CARE HOMES FOR OLDER PEOPLE
Byron Court Gower Street Bootle Liverpool Merseyside L20 4PY Lead Inspector
Mrs Joanne Revie Key Unannounced Inspection 6th March 2007 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.V331931.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Byron Court DS0000017267.V331931.R01.S.doc Version 5.2 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.V331931.R01.S.doc Version 5.2 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. The Service may provide nursing care to one named female service user out of category as under pensionable age. Should this service user leave this condition will cease. 20th July 2006 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. 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.V331931.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The visit was unannounced and lasted one day. Two inspectors undertook this. The purpose of the visit was to assess compliance with an improvement plan that had been produced by the home earlier in the year to address outstanding serous concerns that CSCI had regarding outstanding unmet requirements that could affect the health and welfare of people living there. The purpose of the visit was also to carry out the services second key inspection to establish whether the service had improved for the people living there. Six residents were case tracked. This means that their experience of living at the home was focused on and judgements were made as to whether they were receiving adequate care and support. Comments from residents, relatives and staff have been included in the summary section of the report. A variety of documentation was viewed as part of the visit. This is referred to in the evidence section of the report Evidence was viewed which showed that staff clearly understand how to promote equality and diversity needs of residents who live at the home. The home charges between £387.00 pounds and £485.00 pounds per week. Any extra charges required should be discussed with the manager before admission takes place. What the service does well:
The home manager ensures that each resident receives a full assessment of needs before they are admitted to the home. This enables staff to plan for new residents care and ensure that the resident does not have needs that the staff cannot meet. Residents and residents like the staff team and believe they are very well cared for. Comments included” the girls work very hard- they’re very good” and “ I just need to press that bell and they get to me as quickly as they can”. The staff team is stable which means that residents are receiving care and support from staff that they know. Byron Court DS0000017267.V331931.R01.S.doc Version 5.2 Page 6 Over half the staff have achieved a recognised care qualification and all receive regular basic training in how to meet the residents health and safety needs. Visitors are welcomed by the staff at the home and can visit whenever they choose. Relatives believe that there is always somebody available to talk to them and answer any questions. Residents enjoy the food that they are offered and believe that the chef tries very had to please them. Comments included” nothings too much trouble” and “ if im not well he’ll always make me something tasty, he tries very hard to please.” Residents and relatives believe their complaints and concerns are listened to and acted on. The home is very clean and presents as a homely comfortable place to live. What has improved since the last inspection?
The service has complied with the improvement plan that was produced to CSCI. This means that the outstanding breach of the care home regulations 2001 has been met as shows a commitment to work within the law.This means that the service is now a safer place for people to live in. A document called a statement or purpose has been produced. This contains detailed information about the homes aims, objectives and structure as well as key policies. This means that vital information about the service is available to residents and other interested parties,and can help them to make a decision as to whether Byron Court is the right place for them to live. Residents care records are much more organised and are regularly reviewed to ensure that they are up to date. This means that staff have access to current information about how to care and support residents. Risks to resident’s health such as development of pressure sores are managed better which shows staff understand how to care for the residents. The provision of activities has improved although residents have mixed views about whether these are supplied in sufficient amounts. However an activities organiser has been employed specifically for this role and is commencing work soon at the home. This should produce further improvements. Residents are being offered a choice of meals at every meal time rather than relying on staff knowledge of who likes what. This helps to promote empowerment and ensures residents eat food that they like. Byron Court DS0000017267.V331931.R01.S.doc Version 5.2 Page 7 Efforts have been made to make the environment more homely through pictures, soft furnishing etc and communal areas appeared tidier and more organised than previous. This shows that staff are taking pride in the services appearance and respecting it as the resident’s home. Staff files are much more organised and records were available to show that the manager has undertaken necessary checks to make sure staff are suitable to work with vulnerable adults. All mandatory training which ensure staff have skills to keep themselves and resident safe has been undertaken and is up to date. The new manager has settled into post and has impacted positively on the home. One staff member commented “ it is now a “pleasure to come to work”. The staff member felt that the new Manager has motivated everyone and “her enthusiasm builds everyone up”. Another member of staff said” the home is now on the up”. A visitor commented about the manager that “ Things are tip top now -she deserves ten out of ten”. The manager has introduced a verity of checks to develop and set standards of care within the home. What they could do better:
The care plan records could benefit from some further development. Resident’s social needs should be included in the plans of care and staff should consider their use of written language when writing daily records. Some out of date terms were being used such as “ cot sides” for bedrails,which implies a lack of respect for the person. Some concerns were noted around the administration of medications. A requirement and a recommendation have been made regarding this matter at the end of the report. Medications must be managed safely to ensure residents health and welfare is promoted. Consideration must be given to how soft diets are presented to residents who have swallowing difficulties.Residents are more likely to enjoy separate tastes of food, which is visually appetising rather than all ingredients being served as one meal. Although decorative works have been carried out to bathrooms and toilets some further works are required in some areas and this should be addressed so that all bathrooms ant toilets are of a standard that would be expected in a domestic home.
