Random inspection report
Care homes for older people
Name: Address: Byron Court Gower Street Bootle Liverpool Merseyside L20 4PY two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Stephanie West Date: 1 1 0 3 2 0 1 0 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): Name of registered manager (if applicable) Karon Elizabeth Wilcox- George Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mary George Ltd care home 52 Number of places (if applicable): Under 65 Over 65 0 44 dementia old age, not falling within any other category Conditions of registration: 8 0 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
Care Homes for Older People Page 2 of 10 Brief description of the care home 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. 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 3 of 10 What we found:
We visited the home following receipt of a number of concerns with regards to the care provided. These concerns had been shared with us by Liverpool Social Services. Most of the concerns had already been investigated by an Operations manager within the company and some action had been taken by the company as a result. The concerns, in the main, related to staff practice in supporting people residing at the home, a lack of communicating information across the service and with other stakeholders, and medication practice issues. An operations manager for the company was present at the home and they informed us that they had taken steps to investigate some of the issues raised as these had previously been raised directly with the home. They had called a staff meeting to explore some of the issues raised and to ensure appropriate protocols and practices were in place. The manager of the home was absent from the home at the time of the visit and therefore all issues were explored with the operations manager for the company. The level of information which we had received about the concerns was not particularly detailed and therefore we explored some general themes with people living at the home and with members of the staff team. We looked at a small number of records to confirm our findings. We asked staff and people living at the home about their access to drinks throughout the night, the use of commodes and access to the nurse call system, we looked at how staff deal with clinical waste and we looked at the means by which staff communicate with each other on a daily basis. We found no evidence to substantiate these particular areas of concern. We did ask the operations manager to follow a small number of issues through and they readily agreed to do this. The visit involved discussion of medicines handling with nursing and senior care staff and examination of medicines records and storage arrangements. We looked at medicines administration. All medicines were administered by nurses or, to people resident for personal care only, by senior staff who had completed certificated medicines training. People wishing to self-administer medication were supported to do so. The home had made arrangements for the use of homely remedies so that non-prescribed medicines for the treatment of minor ailments could be given. But, this had not been consistently applied throughout the home. Consideration needs to be given to whether this policy can be extended to benefit all people living in the home. We examined a sample of medicines records and stock. Most medicines were supplied in a monitored dosage system and this was used correctly. But, we were concerned to find occasional examples of inaccurate record keeping and stock not adding up with records. This was particularly evident for medicines in traditional boxes and bottles. For example, it was of concern that there was no evidence to show that a prescribed supplementary drink had been administered to one person who was losing weight. There was no reference to the use of the supplementary drink within their care plan and no regular records of administration. We saw that while records of medicines received into the home with the main monthly medicines delivery were mostly clearly made, entries were sometimes missed for medicines delivered at other times. We also saw two examples where medication was kept in stock but not listed on peoples current medicines administration record. This meant it was impossible to account for (track) the handling of
Care Homes for Older People Page 4 of 10 these medicines. We found some inconsistency in recording advice from healthcare professionals, records were mostly clearly made and followed-up, helping to ensure any changes were promptly addressed. But, on occasion written records could not be found to support changes to peoples medicines. Similarly, there was inconsistency in the way records were completed when medicines were not given, with some but not all staff recording the reason in full. It is important that clear and accurate records are maintained to support and evidence the safe administration of medication. We looked at how care plans supported the safe use of medicines. We looked at care plans for people who had chosen to self-administer some of their medication. We found that written assessments had not been completed, and there was a lack of clear up-todate information about how this was supported. Similarly, there was little or no information about the use of prescribed external preparations e.g. creams or about the use of medicines prescribed, when required. Supporting information about the use of peoples medicines should be included with peoples care plans to help ensure medication is used correctly, as needed. We found that all medicines including Controlled Drugs were safely locked away; this helps to ensure that they are not misused or mishandled. But, we were concerned to find that on two occasions there had been a delay in changing a pain-reliving patch for one person. It is important that the patches are changed on time to help ensure pain is well managed. Regular medicine audits (checks) were not completed. This should be considered to help ensure that should any weaknesses arise they can be promptly addressed. What the care home does well: What they could do better:
We looked at the system which staff use to communicate important information. This could be improved so as to ensure a more thorough and accountable process and to ensure appropriate records are maintained particularly in relation to periods of hand over of information between groups of staff. During the visit we viewed a number of areas of the home and found the cleanliness was not to standard. This was particularly evident in peoples bedrooms. We found that there was one member of domestic staff responsible for cleaning the whole home. We asked the operations manager about this and she told us that there are now two staff from the domestic team dedicated to cleaning but at the time of the visit one of these staff was absent. We discussed the fact that some of the areas were presented as not having been cleaned for longer than one day. The provider must ensure staff are employed in sufficient numbers to ensure the care home is appropriately clean and hygienic at all
Care Homes for Older People Page 5 of 10 times. During a tour of the home we noted open access to a staircase which had been the subject of a recent safeguarding investigation. The registered person must carry out a risk assessment on access to staircases for people living at the home and must carry out any necessary works in line with managing risks identified. This must be carried out in conjunction with advice from the Fire Authority. Medicines record keeping needs to improve to enable the handling of medicines to be accounted for (tracked). Care needs to be taken to ensure any individual information about use of medication for example; when required medicines, or self-administration is regularly reviewed and kept up-to-date. 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 set out on page 2. Care Homes for Older People Page 6 of 10 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards.
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 7 of 10 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, 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 9 13 Where people self-administer 19/04/2010 medication written assessments must be completed and kept under review to help ensure people receive any support they may need to safely manage their medicines. 2 9 13 Medication must be given as prescribed. Medication records must be completely, clearly and accurately maintained to support and evidence the safe administration of medication. 19/04/2010 3 19 13 The registered person must 19/04/2010 carry out a risk assessment on access to staircases for people living at the home and must carry out any necessary works in line with managing these. This must be carried out in conjunction with advice from the Fire department.
Page 8 of 10 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 To ensure the health, safety and wellbeing of people living at the home. 4 26 16 All areas of the home must 19/04/2010 be maintained to a clean and hygenic standard. To ensure the health, safety and wellbeing of people lviving at the home and ensure people are provided with a clean home environment. 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 9 Written medication audits (checks) should be completed to help ensure that should any shortfalls arise they can be promptly addressed. Where medicines are prescribed when required there should be individual information about when they may be needed and how this need will be made know. There should be individual information about the use of external preparations e.g. creams, to help ensure they are used correctly, when needed. Care Homes for Older People Page 9 of 10 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 10 of 10 - 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!
