Inspection on 13/09/06 for Bystock Court

This inspection was carried out on 13th September 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bystock Court 04/09/07

Bystock Court 10/01/06

Bystock Court 09/08/05

Bystock Court 06/01/05

Bystock Court 13/07/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Bystock Court Old Bystock Drive Exmouth Devon EX8 5EQ Lead Inspector Vivien Stephens Unannounced Inspection 13th and 14 September 2006 11:00 th Bystock Court DS0000021897.V306135.R01.S.doc Version 5.2 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 Bystock Court DS0000021897.V306135.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 Adults 18-65. 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. Bystock Court DS0000021897.V306135.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bystock Court Address Old Bystock Drive Exmouth Devon EX8 5EQ 01395 266605 01395 222689 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) Devon Sheltered Homes Trust Application for manager pending Care Home 41 Category(ies) of Learning disability (41), Learning disability over registration, with number 65 years of age (41) of places Bystock Court DS0000021897.V306135.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th January 2006 Brief Description of the Service: Bystock Court is a registered charity. The day-to-day operation of the home is carried out by Devon Community Housing Society (DCHS). Bystock Court is registered to provide accommodation and personal care for up to 41 adults with learning disabilities. Out of the 41 rooms one is used to provide short-term care. Although the home does not admit persons over retirement age, some of the residents have continued to live there after their retirement. The main building is a large period style house set in large grounds on the outskirts of Exmouth. There are 41 single bedrooms and a range of communal areas including lounge, dining room, ballroom, craft room, games room, laundry and kitchen. There are two semi-independent units, with three ensuite bedrooms in each, a lounge and kitchen. Within the grounds are a range of buildings including a small farm, greenhouses and a paper shredding business. Residents are encouraged to participate in the running of the home and work in units according to their interests and abilities. The home also provides a range of education and leisure activities. Fees paid by residents at the time of this inspection ranged from £550 per week. A copy of this report will be displayed on the notice board in the home. Bystock Court DS0000021897.V306135.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Several weeks before this inspection the home completed a pre-inspection questionnaire and forwarded it to the Commission. On receipt of this, questionnaires were sent to residents, staff and visitors. The results of these have helped to form the outcomes of the inspection. This inspection took place over two days. On the first day the inspector met with the Manager, Lyn Lockwood, and a tour of the building took place. Four care plan files were inspected. On the second day a tour of the work units in the grounds of the home took place. Discussions were held with residents and staff. Lunch was shared with the residents. The administration of medicines, staff records and other records required by legislation were also inspected. What the service does well: The home has good admission and assessment procedures in place. Good written and pictorial information is given to residents and plenty of opportunities to visit the home are offered before residents move in, ensuring that residents are able to make an informed choice about where they want to live. Good information about the prospective resident is obtained to ensure that the home is able to meet their needs. Over the last year much work has been carried out on the care planning systems and these now give detailed information for staff about how the resident wants to be assisted. The plans have been kept in the main office and Lyn Lockwood said they would consider keeping a copy with the daily report files in the staff room to ensure staff work with the plans on a daily basis. The plans are regularly reviewed by the home to ensure they are up-to-date, and once a year a full review is held involving the resident and their relatives and supporters where appropriate. Risk assessments have been carried out on activities to ensure that residents are supported to take responsible risks. The home provides an excellent range of work, education and leisure opportunities to suit all interests and abilities. Emphasis is placed on providing fulfilling work opportunities. Within the grounds there is a working farm, paper shredding unit, productive greenhouses and gardens. In the house there are opportunities to work in the laundry, kitchen or the craft workshop. Residents go out into the local community regularly. They attend a range of social and sporting facilities including swimming, horse riding, pubs and restaurants. Residents are able to keep good contact with friends and families. Transport is provided by the home if required. Bystock Court DS0000021897.V306135.R01.S.doc Version 5.2 Page 6 Menus are balanced and varied. Good choices are provided to ensure all likes, dislikes and dietary needs are catered for. The dining rooms are bright and well furnished. Care plan files provide good evidence of how staff support residents with personal and health care needs. Information received from health and social care professionals during the inspection confirmed that they are satisfied with the care provided. Medicines