Byron Court DS0000017267.V331931.R01.S.doc Version 5.2 Page 8 Issues were identified regarding the security of the ground floor windows of the home which face the main road and this must be explored so that the residents home is secure. . Although staff have received basic training, a plan should be developed to identify any specialised needs of the residents. This would also show that resident’s needs are been considered separately and staff are trying to promote individualised care. Although staff recruitment is robust the manager must carry through her intention to ensure nursing staff are registered to nurse with the nursing professional body ( NMC).This will ensure that residents are receiving care form staff qualified to do so. A serious concern was identified around why the organisation acts, as appointee for some residents benefit money,and no information was available to show how these residents monies were being managed or were they were being kept. A requirement has been made in respect of this matter as residents financial interests must be safeguarded. A tool should be developed identifying residents dependency needs so that staff can be provided in sufficient numbers to meet residents needs rather than relying on occupancy levels within the home to dictate staffing numbers. This will reduce the risk of resident’s care being neglected. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Byron Court DS0000017267.V331931.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Byron Court DS0000017267.V331931.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Residents are provided with information that tells them about the home. Residents have their needs assessed prior to admission taking place EVIDENCE: A statement of purpose was viewed and displayed in the foyer of the home. This is an improvement since the last inspection and shows compliance with the homes improvement plan. Two care plans were viewed. Both contained information, which showed that assessments had been carried out, by the homes manager and the residents social worker before admission took place, this ensures that staff are aware of, and can meet the persons needs and choices. Byron Court DS0000017267.V331931.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each resident has an up to date plan of care,and residents health care is met. Care Plans lack residents social needs and Some resident’s dignity is not promoted as well as others. Staff do not always promote dignity when completing Care records. Medications are not managed as safely as they could be. EVIDENCE: Four care plans were viewed. A summary section has also been added so an overview of the residents needs was available at a glance. The plans were very detailed around the resident’s physical, psychological and medical needs. Two plans had life history’s but two plans didn’t. None of the plans identified social input as a need. The plans were reviewed regularly. Two had input from residents relatives and two did not. Byron Court DS0000017267.V331931.R01.S.doc Version 5.2 Page 12 All plans viewed contained evidence of input from health care professionals when the need arose. Staff are monitoring residents health by observing blood pressure pulse, temperature and respiration and undertaking blood monitoring tests when appropriate. The plans also contained assessments, which covered the risk of falls, pressure sores, and malnutrition occurring. These were up to date. All residents spoken with (seven) agreed that they were looked after well. Six completed surveys reflected positively on staff’s ability to provide care. Wound care records were viewed. These gave clear instructions and a clear audit regarding the care to be given and delivered to date. Three photos were available for viewing. One was dated. Two were not.The use of dated photographs ensures that wounds are monitored and action taken quickly if they are not improving. Medication storage systems and records were viewed. The manager had commenced medication audits, which is an improvement since the last inspection, this ensures that any actual or potential errors are noted and acted upon quickly. Medication administration records were viewed. One resident had been prescribed antibiotics. Records showed that these had been administered erratically and not regularly as prescribed, this could cause medication to be ineffective. Records for both residents had handwritten instructions regarding the administration of medication. No signature was available to show who had written these.If only one member of staff writes a medication sheet, this could lead to errors being made. Another residents records were viewed. Blank spaces were viewed regarding the administration of pain relief medication. If a medication is not given the reason should be recorded so that any difficulties are quickly noted and acted upon. Storage systems are secure and medication is stored within specifically designed trolleys within a locked room. Staff are recording the fridge temperature on a daily basis however staff are recording temperatures that would suggest that they don’t understand the use of a maximum /minimum thermometer, the lack of accurate temperature control for medication may cause it to be ineffective. Staff are keeping clear daily records about each residents progress. Some of the language within these could be viewed as demeaning i.e. “ chair bound” and “ cot sides”. During the visit residents appeared well cared for and attention had been paid to their personal appearance however one resident was viewed in the lounge who was wearing stained clothing and had dirty fingernails.Staff had not provided her with the support she needed to maintain her appearance and dignity.
