CARE HOMES FOR OLDER PEOPLE
BYRON LODGE CARE HOME Dryden Road West Melton Rotherham South Yorkshire S63 6EN
Lead Inspector Valerie Hoyle Unannounced 14 April 2005 09:00. The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. BYRON LODGE CARE HOME Version 1.10 Page 3 SERVICE INFORMATION
Name of service Byron Lodge Care Home Address Dryden Road West Melton Rotherham South Yorkshire S63 6EN 01709 761280 0113 2382691 None Florence Mallaband Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Tracey Anne Cowdell CRH 61 30 : OP 46 Category(ies) of DE(E) registration, with number of places BYRON LODGE CARE HOME Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: The service may admit person 60 years of age and above Date of last inspection 23rd September 2004 Brief Description of the Service: Byron Lodge is a registered care home for 61 service users. It is owned by Florence Mallaband Ltd. and managed by Tracey Cowdell Registered General Nurse and Registered Mental Nurse. The home is situated in the residential area of West Melton, close to all local amenities. The accommodation comprises of single and double bedrooms all of which have en-suite facilities. The home is built on two floors and divided into four units. Shakespeare accommodates residents in need of nursing care. Ruskin provides nursing care for the elderly mental infirm (EMI). Browning and Wordsworth are both residential care units. BYRON LODGE CARE HOME Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Two inspectors conducted this unannounced inspection over 8 hours where a partial tour of the building was undertaken. The inspectors examined five service users care plans and supporting documentation. 20 service users and 6 staff were spoken to during the visit. The inspectors were able to speak to two relatives, the hairdresser, district nurse, chiropodist and dietician, to gain their views on how the home is run. What the service does well: What has improved since the last inspection?
A number of bedrooms and one of the lounges and corridors has been decorated since the last inspection. This has improved the areas for service users to spend time in. A new manager has been appointed and registered recently and she holds the required nursing and management qualifications. She has started to develop good working relationships with staff and has reintroduced relatives and service user meetings, to gain the views of people using the service.
BYRON LODGE CARE HOME Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. BYRON LODGE CARE HOME Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection BYRON LODGE CARE HOME Version 1.10 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Service users are not admitted into the home without a full needs assessment undertaken by the registered manager, to ensure their needs are met. EVIDENCE: Assessment documents were examined on five service users and these included sufficient information to ensure care needs can be met by the staff at Byron Lodge. The placing authority provides information to the home prior to admission and the registered manager is able to make an initial judgement about the suitability of the service user. A new service user was able to confirm that he/she was visited prior to admission, and said the staff were very good and were able to meet his/her needs. BYRON LODGE CARE HOME Version 1.10 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 , 8, 9, 10. The care planning system is not sufficient to enable staff to deliver the care to service users who have specific identified risks. Service users must be given the opportunity to agree and sign their care plan, so that they are fully aware of the care they can expect to receive. Arrangements for dealing with service users health issues are adequately met by staff at the home, although staff must adhere to the policies relating to the administration of medication to ensure their safety and protection. Staff have the necessary skills and knowledge to ensure service users are treated with respect and dignity. EVIDENCE: Five care plans examined provided insufficient details to enable staff to deliver care appropriately. Risk assessments were not always up to date and contained incorrect intervention. Observation by the inspector and discussion with the qualified staff confirmed staff are at risk of injury while moving and handling service users who have had their bed base removed for safety reasons. Discussion with a number of service users said that they were not sure what details are recorded in their care plan, they confirmed that they had not been