are stored and administered safely. Good records are kept to show that medicines have been correctly administered. Two staff are always involved in the administration process to ensure that no mistakes are made. Staff have received training on the safe administration of medicines. Residents are safeguarded from abuse, neglect or self-harm. Residents confirmed that they know how to make a complaint, and felt able to speak to staff or the manager if they have any problems or concerns. The home has been generally well maintained. All equipment has been serviced and maintained regularly. Good systems are in place to ensure all areas are kept clean. The laundry is well equipped and runs smoothly. There are good recruitment procedures in place to ensure all necessary checks are carried out before new staff are confirmed in post. Staffing levels are usually sufficient numbers to meet the needs of the residents. Training has been given a high priority with 75 of the care staff having achieved a National Vocational Qualification to at least level 2. Records have been well maintained. What has improved since the last inspection? What they could do better: Assessment forms should be amended to ensure that information gained is based on the views of the prospective residents and ensures the home follows a ‘person centred’ approach at all times. Initial information gathered before admission should also specify the religion and preferred denomination of church of the prospective resident. Bystock Court DS0000021897.V306135.R01.S.doc Version 5.2 Page 7 Greater emphasis should be placed on working towards goals of greater independence. This should be set out in the care plans with agreements about how staff will help residents to meet those goals. The medication policy should be expanded to ensure it covers all areas set out in guidance provided by the Commission. The decoration of the corridors should be improved. The areas appear long, dingy and institutional. Some areas of paintwork are chipped. Some parts of the corridors have a musty odour – this should be addressed. Some of the bathrooms and toilets are outdated and institutional. Some bathrooms have been locked to prevent access as they are in a poor state of repair. Those bathrooms and toilets that have not been upgraded in recent years must be modernised and decorated to ensure they have a domestic and homely appearance. Staff rotas and staffing levels should be adjusted to ensure there are sufficient staff to provide on-to-one care for individuals with higher care needs. Some staff voiced concerns about the overall management of the home and suggested that in some cases staff morale is low. The home must ensure that systems are in place to seek the views of staff and address concerns and issues that may have an effect on the care of residents. Some systems are in place to check on the quality of the services, although this could be improved by regular visits by the registered provider and greater consultation with staff. 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. Bystock Court DS0000021897.V306135.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bystock Court DS0000021897.V306135.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 “Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.” The home has good admission and assessment procedures in place, ensuring that residents are able to make an informed choice about where they want to live. A few minor adjustments to admission forms are recommended. EVIDENCE: The Statement of Purpose was updated on 26th April 2006. This document is comprehensive, well laid out and gives good information about all aspects of the home. Many of the residents have lived at the home for a number of years. Some of those who have moved in over the last couple of years talked about how they chose the home. One resident said he had looked at the written information, and said that when he saw the pictures of the home he knew Bystock was the place for him. Other residents talked about how they visited the home several times before finally moving in. The home has a comprehensive assessment form that is used to help them get to know prospective new residents and decide whether Bystock Court will meet their needs. The forms have been completed thoroughly and showed that the home has taken time to get to know prospective residents well before agreeing to admit them. The wording of a few of the questions on the forms are ‘parental’ and Lyn Lockwood agreed to amend the form to ensure that the questions help to form an ‘adult to adult’ working relationship between staff and residents right from the start. The forms have a section on religion, but Bystock Court DS0000021897.V306135.R01.S.doc Version 5.2 Page 10 these sections had not been generally well completed, although it was clear later in the files that some residents enjoy going to church. It is suggested that the home finds out more about the particular religion and/or denomination before admission to ensure the resident is able to continue to attend the religious services of their choice. Documents held on the files showed that during the assessment and admission process the home obtains good information from other sources including health and social care professionals. Bystock Court DS0000021897.V306135.