Byron Court DS0000017267.V331931.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Plans are in place to develop activities inside and outside the home. Visitors are free to visit when they choose and are welcomed by the staff at the home. Residents are encouraged to make small choices, which affect their everyday lives. Residents enjoy the food offered however the preparation of soft diets must be altered so that these residents receive the same choice of food as those who eat a normal diet. EVIDENCE: Activities records were viewed for two weeks in February 2007. These showed that activities such as, music & wine, trip to local shops, video and cinema film plus hairdresser and a walk in the local park had taken place.. Discussions with 5 residents took place around the provision of activities these were mixed – “there’s not much to do in the day”, “we get a beer or a wine and have an entertainer.”,“ sometimes we have a singer”. Byron Court DS0000017267.V331931.R01.S.doc Version 5.2 Page 14 The manager explained that an activities coordinator had been employed and that this new employees police check had just been received so employment would commence in the near future. The manager also produced a handwritten action plan for year 2007 which identified the need to develop activities further. No activities were taking place during the site visit. During discussions six residents commented that although they go outside they do not leave the grounds of the home. “ I sit in the garden- no further” Other residents who are more independent go out as they choose. A trip out Christmas shopping occurred in December 2006. A discussion with one visitor revealed that they visit the home everyday whenever they choose. They believed that staff were always welcoming and the manager was very approachable and always available to answer any concerns. Throughout the visit evidence of residents being offered choice was seen. Three residents in discussions confirmed that they are able to go to bed and get up when they choose. All agreed that they chose what they wanted to wear that day and where they wanted to sit. Staff were heard offering these choices at different times during the visit. The kitchen was visited and a discussion took place with the chef. Records of meat and fridge temperatures aretaken regulary, this helps to ensure that food is prepared and stored safely. The chef explained that he currently liquidises meals together for residents who require a soft diet as he feels this keeps the food warmer. This was later discussed with the Manager who stated that she would ensure that these soft meals are prepared and served with each component of the meal separate to make meal more visually appealing. New laminated menus have been complied and were seen. The chef and the Manager advised that these are to be put on the table daily and they evidenced that a choice of meal is offered. This included, cereal or cooked breakfast, a choice of two main meals at lunchtime and a choice of lighter meals at teatime. Surveys received and discussions with four residents reflected positively on the standard of food available in the home. The teatime meal was briefly observed. Staff appeared to be supporting residents in a dignified manner. The atmosphere was calm. Tables were set with cloths and the food appeared appetising. Residents were being served different meals according to their preference. Byron Court DS0000017267.V331931.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents know how to complain and believe their concerns will be listened to and acted on. Staff have the skills to protect the residents from abuse. EVIDENCE: Discussions took place with a group of five residents. They agreed that if they were not happy with any aspect of the home they would speak with the manager. A visitor confirmed that they had no concerns about the home since the new manager had come into post. They believed any concerns they had would be dealt with quickly and efficiently. Complaints records were viewed, which showed that two complaints had been made to the manager since the last inspection. Records showed that an investigation took place by the manager and both complainants were happy with the outcome and received a response within the homes timescale. Complaints procedures were displayed in communal areas of the home. Byron Court DS0000017267.V331931.R01.S.doc Version 5.2 Page 16 Viewing the communications diary showed that staff were undertaking further training in protection of vulnerable adults in April 07. Viewing staff’s files showed that the Adult protection officer has also delivered this training in the past from the local council. Discussions with two members of staff revealed that they understood what abuse was and knew what to do if they suspected it had occurred. Byron Court DS0000017267.V331931.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Communal areas are clean and comfortable. Works have been carried out to bathrooms although further works are still required to ensure that these rooms are of an acceptable standard for the residents to use. The home is not as secure as it could be. EVIDENCE: A risk assessment has been competed for people smoking in the open lounge. This was viewed and was dated 20/11/06. The risk assessment provides a way for staff to ensure people who wish to smoke can do so, whilst other people are protected from any harmfull effects.A tour of the environment was undertaken. Bathroom 1 is located on the ground floor at the front of the home, leading to a small front garden with railings then a busy main road.
