provide a copy. This was provided and the manager was advised to display this as evidence of the current insurance cover for the building. A number of financial records held on behalf of the residents were looked at. These were found to be up to date and evidenced staff signatures for transactions made. The records in place help to protect the financial interests of the residents. Staff supervision records were seen; these showed that the supervisory sessions were not being held regularly. In light of concerns raised over the deployment of staff in the home and also the lack of training, it is recommended that more regular supervision sessions be held for the staff. This will give them more opportunities to express their concerns and opinions, improve communication and help provide support with training. The AQAA gave details of a number of policies and procedures for safe working and for care practices. The policies and procedures should be reviewed, as these were seen to be dated up to 2006. A review will help to ensure they are in accordance with current legislation and to implement best practice to help protect people. The AQAA gave details of contracts for equipment and services to the home. A spot check was undertaken for contracts for the electricity, lift and hoisting equipment. The AQAA evidenced a date for the last gas certificate for December 2008 and this was found to be the case when seen at the home. The certificate was therefore out of date and head office were contacted. They provided a copy of the current gas certificate. The manager must ensure all certificates for services such as this are provided in the home for inspection and to ensure they are working effectively. Fire drills are conducted with the staff and this forms part of the fire training. Names of staff who have attended were available. It was, however, difficult to ascertain the level of training and whether it was attended by the day and night staff. The manager was advised to record more information with regard to this and to ensure the fire training was up to date for all staff. This helps to ensure staff know how to act in the event of a fire. One staff member interviewed said she has not received any fire Care Homes for Older People Page 30 of 37 Evidence: training while another person said they had. A contract was in place for completing checks of fire prevention equipment. Records showed that fire alarms had been tested weekly and a check was undertaken at the time of the inspection. The alarm was working satisfactorily. Two accident reports were seen for incidents that affected the residents welfare. These recorded the nature of the incident and any treatment needed to help monitor the residents condition. The manager also sends us formal reports of incidents that affect a residents welfare. For example, if a resident has a fall and needs hospital treatment. This helps us to monitor the service offered to people. As previously stated there were no evidence of up to date training for the staff. The manager must provide training and development for them, so that they have the skills and knowledge to undertake their work safely and competently. Staff require training in safe working practices, such as moving and handling, infection control, food hygiene and first aid. A lack of training for staff has the potential to place residents at risk. New safeguards have been introduced under the Mental Capacity Act 2005. A Deprivation of Liberty safeguard was put in place recently for a resident, however this has now been withdrawn as it is not deemed necessary. These safeguards are put in place to help people who may lack the capacity to make certain decisions. The manager said training in this area was being provided for the staff, however there were no dates available to support this. Workbooks seen with regard to the Mental Capacity Act 2005 had not been completed. Deprivation of Liberty training should be provided for the staff. This will help to ensure they are aware of what is required from them to help people who may lack the capacity to make certain decisions. In light of a recent safeguarding referral it is recommended that staff receive guidance and training with regard to how to deal with an incident that affects the health and safety of a resident. Staff need to be confident on how to react if something untowards occurs in the home. This should be addressed through the homes training plan and support provided for employees on a one to one basis. Care Homes for Older People Page 31 of 37 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 32 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 16 Work must be carried out to improve the overall environment. This must include decoration and refurbishment of bedrooms. This will ensure residents live in pleasant surroundings that are well maintained. 21/03/2010 2 26 23 The standard of cleanliness in the building must be improved. Bathrooms, bedrooms and communal areas must be kept clean. This will ensure good standards of hygiene for the residents. 21/02/2010 3 38 18 Staff require training in safe working practices. This will help to ensure they have the skills and knowledge to undertake their work safely. 02/03/2010 Care Homes for Older People Page 33 of 37 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 8 Risk assessments viewed identified the area and level of risk but they did not provide staff with information about the action they needed to take to minimise the risk. The risk assessments should contain more detail about the action that staff need to take so that the risk is properly managed. This helps to ensure the health and safety of the residents. Pureed foods were served as one meal. With respect to the resident and to ensure meals look appetising, pureed foods should be served individually on the plate. Taste and colour are then maintained. A large amount of rubbish was located outside the dining room window and this can be seen by the residents from the dining room tables. This does not provide a pleasant outlook for the residents. The rubbish should be removed, as a view of rubbish detracts from what should be a sociable occasion for the residents. None of the windows in bedrooms on the upper floors were fitted with blinds or nets and most of them were overlooked from outside. Daily activities undertaken by the residents can therefore be seen. All bedroom windows be fitted with blinds or nets as a mark of respect and privacy for the residents. 2 10 3 14 This is the residents home and the residents should be allowed to move freely around the home as long as it is safe for them to do so. If it is not safe for them to move around independently, then this should be recorded in their care plan, with the reason why. Residents should be allowed to exercise choice around where and how they wish to spend their day. A copy of the menu should be placed on the dining room tables to help ensure residents know the choices available over a period of time. They should also be given to residents who wish to remain in their own room, as they would not see the menu in the hall. Records should be kept of dietary preferences so that everyone is aware of what residents prefer to eat or need as part of their medical condition. For example, residents 4 15 Care Homes for Older People Page 34 of 37 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations who have diabetes. These records help to ensure they receive meals they enjoy or are required to have to keep them healthy. 5 16 The complaints policy and procedure should be should be displayed so the that residents, their families and the staff can easily access this information and are aware of how to raise a concern. Seftons local guidelines for the protection of vulnerable adults should be made available for the staff. This document provides information for everyone at the home with regard to how to respond in an appropriate way to protect people. The manager should review how staff are deployed on the floors. This will help the staff team to work effectively when providing the necessary care and support to the residents. A training plan should be made available for the staff to evidence courses they have undertaken and those planned. Staff should receive regular supervision of their job role. This will give them more opportunities to express their concerns and opinions, improve communication and help provide support with training. The AQAA gave details of a number of policies and procedures.The policies and procedures should be reviewed as this will help to ensure they are in accordance with current legislation and to implement best practice to help protect people. 10 38 The homes insurance certificate for the business should be displayed and certificates for services to the home should be available for inspection and for checking services are working safely to protect people. Staff should receive guidance and training with regard to how to deal with an incident that affects the health and safety of a resident. Staff need to be confident on how to react if something untowards occurs in the home. This should be addressed through the homes training plan and support for the employee provided on a one to one basis. 6 18 7 27 8 9 30 36 Care Homes for Older People Page 35 of 37 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Deprivation of Liberty training should be provided for the staff. This will help to ensure they are aware of what is required from them to help people who may lack the capacity to make certain decisions. Care Homes for Older People Page 36 of 37 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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