BYRON LODGE CARE HOME Version 1.10 Page 10 asked to agree and sign the care plan. The inspectors found none of the care plans examined had signatures of the service user. Health professionals including the district nurse, chiropodist and dietician visiting the home confirmed health care arrangements for the service users. The district nurse praised staff for their assistance while visiting the home and said they appeared to have a good understanding of how to contact them if they needed assistance. One complaint recorded at the home regarding a health issue had been investigated by the registered manager and the service user told the inspector that he was happy with the outcome. Medication records and discussion with staff confirmed they have the skills and knowledge to ensure the safe storage and administration of medication, although examination of the records for taking the temperature of the medication fridge was not up to date. One service user had two medication dispensing pots in his/her bedroom. This contained controlled drugs and could have put other service users at risk. During the inspection there were many examples of good practice by staff and on many occasions there were good interactions between staff and service users and the visiting relatives. Most service users were referred to by their first name and this was with the approval of users, and was also stated in their care plan. A tour of the building and discussion with service users demonstrated that private telephones were encouraged. One service user said this was an important aspect of his/her life and a means of keeping in touch with family and friends. BYRON LODGE CARE HOME Version 1.10 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15 Social activities are arranged by the home and service users spoke favourably about their daily experiences. Mealtimes are well managed and the facility promotes a calm environment with four dining areas to accommodate all service users. The home has clear policies and procedures to ensure service users can maintain contact with their family and friends. EVIDENCE: The home employs an activities organiser, her contracted hours are 30, which she works to suit the activities being arranged and is therefore available some evenings. She spends time on each unit to ensure all service users have an opportunity to be involved in some form of activity. Several service users were able to confirm arrangements for activities, and there is evidence that service users have access to daily newspapers and magazines. Posters displaying forthcoming events were seen, including minutes from service users meetings. One visitor said that she felt that the activity co-ordinator spent too much time on administration, and the registered manager said that the co-ordinator role was under review to ensure it met the social needs of service users. BYRON LODGE CARE HOME Version 1.10 Page 12 Service users are able to make choices with regard to meals and meal times, joining in activities and the time that they go to bed and get up. The inspector observed service users spending time in their own bedrooms, watching T.V and reading daily newspapers. All service users spoken to said the food was very good and “the cook makes beautiful cakes”. The Inspector joined service users for lunch and said it was well cooked and presented. Staff was observed assisting service users appropriately and the meal was unhurried. BYRON LODGE CARE HOME Version 1.10 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17, 18, Service users are provided information to enable them the raise concerns about the home and their care. Adult protection Policies, procedures and training of staff ensure the protection of service users from abuse. EVIDENCE: BYRON LODGE CARE HOME Version 1.10 Page 14 The home has a complaints procedure that is available to service users and visitors that is kept in the entrance. The procedure is also referred to in the service users guide, identifying the stages to follow; this includes the time scales to respond to complaints. The address and telephone number of the Commission for Social Care Inspection is included in the procedure. One service user told the inspector that he had used the complaints procedure and was satisfied with the outcome. Several other service users said they would “tell the manager if they were upset about something”. The inspector examined documentation for four complaints and three had been upheld, with one complaint still being investigated. Service users told the inspector that they are given a choice when making decision about how to exercise their right to vote, and spoke about the forthcoming general election. The home has the RMBC policy on Adult Abuse and Whistleblowing and operates to those standards. The home investigates fully any allegations of abuse and would follow the necessary procedures if any were substantiated. The home holds discussions with staff to talk over issues and how to recognise different forms of abuse. BYRON LODGE CARE HOME Version 1.10 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 26. The registered providers continue to improve the décor and furnishings at the home creating comfortable and safe environments for service users. The home has made considerable investment in creating a safe area for the benefit of service users. The home is clean and free from odours and there is sufficient domestic staff to maintain good hygiene standards. EVIDENCE: There are pleasant paved patios leading from the downstairs lounges, a smallenclosed garden, it has a raised flowerbed with a water feature for service users to plant. This area has been extended using some of the lawned area to create a sensory area with scented plants and herbs. Service users told the Inspector that they are looking forward to the better weather to be able to sit in the area. The home was clean and free from offensive odours and a number of visitors to the home confirmed that the home was always that way. The domestic staff are commended for their efforts in maintaining the cleanliness of the home.