Byron Court DS0000017267.V331931.R01.S.doc Version 5.2 Page 18 The window was open with a chain restrictor fitted, this could easily be broken and allow access to the home by uninvited people. The bath enamel in this room was noted to be stained. Toilet 9 on the top floor has a lock with override fitted, also a bolt on inside door with no override. Staff could not easily access this room in the event that someone required help. The manager explained that only one resident was living on the top floor of the home at the time of the visit. Liquid soap and paper towels were seen in all bathrooms and toilet areas. Small stains were noted to several bathroom and toilet ceilings, including rooms 7 / 6/ 5. The cistern in toilet 5 had a crack that had been obviously repaired. Bathroom 2 had been decorated to a good standard, however the bath was chipped. The communal lounges and dining areas within the home were viewed. All presented as clean and tidy with good quality furnishings. There is a large lounge on the ground floor of the home. Although of an acceptable standard this room did not present as nicely as the others. The manager explained that this had been identified and plans have been developed to refurbish this in the near future. Viewing the staff rota showed that the home employs a regular team of domestic staff on a daily basis, to ensure that the environment is clean at all times. Byron Court DS0000017267.V331931.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff may not be provided in sufficient numbers to meet the resident’s needs. Staff have the skills to provide care to residents but a training plan identifying indivual needs of residents would develop this further. Robust recruitment procedures exist and are followed. EVIDENCE: Viewing staff files and discussions with two staff and the manager revealed that staff receive basic training to enable them to support Residents and that there are clear recruitment polices in place, which are followed this helps to ensure staff are suitable to work with people living at Byron Court. No training plan was in place to identify any specialist training required by staff however discussions with two staff members revealed that they had undertaken training such as wound care and palliative care in the past. Records showed that 8 of the 15 care staff employed have achieved a qualification in care. A further two staff were undertaking this training at the time of the visit. Byron Court DS0000017267.V331931.R01.S.doc Version 5.2 Page 20 Discussions with residents revealed that Residents like the Staff team but some of them don’t always feel there are enough staff available to provide support when they need it. A discussion with the manager revealed that no process exits to ensure staff are provided in sufficient numbers to meet the needs of the residents and that staff are provided according to the number of people living there. Viewing staff files for qualified nursing staff revealed that checks on whether nurses have a current nursing registration have not yet been made. The manager provided evidence to show that she had approached the nursing and midwifery council to request confirmation.These checks help the manager to ensure that nursing staff are qualified and up to date enough to work as nurse. Not all files viewed had a current photograph of the staff member, however the content of the staff files is greatly improved since the last inspection as all other information required by the Care Home Regulations 2001 was in place. A copy of a staff handbook was viewed. This is an improvement since the last inspection. Records showed that the manager is in the process of providing a copy of this to each member of staff.These handbooks will provide staff with up to date information about how they are expected to work. Byron Court DS0000017267.V331931.R01.S.doc Version 5.2 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager has the skills to organise and manage the service. Resident’s views of the service are requested but need to be acted on. Resident’s financial interests may not be safeguarded. The home is a safe place to live Byron Court DS0000017267.V331931.R01.S.doc Version 5.2 Page 22 EVIDENCE: An overview of the site visit showed that all files viewed are much more organised since the last visit. Audits have been developed and undertaken in areas such as medications health and safety staff files and staff training. Check lists are developed from this and action taken in the form of staff meetings and spot checks. One relative commented “ things are tip top now she deserves ten out of ten”. These audits provide a way to ensure that residents receive a good service and any issues are quickly noted and acted upon. The manager’s file was viewed. This showed that she has undertaken a great deal of training which is specific to the care of the residents and her role as manager. The manager has also completed a management qualification (NVQ 4) and is a registered nurse. Further audits