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 “Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.” The home has good care planning systems in place that show how residents want to be supported and assisted by staff. Residents are supported to take responsible risks and make decisions about their lives. EVIDENCE: Four care plan files seen during the inspection were comprehensive and showed that the home has taken time and care to get to know each resident and understand their individual personalities, likes and dislikes, and their personal and health care needs. Although they are not written in the words of the resident, they clearly show how the resident wants to be cared for, and therefore demonstrate a ‘person centred’ approach by the home. However, they are kept in the main office and therefore are not used by staff on a daily basis. Lyn Lockwood said they would consider keeping a copy of the care plan in the staff room alongside the daily reports. Bystock Court DS0000021897.V306135.R01.S.doc Version 5.2 Page 12 The care plans have been reviewed once a month by the home to ensure they are up-to-date. There is a full review of the care plan once a year. The review is held with the resident, keyworker and home manager. Care managers and relatives and/or advocates are invited to these meetings. One professional who responded to the inspection by completing a questionnaire commented that there are few opportunities for clients to develop independence, for example in preparing meals or pursuing activities without being part of a large group. It is recommended that the care plans also focus on goals that help residents work towards independence. Five residents who responded to questionnaires sent out by the Commission said they are always able to make decisions about what they do each day. Six said they usually make decisions and one said they sometimes can make decisions about what they do each day. This suggests that the home is generally good at enabling residents to make decisions and therefore be independent, although there is room for improvement. Comprehensive risk assessments have been carried out on all activities where the home considers the resident may be at risk of harm. These show how the home supports residents to lead active lives with appropriate safeguards where necessary. Bystock Court DS0000021897.V306135.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15, 16, 17 “Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service.” The home provides an excellent range of work, education and leisure opportunities to suit all interests and abilities. Resident’s benefit from maintaining good contact with relatives and friends. Menus are balanced and varied and meet the nutritional needs of the residents. EVIDENCE: The emphasis at Bystock Court is clearly one of providing meaningful and fulfilling employment. The grounds are extensive, and within both the house and the grounds there are a range of work opportunities. There is a working farm with sheep, cattle, goats, chickens, ponies and guinea pigs. Those residents who are interested in farming are employed in all aspects of animal care and maintenance of the farm. There is a paper shredding business that supplies bedding for animals on a commercial basis, and a number of residents enjoy working in this unit. There are also gardens and greenhouses that Bystock Court DS0000021897.V306135.R01.S.doc Version 5.2 Page 14 produce plants for sale throughout the year, and residents who like gardening were seen busily working in these areas. . Some residents have chosen to work within the house. Some work in the kitchen, some in the laundry, and some in the craft workshop. The residents who work in the craft workshop are clearly very talented and have produced some stunning art and craftwork, some of which is displayed around the home. During the inspection residents stopped to talk about their work. They were clearly proud of the work they do. They talked about how they chose where they want to work, and how they have been able to change their workplaces, or their working week to fit in with their lifestyles or other interests and activities. Some talked about college courses they have attended. Comments from one visiting professional suggested that there are limited opportunities for residents to work towards more independent living skills. (See standard 7). However, for those residents who live in the two self contained flats the emphasis is clearly focussed on encouraging independence. For other residents, however, greater emphasis could be placed on working on individual skills. The residents lead busy social lives and go out and about in the local community. One resident talked about some of the places he has been to recently, and about places he plans to visit in the near future. Some residents talked about their holidays, and others talked about clubs, pubs and restaurants they like to go to. Activities outside of the home include swimming, gym, horse riding, Gateway Club, short mat bowling, church trips and Faith and Light meetings. The home provides a good range of leisure facilities including games, computers and musical equipment. Residents talked about the friendships they have both inside and outside of the home. They also talked about their families and how families are always made welcome whenever they visit. Residents are encouraged to keep their own rooms clean and tidy and to ensure their clothing is kept laundered. Staff provide help with these tasks where necessary. The inspector sat with the residents at lunchtime. The kitchen is laid out in two main areas, both large, bright and well-equipped. The main dining room is a bright and comfortable room. At mealtimes the room has a bustling and lively atmosphere with lots of friendly conversation. There is also a quieter room where some residents prefer to eat their meals. There is a self-service ‘carvery’ system that enables residents to choose what they want to eat. There is a strong emphasis on healthy eating, and menus have been carefully drawn up to ensure residents have good variety and choice. Fresh fruit and vegetables are purchased locally. Residents are consulted regularly on the Bystock Court DS0000021897.V306135.R01.S.doc Version 5.2 Page 15 content of the menus and adjustments are made accordingly. Residents talked about how much they enjoy the meals. Bystock Court DS0000021897.V306135.