BYRON LODGE CARE HOME Version 1.10 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29. Staff have the skills and knowledge to fulfil their roles within the home. A stable staff group ensures continuity of care by staff who know the service users. There remains an outstanding requirement with regard to the deployment of staff, which could affect the wellbeing of service users. Recruitment policies are followed ensuring the safety and protection of service users. EVIDENCE: Staff rotas examined showed sufficient staff to meet the needs of service users, although sickness had reduced staffing levels on one of the units. Efforts to replace the staff member were made and cover was obtained by mid morning. The nurse was able to offer assistance to enable service users to get up and have breakfast. A reduction of staffing in an area where highly dependant service users reside must be avoided as this could potentially put service users at risk. Staff have adequate skills to meet the needs of service users, although they do not meet the requirement of 50 NVQ qualified staff. A number of staff are working towards the award and one staff member said that she was hoping to have the opportunity to start the award in the near future. A number of staff recruitment files were examined and discussed with the manager, and there is evidence that all the required employment checks have been undertaken prior to commencing work at the home.
BYRON LODGE CARE HOME Version 1.10 Page 17 Examination of nurses PIN and qualifications confirmed that a mix of Registered General Nurse (RGN) and Registered Mental Health Nurse (RMN) are employed at the home. This ensures that they have the required skills to meet the nursing and mental health needs of the service users. The appointment of a deputy manager should be considered as a number of concerns/complaints have occurred in the absence of the registered manager. Complaint documentation examined confirmed communication within the home could be improved. BYRON LODGE CARE HOME Version 1.10 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 35, 38. The home is well managed to ensure the safety and protection of the service users. Procedures are in place to safeguard the financial interests of service users, and the regional manager provides advice and support to the home. Health and Safety policies are in place although staff do not appear to have up to date training in Fire evacuation. This could endanger the safety of service users if any emergency circumstances arouse. EVIDENCE: The registered manager has been in post since January 2005 and was successfully registered with the Commission for Social Care Inspection in February 2005. She is a registered nurse and is able to update her knowledge by attending workshops and reading articles from the Nursing Journals. She holds the relevant NVQ level 4 management qualifications. The registered manager was able to discuss her own development, and intends to further develop her knowledge on Dementia care.
BYRON LODGE CARE HOME Version 1.10 Page 19 An audit of service users financial records were examined and they were accurate and provided clear audit trails. The hairdresser was able to confirm the arrangement for payment, and service users are aware that they have access to their money. The home acts, as agent for one service user and advice should be sought to ensure access could be gained to savings. Servicing of essential equipment takes place within the recommended timescale records examined provided evidence of this. Accident reports are analysed by the manager to ensure risk assessments are developed where required. Maintenance of the fire system examined showed that staff have not received fire instruction, the registered manager must arrange this training. BYRON LODGE CARE HOME Version 1.10 Page 20 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 2 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 x x x 3 x x 2 BYRON LODGE CARE HOME Version 1.10 Page 21 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement The registered manager must ensure that care plans reflect up to date needs of service users and reviewed as stated in the homes policies and procedures.Risk assessments must demonstrate how risks will be managedThe registered manger must ensure wherever possible that the service user agrees and signs the plan of care. (previous timescale of 1st November 2004 not met) The registered manager must ensure that staff administerering medication ensures that it is taken by service user. The registered manager must ensure that the temperature of the medication fridge is accurately recorded The registered manager must continue to review the staffing ratios to ensure the needs of service users can be met. (previous timescale of 1st November 2004 not met) The registered manager must ensure staff receives fire evacuation training Timescale for action 1 September 2005 2. OP9 13 1 May 2005 3. OP27 12 1 May 2005 4. OP38 23 1 May 2005 BYRON LODGE CARE HOME Version 1.10 Page 22 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. Refer to Standard OP28 Good Practice Recommendations To continue to implement the training programme, to ensure that 50 of the staff have an NVQ qualification in 2005. BYRON LODGE CARE HOME Version 1.10 Page 23 Commission for Social Care Inspection 1st Floor Barclay Court Heavens Walk Doncaster South Yorkshire DN4 5HZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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