were viewed around the homes administration systems and staffing. Residents have been surveyed to gain their opinion of the service, which is also an improvement. The manager intends to develop an action plan identifying how strengths can be developed where residents have identified a weakness. There are currently 30 people living in the home, the Manager advised that the organisation act as appointee for 7 peoples benefit money. She also advised that if a Resident needs money she requests this from head office that forwards it to the home. Two residents monies were looked at The Manager was unable to supply information about which account Resident’s money is held in by the organisation. No information about why the organisation acts, as appointee was available. No information about the amount held for each person by the organisation was available.It is therefore not possible for the person themselves or the CSCI to ensure that residents money is safely managed by the organisation. A variety of certificates and service contracts were viewed which shows that the manager has ensured that necessary health and safety tests are carried out to ensure all equipment (including that relating to fire) is tested within the home. In particular the outstanding potable appliance testing has been completed, the passenger lift has been repaired and the emergency lighting system is operational. These are all improvements and help to ensure Byron Court is a safe place to live. Byron Court DS0000017267.V331931.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 Byron Court DS0000017267.V331931.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13. - (2) Requirement Staff must ensure that they administer medication as prescribed to promote resident’s heath and welfare. The lock on the top floor toilet needs an overriding device so staff can access the room should a resident suddenly become ill. The ground floor bathroom of the home needs window security so that the home is a safe place to live. Records of any monies held by the organisation on behalf of a resident must be held within the home. This must include evidence that no resident’s monies are held in a company account. Information detailing which account residents monies are held in must be available within the home. This will show that the organisation is safeguarding resident’s monies and acting in resident’s best interest. Timescale for action 30/04/07 3 OP19 13. (4)(a)(c) 30/04/07 4 OP35 20. (1)(a)(b)( 3) 30/04/07 Byron Court DS0000017267.V331931.R01.S.doc Version 5.2 Page 25 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 OP9 Good Practice Recommendations Residents social needs should be included in the plan of care so that staff know what support to give residents to enable them to lead a fulfilling life. Guidance should be given to staff regarding the recording of fridge temperatures and the use of a maximum/minimum thermometer. This will ensure that medications are being stored at the right temperature. Staff should ensure that they sign and ask a witness to sign any handwritten instructions on medication records. This will reduce the risk of a mistake being made and a residents being given the wrong medication. Plans should be carried through to offer further activities inside and outside the home. This will enable residents to spend their time in a meaningful way. All complaints records should be signed by the manager on completion to verify that is she aware of the outcome and agrees that the matter has been resolved. This will ensure that any issues have been addressed to her satisfaction A dependency tool should be developed so that staff can be provided in sufficient numbers to meet residents needs rather than relying on occupancy levels within the home to dictate staffing levels. This will reduce the risk of residents care being neglected. The manager should ensure that she carries through her intention to ensure that nursing staff are registered with the NMC. Staff files should contain a recent photograph of the staff member. These actions will help to ensure that staff are suitable to work with vulnerable adults. The manager should develop a staff training plan, rather than providing general training for all staff on typical subjects. This will ensure that staff are skilled to meet the indivual needs of the residents The manager should carry though her intention to develop an action plan following the recent residents surveys. This will show that the resident’s opinion is important to the home and that the home is trying to match their expectations. Soft meals must be prepared with separate components so that resident’s benefit from a variety of taste and the meal
DS0000017267.V331931.R01.S.doc Version 5.2 Page 26 3 OP9 4 5 OP13 OP16 6 OP27 7 OP29 8 OP30 9 OP33 2 OP15 Byron Court appears more appetising. Byron Court DS0000017267.V331931.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Byron Court DS0000017267.V331931.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