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 “Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.” Residents receive good support from well-trained staff to meet their personal and health care needs. Medicines are stored and administered safely. The medication procedure should be expanded. EVIDENCE: The care plans clearly explain the abilities of each resident to meet their own personal care needs. Where support is needed from staff the care plans explain how the residents want this help to be carried out. Through discussion with the Manager, staff and residents there was evidence of staff working in partnership with residents, and respecting their right to privacy and dignity. Residents are able to choose when they get up and when they go to bed. They can choose when they have a bath, what they want to wear, their hairstyles and make up. The home has a keyworking system to ensure there is a consistent method of support and close working relationship and understanding between residents and staff. Bystock Court DS0000021897.V306135.R01.S.doc Version 5.2 Page 17 The care plan files showed that the home has sought medical advice and treatment appropriately. Health care professionals contacted during this inspection indicated they are satisfied with the health care provision for residents. The home uses a monitored dosage system of medication. Medicines are held in secure cupboards in a room on the ground floor. These are separated into three cupboards, one for each floor. Staff said that residents prefer to go to this room to collect their medications rather than staff take medicines to them in their rooms. Two experienced and trained staff administer the medications. Records were found to be well maintained. The cupboards were found to be neat and orderly. A secure refrigerator is available for any medicines that have to be kept cool. The home has been visited regularly by the pharmacist to provide advice and support to the staff. The home has a medication procedure in place. This was found to have a good level of information, although should be expanded to ensure it covers all of the areas set out in guidance forwarded to the home by e mail following the inspection. At the last inspection a recommendation was made that supplement medicines not prescribed by a GP should be labelled with the name of the resident for whom it is intended. This has been addressed. There are now letters on file from each resident’s GP setting out the homely remedies that are approved for use. Bystock Court DS0000021897.V306135.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 “Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.” Residents are safeguarded from abuse, neglect or self-harm. Good procedures are in place to ensure all complaints and concerns are listened to and acted upon to the residents’ satisfaction. EVIDENCE: The home has a clear complaints procedure in place. All of the residents who responded to this inspection by questionnaire said they knew who to speak to if they were unhappy. They all said they knew how to make a complaint. Some said they would talk to their link worker, and some said they would talk to the home manager, Lyn Lockwood. Since the last inspection neither the home or the Commission have received any complaints relating to the care of the residents. The home has maintained a record of all complaints, and this shows that where neighbours or the public have contacted the home about matters relating to the grounds or the businesses carried out at Bystock Court, these have been addressed promptly in order to maintain good neighbourly relationships. Staff have received training on the protection of vulnerable adults. All staff who responded to this inspection by questionnaire said they understand the procedures to be followed if there is a concern about the protection of a vulnerable adult. Bystock Court DS0000021897.V306135.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 30 “Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” The home has been generally well maintained. However, many corridors and bathrooms appear institutional and must be upgraded. Bedrooms are comfortable and homely. There are good systems in place to ensure all areas are kept clean. Musty odours in some corridors should be addressed. EVIDENCE: Bystock Court is a large and imposing period style building situated on the outskirts of Exmouth. New housing estates have been built in the surrounding area in recent years. The grounds and exterior of the building have been well maintained. Inside the home the communal rooms and bedrooms have been well maintained and attractively decorated. The entrance hallway, dining rooms, sitting rooms and ballroom are bright, comfortable and well furnished areas. All residents are accommodated in single bedrooms that are laid out over three floors. Most of the bedrooms are large rooms that have been attractively Bystock Court DS0000021897.V306135.R01.S.doc Version 5.2 Page 20 furnished and decorated to suit the tastes and preferences of each resident. They have been furnished as bedsitting rooms, and some have kitchenette areas, fridges and tea/coffee making facilities. There are also two selfcontained flats within the home providing more independent accommodation for residents. Despite the considerable efforts in recent years to improve the facilities, especially residents’ bedrooms, the overall impression is still one of a large institution. The corridors are long, and the decoration is beginning to look tired, with dull lighting. Some of the corridors have a musty smell. A few bathrooms have been updated in recent years and now appear attractive and homely. However, there still remains a large number of bathrooms and toilets that are outdated, shabby, and appear cold and uninviting rooms. Some have toilet cubicles and baths in the same rooms, and one bathroom has two baths in the same room, giving these rooms a particularly institutional appearance. These rooms must be updated. Some bathrooms are in such poor condition that they have been locked to prevent them being used. Staff reported difficulties due to the lack of bathrooms and toilets. Unused bathrooms must be upgraded in order to ensure there are sufficient bathroom and toilet facilities for residents. Bystock Court DS0000021897.V306135.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 “Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” Residents are supported by competent and trained staff. Staffing levels are usually sufficient numbers to meet the needs of the residents, although at times more staff are needed to provide on-to-one care for individuals with higher care needs. Good recruitment procedures are followed to ensure residents are in safe hands. Staff generally have a very positive attitude. However, staff views must be sought in order to address areas that are affecting the morale of some staff. EVIDENCE: The home has two distinct staff teams – those employed in the main house to provide personal care fro the residents, and those staff employed in the workshops, gardens and farm. From information provided for this inspection the staffing levels generally meet most of the residents’ needs. However, where residents need a high level of individual attention, for instance during a period of illness, the staff struggle at times to meet those needs. Lyn Lockwood said the home has attempted to obtain funding on an individual basis for these residents. Bystock Court DS0000021897.V306135.R01.S.doc Version 5.2 Page 22 Four files were seen during the inspection of staff recruited in the last year. These files showed that good recruitment procedures have been followed, with application forms, interview forms, at least two satisfactory references, Criminal Records Bureau checks, and Protection of Vulnerable Adults checks carried out before the person has been confirmed in post. Residents views are usually sought on an informal basis when new staff are recruited – Lyn Lockwood said they would consider using residents in a more formal way in future staff recruitments. Good induction training is provided to new staff. Induction records show that staff receive good information on the first day of work, and after this they work alongside experienced staff while they undertake a more thorough 6 week induction training. The home has placed a high emphasis on providing staff with a good level of training. 75 of the care staff have obtained a National Vocational Qualification to at least level 2. Staff have received training and updates on mandatory health and safety topics. Nine staff completed questionnaires prior to this inspection. Those recruited more than 2 years ago felt they had not received adequate induction and support when recruited. Those recruited in the last 2 years, under the current management, were satisfied with the support and induction training they received. Overall the comments from the staff were mixed. Some staff said the home puts residents first, and that they manage a lovely ‘homely’ feel even though the home is large. Some said the home is very good at supporting residents as individuals, providing meaningful work and creating meaningful work and a sense of achievement for the residents. One staff member said “Bystock Court is a friendly and happy place to work and I really enjoy my work”. Some staff talked about poor morale. “Staff do not feel valued. Having a large Corporate management we feel we have little say in things. Things happen without consultation. We see fat cat situations where we’re expected to take far more responsibility for no reward. Corporate Companies are about profit – Learning Disabilities is about care.” “I feel staff sometimes do what they want, when they want, and not a lot of organisation.” “I feel that lately some decisions have been made that should have been made by the residents not the staff.” “A tougher approach is needed when there are repeated complaints and worries made about a staff member….” Bystock Court DS0000021897.V306135.R01.S.doc Version 5.2 Page 23 One staff said there should be better staff handovers. Several staff said there should be better communication between all management and staff. Most staff said they have regular supervision and staff meetings, but one staff said these are often cancelled. There were comments about the method of supervision and suggestions that the style of supervision should be altered to include questions that ensure early identification and action to protect residents from possible abuse. One staff commented that their manager never leaves their station and therefore does not observe staff during their work. These comments suggest that improvements are needed to the supervision, support and communication with staff throughout the home, and that attention should be paid to addressing staff concerns and improving staff morale. Bystock Court DS0000021897.V306135.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41, 42 “Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.” The home is well managed. Adequate systems are in place to check on the quality of the services, although this could be improved by regular visits by the registered provider and greater consultation with staff. Records have been well maintained. The health and safety of residents and staff is protected by good procedures and training. EVIDENCE: Since the last inspection Lyn Lockwood has been appointed as the manager of the home. She is responsible for the personal care provided to residents. An application for her registration is currently pending. She has had many years of relevant experience and holds NVQ level 3. Bystock Court DS0000021897.V306135.R01.S.doc Version 5.2 Page 25 Andrew Scott has been appointed as General Manager with responsibility for overseeing the services, facilities and all work units. Due to these changes in the management of the home, for the time being a decision has been made that no deputy manager will be recruited. Within the main house there are teams of support workers and senior support workers. There are also 6 unit managers, each responsible for one of the work units. The home has systems in place that measure the quality of care delivered within the care home. These include care plan reviews, service user surveys, service user’s meeting, staff meetings and supervision. Relatives are invited to attend care plan reviews and therefore have some input into the provision of care. The home has also formalised a quality assurance document that sets out a systematic plan of reviewing the quality of care delivered within the home. At the last inspection a requirement was made for monthly visits to be made to the home by the Registered Provider. While some reports have been received by the Commission these have not been on a regular basis. These visits can play a vital role in ensuring the quality of the service is continuously monitored. The visits can also ensure any matters relating to staff morale are picked up and dealt with quickly. The requirement therefore continues to be made. Records seen during this inspection include – Residents’ assessment and care plan files Staff rotas, recruitment and training files Accident records Menus Administration of medicines Fire log book These records were found to be well maintained. Good procedures are in place to ensure the health and safety of residents and staff. Equipment has been regularly services and maintained. Risk assessments have been carried out. Policies and procedures are in place on all health and safety topics. Staff have received regular training and updates on all health and safety related topics. Bystock Court DS0000021897.V306135.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 2 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 x 30 2 STAFFING Standard No Score 31 x 32 3 33 2 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 x 3 x LIFESTYLES Standard No Score 11 3 12 4 13 4 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 3 2 x 3 3 x Bystock Court DS0000021897.V306135.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? yes 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 YA24 Regulation 23 Requirement Timescale for action 01/04/07 2 YA27 23(2)(j) 3 YA36 21 4. YA39 26 All parts of the home must be kept reasonably decorated. (This relates to the decoration of the corridors) 01/04/07 There must be provided at appropriate places in the premises sufficient numbers of lavatories and of wash basin, baths and showers. (Outdated and institutional toilets and bathrooms should be upgraded. Toilets and bathrooms that are currently kept locked due to the poor state of the facilities should be upgraded and brought back into use.) The home must ensure that staff 01/04/07 views are sought about any matters that may affect the health or welfare of the service users. (this relates to the communication with staff, supervision and support in order to improve staff morale where this is low) Visits under paragraph (2) of 01/11/06 Regulation 26 shall take place at least once a month and shall be DS0000021897.V306135.R01.S.doc Version 5.2 Bystock Court Page 28 unannounced. (C) prepare a written report on the conduct of the home. (5) The registered provider shall supply a copy of the report required to be made under paragraph (4) (c) to the Commission. (previous timescale 11/09/05) 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 3 4 5 6 Refer to Standard YA2 YA2 YA7 YA20 YA30 YA33 Good Practice Recommendations Assessment forms used by the home should be amended to provide a more ‘person centred’ approach. The home should record the religion of prospective new residents and determine their preferred denomination/place of religion. The care plans should set out how the home will help residents to work towards goals of independence. The home’s medication procedure should be expanded to cover all of the areas covered within guidance forwarded to the home by the Commission. Attention should be paid to those areas of the home where there is a musty odour. The home should adjust or improve staffing levels in order to ensure those residents with higher care needs receive the support they need. Bystock Court DS0000021897.V306135.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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